Infectious complications in children with end-stage renal disease on replacement therapy
Main Article Content
Keywords
Chronic kidney failure, Peritoneal dialysis, Dialysis
Abstract
Background: Annually, 5000 children younger than 20 years of age and 200 younger than two-years require treatment for chronic kidney disease (CKD). The objective was to estimate the incidence rate of infectious complications in children requiring renal replacement therapy.
Methods: Retrospective cohort. Patients with a minimum of three months of follow-up in programs of peritoneal dialysis and hemodyalisis were included. The incidence rate for infections associated to replacement therapy was calculated.
Results: 67 patients were analysed. In 88 %, initial therapy for CKD was peritoneal dialysis. A total of 52 episodes of peritonitis occured, with an incidence rate of 0.63 episodes/patient-year. Thirty children (48 %) never had an episode of peritonits during the folow-up. At six months, 90 % of the children had the same peritoneal dialysis catheter, decreasing to 84, 74 and 50 % at 12, 18 and 24 months, respectively. Forty-five children were on hemodialysis, 82 % preceded by peritoneal dialysis. Dialysis treatment time in 25 % of them was longer than 19 months. Twenty-two episodes of catheter-related bacteremia occurred, with an incidence rate of 1 episode/1000 catheter-days or 2.5/1000 hemodyalisis sesions. Twenty-nine patients received a transplant (43 %); two of them died. Median waiting time to transplant was 15 months.
Conclusions: Incidence rate of infectious complications was similar to the rates reported in the literature by other centers. At 20 months, half of the patients had at least one infectious complication.
References
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266.
Harambat J, van Stralen KJ, Kin JJ, Tizard E J. Epidemiology of chronic kidney disease in children. Pediatr Nephrol. 2012;27(3):363-73.
U.S. Renal Data System. USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. Bethesda, MD; 2013. Disponible en http://www.usrds.org/atlas.aspx
Ardissino G, Daccò V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, et al. Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics. 2003;111(4 Pt 1):e382-7.
Valderrabano F, Jones EHP, Mallick NP. Report on management of renal failure in Europe XXVI, 1993. Nephrol Dial Transplant. 1995;10 Suppl 5:1-25.
Mitsnefes MM, Daniels SR, Schwartz SM, Khoury P, Strife CF. Changes in left ventricular mass in children and adolescents during chronic dialysis. Pediatr Nephrol. 2001;16(4):318-23.
Wood EG, Hand M, Briscoe DM, Donaldson LA, Yiu V, Harley FL, et al. Risk factors for mortality in infants and young children on dialysis. Am J Kidney Dis. 2001;37(3):573-9.
McDonald SP, Craig JC; Australian and New Zealand Paediatric Nephrology Association. Long-term survival of children with end-stage renal disease. N Eng J Med. 2004;350(26):2654-62.
Su-Hernández L, Abascal-Macías A, Méndez-Bueno FJ, Paniagua R, Amato D. Epidemiologic and demographic aspects of peritoneal dialysis in Mexico. Perit Dial Int. 1996;16(4):362-5.
Paniagua R, Ramos A, Fabian R, Lagunas J , Amato D. Chronic kidney disease and dialysis in Mexico. Perit Dial Int. 2007 Jul-Aug;27(4):405-9.
Foley RN, Guo H, Snyder JJ, Gilbertson DT, Collins AJ. Septicemia in the United States dialysis population, 1991 to 1999. J Am Soc Nephrol. 2004;15(4):1038-45.
Taylor G, Gravel D, Johnston L, Embil J, Holton D, Paton S, et al. Incidence of bloodstream infection in multicenter inception cohorts of hemodialysis patients. Am J Infect Control. 2004 May;32(3):155-60.
Kawaguchi Y, Hasegawa T, Nakayama M, Kubo H, Shigematu T. Issues affecting the longevity of continuous peritoneal dialysis therapy. Kidney Int Suppl. 1997 Nov;62:S105–7.
Meza-Pastrana MJ, García-López E, Mendoza-Guevara L, Miranda-Novales MG, Solórzano-Santos F. Factores de riesgo de peritonitis recurrente en pacientes pediátricos con insuficiencia renal crónica en diálisis peritoneal continua ambulatoria. Enf Inf Microbiol. 2006;26(2):46-51.
Wong CJ, Moxey-Mims M, Jerry-Fluker J, Warady BA, Furth SL. CKiD (CKD in Children) prospective cohort study: a review of current findings. Am J Kidney Dis. 2012 Dec;60(6):1002-11.
Goldstein SL, Somers MJ, Brophy PD, Bunchman TE, Baum M, Blowey D, et al. The Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry: design, development and data assessed. Int J Artif Organs. 2004;27(1):9-14.
Smith JM, Martz K, Blydt-Hansen TD. Pediatric kidney transplant practice patterns and outcome benchmarks, 1987–2010: a report of the North American Pediatric Renal Trials and Collaborative Studies. Pediatr Transplant. 2013 Mar;17(2):149-57.
North American Pediatric Renal Trials and Collaborative Studies. NAPRTCS 2011 Annual Dialysis Report [Internet]. De próxima aparición. Disponible en https://web.emmes.com/study/ped/annlrept/annlrept.html
Amato D, de Jesús Ventura M, Miranda G, Leaños B, Alcántara G, Hurtado ME, et al. Staphylococcal peritonitis in continuous ambulatory peritoneal dialysis: colonization with identical strains at exit site, nose, and hands. Am J Kidney Dis. 2001;37(1):43-8.
Vidal E, Edefonti A, Murer L, Gianoglio B, Maringhini S, Pecoraro C, et al. Peritoneal dialysis in infants: the experience of the Italian Registry of Paediatric Chronic Dialysis. Nephrol Dial Transplant. 2012;27(1):388-95.
Schaefer F, Kandert M, Feneberg R. Methodological issues in assessing the incidence of peritoneal dialysis-associated peritonitis in children. Perit Dial Int. 2002 Mar-Apr;22(2):234-8.
Warady BA, Feneberg R, Verrina E, Flynn JT, Müller-Wiefel DE, Besbas N, et al. Peritonitis in children who receive long-term peritoneal dialysis: a prospective evaluation of therapeutic guidelines. J Am Soc Nephrol. 2007;18(7):2172-9.
Taylor G, Gravel D, Johnston L, Embil J, Holton D, Paton S, et al. Incidence of bloodstream infection in multicenter inception cohorts of hemodialysis patients. Am J Infect Control. 2004 May;32(3):155-60
Al-Said J, Pagaduan A, Murdeshwar S. Successful elimination of hemodialysis-related bacteremia and vascular access infection. Saudi J Kidney Dis Transpl. 2013 Nov;24(6):1228-32.
Fysaraki M, Samonis G, Valachis A, Daphnis E, Karageorgopoulos DE, Falagas ME, et al. Incidence, clinical, microbiological features and outcome of bloodstream infections in patients undergoing hemodialysis. Int J Med Sci. 2013 Sep 20;10(12):1632-8.