Peritoneal dialysis access revision in children: Causes, interventions, and outcomes

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dc.contributor.authorBorzych-Duzalka D.
dc.contributor.authorAki T.F.
dc.contributor.authorAzocar M.
dc.contributor.authorWhite C.
dc.contributor.authorHarvey E.
dc.contributor.authorMir S.
dc.contributor.authorAdragna M.
dc.contributor.authorSerdaroglu E.
dc.contributor.authorSinha R.
dc.contributor.authorSamaille C.
dc.contributor.authorVanegas J.J.
dc.contributor.authorKari J.
dc.contributor.authorBarbosa L.
dc.contributor.authorBagga A.
dc.contributor.authorGalanti M.
dc.contributor.authorYavascan O.
dc.contributor.authorLeozappa G.
dc.contributor.authorSzczepanska M.
dc.contributor.authorVondrak K.
dc.contributor.authorTse K.-C.
dc.contributor.authorSchaefer F.
dc.contributor.authorWarady B.A.
dc.contributor.authorfor the International Pediatric Peritoneal Dialysis Network (IPPN) Registry
dc.date.accessioned2019-10-26T21:16:50Z
dc.date.available2019-10-26T21:16:50Z
dc.date.issued2017
dc.departmentEge Üniversitesien_US
dc.description.abstractBackground and objectives Little published information is available about access failure in children undergoing chronic peritoneal dialysis. Our objectives were to evaluate frequency, risk factors, interventions, and outcome of peritoneal dialysis access revision. Design, setting, participants, & measurements Data were derived from 824 incident and 1629 prevalent patients from 105 pediatric nephrology centers enrolled in the International Pediatric Peritoneal Dialysis Network Registry between 2007 and 2015. Results In total, 452 access revisions were recorded in 321 (13%) of 2453 patients over 3134 patient-years of follow-up, resulting in an overall access revision rate of 0.14 per treatment year. Among 824 incident patients, 186 (22.6%) underwent 188 access revisions over 1066 patient-years, yielding an access revision rate of 0.17 per treatment year; 83% of access revisions in incident patients were reported within the first year of peritoneal dialysis treatment. Catheter survival rates in incident patients were 84%, 80%, 77%, and 73% at 12, 24, 36, and 48 months, respectively. By multivariate logistic regression analysis, risk of access revision was associated with younger age (odds ratio, 0.93; 95% confidence interval, 0.92 to 0.95; P<0.001), diagnosis of congenital anomalies of the kidney and urinary tract (odds ratio, 1.28; 95% confidence interval, 1.03 to 1.59; P=0.02), coexisting ostomies (odds ratio, 1.42; 95% confidence interval, 1.07 to 1.87; P=0.01), presence of swan neck tunnel with curled intraperitoneal portion (odds ratio, 1.30; 95% confidence interval, 1.04 to 1.63; P=0.02), and high gross national income (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.19; P=0.01). Main reasons for access revisions included mechanical malfunction (60%), peritonitis (16%), exit site infection (12%), and leakage (6%). Need for access revision increased the risk of peritoneal dialysis technique failure or death (hazard ratio, 1.35; 95% confidence interval, 1.10 to 1.65; P=0.003). Access dysfunction due to mechanical causes doubled the risk of technique failure compared with infectious causes (hazard ratio, 1.95; 95% confidence interval, 1.20 to 2.30; P=0.03). Conclusions Peritoneal dialysis catheter revisions are common in pediatric patients on peritoneal dialysis and complicate provision of chronic peritoneal dialysis. Attention to potentially modifiable risk factors by pediatric nephrologists and pediatric surgeons should be encouraged. © 2016 by the American Society of Nephrology.en_US
dc.description.sponsorshipInternational Society for Peritoneal Dialysisen_US
dc.description.sponsorshipWe acknowledge Dr. Mabel Sandoval Diaz from Hospital Infantil de Nicaragua, in Managua, Nicaragua, who contributed to the manuscript. We also appreciate the continued dedicated support of the International Pediatric Peritoneal Dialysis Network (IPPN) by the medical and nursing staff in all collaborating centers. We acknowledge the support by the International Society for Peritoneal Dialysis, Baxter Health Care, and Fresenius Medical Care. Principal investigators of the IPPN Registry are listed in the Supplemental Appendix. --en_US
dc.identifier.doi10.2215/CJN.05270516en_US
dc.identifier.endpage112en_US
dc.identifier.issn1555-9041
dc.identifier.issue1en_US
dc.identifier.pmid27899416en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage105en_US
dc.identifier.urihttps://doi.org/10.2215/CJN.05270516
dc.identifier.urihttps://hdl.handle.net/11454/16263
dc.identifier.volume12en_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherAmerican Society of Nephrologyen_US
dc.relation.ispartofClinical Journal of the American Society of Nephrologyen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectAttentionen_US
dc.subjectCatheteren_US
dc.subjectChilden_US
dc.subjectChildrenen_US
dc.subjectDialysis accessen_US
dc.subjectFollow-up studiesen_US
dc.subjectHumansen_US
dc.subjectNephrologyen_US
dc.subjectOstomyen_US
dc.subjectPeritoneal dialysisen_US
dc.subjectPeritoneumen_US
dc.subjectPeritonitisen_US
dc.subjectRegistriesen_US
dc.subjectRisk factorsen_US
dc.subjectSurgeonsen_US
dc.subjectSurvival rateen_US
dc.subjectVesico-ureteral refluxen_US
dc.titlePeritoneal dialysis access revision in children: Causes, interventions, and outcomesen_US
dc.typeArticleen_US

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