Eugene Y H Chan1, Dagmara Borzych-Duzalka2, Caner Alparslan3, Elizabeth Harvey4, Reyner Loza Munarriz5, Dariusz Runowski6, Enrico Vidal7, Paula A Coccia8, Augustina Jankauskiene9, Iliana Principi10, Erkin Serdaroglu11, Maria Szczepanska12, Yincent Tse13, Aida Vazquez14, Donald J Weaver15, Franz Schaefer16, Bradley A Warady17. 1. Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong, Hong Kong. cyh606@ha.org.hk. 2. Medical University of Gdansk, Gdansk, Poland. 3. Tepecik Teaching and Research Hospital, Izmir, Turkey. 4. Hospital for Sick Children, University of Toronto, Toronto, Canada. 5. Cayetano Heredia Hospital, Lima, Peru. 6. Children's Memorial Health Institute, Warsaw, Poland. 7. University-Hospital of Padova, Padova, Italy. 8. Hospital Italiano Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina. 9. Vilnius University, Institute of Clinical Medicine, Vilnius, Lithuania. 10. Hospital Pediátrico Humberto J Notti Mendoza, Mendoza, Argentina. 11. Dr. Behcet Children Research and Education Hospital, Izmir, Turkey. 12. SMDZ, Medical University of Silesia, Katowice, Poland. 13. Great North Children's Hospital, Newcastle Upon Tyne, UK. 14. Hospital Del Nino San Justo, Buenos Aires, Argentina. 15. Levine Children's Hospital of Carolinas HealthCare System, Charlotte, NC, USA. 16. Center for Children and Adolescent Medicine, Heidelberg, Germany. 17. Children's Mercy Kansas City, Kansas City, MO, USA.
Abstract
BACKGROUND: This study aimed to evaluate outcome of children on chronic peritoneal dialysis (PD) with a concurrent colostomy. METHODS: Patients were identified through the International Pediatric Peritoneal Dialysis Network (IPPN) registry. Matched controls were randomly selected from the registry. Data were collected through the IPPN database and a survey disseminated to all participating sites. RESULTS: Fifteen centers reported 20 children who received chronic PD with a co-existing colostomy. The most common cause of end stage kidney disease was congenital anomalies of the kidney and urinary tract (n = 16, 80%). The main reason for colostomy placement was anorectal malformation (n = 13, 65%). The median age at colostomy creation and PD catheter (PDC) insertion were 0.1 (IQR, 0-2.2) and 2.8 (IQR 0.2-18.8) months, respectively. The colostomies and PDCs were present together for a median 18 (IQR, 4.9-35.8) months. The median age at PDC placement in 46 controls was 3.4 (IQR, 0.2-7.4) months of age. Fourteen patients (70%) developed 39 episodes of peritonitis. The annualized peritonitis rate was significantly higher in the colostomy group (1.13 vs. 0.70 episodes per patient year; p = 0.02). Predominant causative microorganisms were Staphylococcus aureus (15%) and Pseudomonas aeruginosa (13%). There were 12 exit site infection (ESI) episodes reported exclusively in colostomy patients. Seven colostomy children (35%) died during their course of PD, in two cases due to peritonitis. CONCLUSION: Although feasible in children with a colostomy, chronic PD is associated with an increased risk of peritonitis and mortality. Continued efforts to reduce infection risk for this complex patient population are essential.
BACKGROUND: This study aimed to evaluate outcome of children on chronic peritoneal dialysis (PD) with a concurrent colostomy. METHODS:Patients were identified through the International Pediatric Peritoneal Dialysis Network (IPPN) registry. Matched controls were randomly selected from the registry. Data were collected through the IPPN database and a survey disseminated to all participating sites. RESULTS: Fifteen centers reported 20 children who received chronic PD with a co-existing colostomy. The most common cause of end stage kidney disease was congenital anomalies of the kidney and urinary tract (n = 16, 80%). The main reason for colostomy placement was anorectal malformation (n = 13, 65%). The median age at colostomy creation and PD catheter (PDC) insertion were 0.1 (IQR, 0-2.2) and 2.8 (IQR 0.2-18.8) months, respectively. The colostomies and PDCs were present together for a median 18 (IQR, 4.9-35.8) months. The median age at PDC placement in 46 controls was 3.4 (IQR, 0.2-7.4) months of age. Fourteen patients (70%) developed 39 episodes of peritonitis. The annualized peritonitis rate was significantly higher in the colostomy group (1.13 vs. 0.70 episodes per patient year; p = 0.02). Predominant causative microorganisms were Staphylococcus aureus (15%) and Pseudomonas aeruginosa (13%). There were 12 exit site infection (ESI) episodes reported exclusively in colostomy patients. Seven colostomy children (35%) died during their course of PD, in two cases due to peritonitis. CONCLUSION: Although feasible in children with a colostomy, chronic PD is associated with an increased risk of peritonitis and mortality. Continued efforts to reduce infection risk for this complex patient population are essential.
Entities:
Keywords:
Children; Colostomy; Exit site infection; Ostomy; Peritoneal dialysis; Peritonitis
Authors: W Robert DeFoor; Andrea Bischoff; Pramod Reddy; Brian VanderBrink; Eugene Minevich; Marion Schulte; Curtis Sheldon; Alberto Peña Journal: J Urol Date: 2015-01-24 Impact factor: 7.450
Authors: N M Dolan; D Borzych-Duzalka; A Suarez; I Principi; O Hernandez; S Al-Akash; L Alconchar; C Breen; M Fischbach; J Flynn; L Pape; J J Piantanida; N Printza; W Wong; J Zaritsky; F Schaefer; B A Warady; C T White Journal: Pediatr Nephrol Date: 2012-09-14 Impact factor: 3.714
Authors: Stefano Giuliani; Paola Midrio; Roger E De Filippo; Enrico Vidal; Marco Castagnetti; Giovanni Franco Zanon; Pier Giorgio Gamba Journal: J Pediatr Surg Date: 2013-03 Impact factor: 2.545
Authors: Christine B Sethna; Kristina Bryant; Raj Munshi; Bradley A Warady; Troy Richardson; John Lawlor; Jason G Newland; Alicia Neu Journal: Clin J Am Soc Nephrol Date: 2016-06-23 Impact factor: 8.237
Authors: H J J van der Steeg; E Schmiedeke; P Bagolan; P Broens; B Demirogullari; A Garcia-Vazquez; S Grasshoff-Derr; M Lacher; E Leva; I Makedonsky; C E J Sloots; N Schwarzer; D Aminoff; M Schipper; E Jenetzky; I A L M van Rooij; S Giuliani; C Crétolle; S Holland Cunz; P Midrio; I de Blaauw Journal: Tech Coloproctol Date: 2015-01-22 Impact factor: 3.781
Authors: Aleksandra M Zurowska; Michel Fischbach; Alan R Watson; Alberto Edefonti; Constantinos J Stefanidis Journal: Pediatr Nephrol Date: 2012-10-09 Impact factor: 3.714