Stephanie Dufek1, Tuula Holtta2, Michel Fischbach3, Gema Ariceta4, Augustina Jankauskiene5, Rimante Cerkauskiene6, Claus Peter Schmitt7, Betti Schaefer8, Christoph Aufricht9, Elizabeth Wright10, Constantinos J Stefanidis11, Mesiha Ekim12, Sevcan Bakkaloglu13, Günter Klaus14, Aleksandra Zurowska15, Karel Vondrak16, Johan Vande Walle17, Alberto Edefonti18, Rukshana Shroff19. 1. Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. Stephanie.dufek@gosh.nhs.uk. 2. Renal Unit, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. tuula.hollta@hus.fi. 3. Renal Unit, Hospital de Hautepierre, Strasbourg, France. michel.fischbach@chru-strasbourg.fr. 4. Renal Unit, Hospital Cruces, Barakaldo, Vizcaya, Spain. gariceta@vhebron.net. 5. Renal Unit, Vilnius University, Vilnius, Lithuania. augustina.jankauskiene@mf.vu.lt. 6. Renal Unit, Vilnius University, Vilnius, Lithuania. rimante.cerkauskiene@mf.vu.lt. 7. Renal Unit, Center for Pediatric & Adolescent Medicine, Heidelberg, Germany. claus.peter.schmitt@med.uni-heidelberg.de. 8. Renal Unit, Center for Pediatric & Adolescent Medicine, Heidelberg, Germany. betti.schaefer@med.uni-heidelberg.de. 9. Renal Unit, University Hospital of Vienna, Vienna, Austria. christoph.aufricht@meduniwien.ac.at. 10. Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. liz.wright@gosh.nhs.uk. 11. Renal Unit, "A & P Kyriakou" Children's Hospital, Athens, Greece. cjstefanidis@gmail.com. 12. Renal Unit, Ankara University Hospital, Ankara, Turkey. ekim@medicine.ankara.edu.tr. 13. Renal Unit, Gazi University Hospital, Ankara, Turkey. sevcan@gazi.edu.tr. 14. Renal Unit, KfH Pediatric Kidney Center, Marburg, Germany. klaus@mailer.uni-marburg.de. 15. Renal Unit, Gdansk University Medical School, Gdansk, Poland. azur@amg.gda.pl. 16. Renal Unit, University Hospital Motol, Prague, Czech Republic. karel.vondrak@lfmotol.cuni.cz. 17. Renal Unit, UZ Gent, Gent, Belgium. johan.vandewalle@uzgent.be. 18. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. aedefonti@hotmail.com. 19. Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. Rukshana.Shroff@gosh.nhs.uk.
Abstract
BACKGROUND: Pleural or pericardial effusions secondary to pleuro-peritoneal fistula (PPF) and pericardio-peritoneal fistula (PcPF) are rare but serious complications of peritoneal dialysis (PD). METHODS: We conducted a 10-year survey across all participating centres in the European Paediatric Dialysis Working Group to review the incidence, diagnostic techniques, therapeutic options and outcome of children on chronic PD with PPF and/or PcPF. RESULTS: Of 1506 children on PD there were ten cases (8 of PPF, 1 each of PcPF and PPF + PcPF), with a prevalence of 0.66%. The median age at presentation was 1.5 [inter-quartile range (IQR) 0.4-2.4] years, and nine children were <3 years. The time on PD before onset of symptoms was 4.3 (IQR 1.3-19.8) months. Eight children had herniae and seven had abdominal surgery in the preceding 4 weeks. Symptoms at presentation were respiratory distress, reduced ultrafiltration and tachycardia. PD was stopped in all children; three were managed conservatively and thoracocentesis was performed in seven (with pleurodesis in 3). PD was restarted in only three children, in two of them with success. CONCLUSION: In conclusion, PPF and PcPF are rare in children on chronic PD, but are associated with significant morbidity, requiring a change of dialysis modality in all cases. Risk factors for PPF development include age of <3 years, herniae and recent abdominal surgery.
BACKGROUND: Pleural or pericardial effusions secondary to pleuro-peritoneal fistula (PPF) and pericardio-peritoneal fistula (PcPF) are rare but serious complications of peritoneal dialysis (PD). METHODS: We conducted a 10-year survey across all participating centres in the European Paediatric Dialysis Working Group to review the incidence, diagnostic techniques, therapeutic options and outcome of children on chronic PD with PPF and/or PcPF. RESULTS: Of 1506 children on PD there were ten cases (8 of PPF, 1 each of PcPF and PPF + PcPF), with a prevalence of 0.66%. The median age at presentation was 1.5 [inter-quartile range (IQR) 0.4-2.4] years, and nine children were <3 years. The time on PD before onset of symptoms was 4.3 (IQR 1.3-19.8) months. Eight children had herniae and seven had abdominal surgery in the preceding 4 weeks. Symptoms at presentation were respiratory distress, reduced ultrafiltration and tachycardia. PD was stopped in all children; three were managed conservatively and thoracocentesis was performed in seven (with pleurodesis in 3). PD was restarted in only three children, in two of them with success. CONCLUSION: In conclusion, PPF and PcPF are rare in children on chronic PD, but are associated with significant morbidity, requiring a change of dialysis modality in all cases. Risk factors for PPF development include age of <3 years, herniae and recent abdominal surgery.
Authors: H Okada; M Ryuzaki; S Kotaki; H Nakamoto; S Sugahara; K Kaneko; T Yamamoto; H Kawahara; H Suzuki Journal: Am J Kidney Dis Date: 1999-07 Impact factor: 8.860