ESPN 50th Annual Meeting

ESPN 2017


 
Surgical outcome of Peritoneal Dialysis Catheter insertion in Pediatric Patients: Experience in Iran
FARIBA JAHANGIRI 1 NAKYSA HOOMAN 1 NASIBEH KHALEGHNEJAD -TABARI 2

1- IRAN UNIVERSITY OF MEDICAL SCIENCES,Tehran,iran
2- PEDIATRIC SURGERY RESEARCH CENTER, SHAHID BEHESHTI UNIVERSITY OF MEDICAL SCIENCES,
 
Introduction:

 Early and late surgical complications of peritoneal dialysis (PD) come along with  devastating morbidity and eventually increase the rate of mortality. The aim of our study was to evaluate the changes in the rate of surgical complications and the outcome of PD catheter in a tertiary center in Iran.

Material and methods:

This is a retrospective cohort study conducted between 1993 and 2012. Inclusion criteria were all children aged <=14 years with chronic kidney disease who underwent PD. Patients with acute peritoneal dialysis or follow up less than six months were excluded. eGRF was calculated using Schwartz formula. The surgical complications including catheter malfunction, leak, Dacron sheet extrusion, and hernia were considered. Catheter survival, rate of catheter changes, and rate of peritonitis calculated in two time period. P-value less than 0.05 treated statistically significant. 

Results:

 During a 19 year interval, 86 PD catheters were inserted in 50 patients, with a median (range) age of 22.5 (1-192) months. The most common underlying diseases were CAKUT. Median eGFR at the time of operation was 7.8 (4-31.4 ml/min/1.73m2). Catheters were inserted laparoscopicaly in 4.6%. Among surgical complications, 39% of patients developed hernia in median of five months after surgery, in addition catheter malfunction, dislocation, adhesion, or cuff extrusion developed in 22% of cases. The most common reasons for removal were catheter related (outflow failure, adhesion, cuff extrusion) (21%) and infection (peritonitis, tunnel infection) (17.4%). Reoperation for catheter related complication was required in 21 patients (42%). However, the number and the cause of catheter exchange and the outcome of patients were not statistically significant in two time periods; The rate of outflow failure (77% vs. 25%), peritonitis rate (1 per 7.5 vs. 56.9 patient- months)  and  catheter reinsertion rate (1 per 30.8 vs. 63.7 patient-months) improved significantly from the  time period before 2005and afterward. The median (range) follow up of patients was 29 months (6-126 months). Almost 20% transplanted, -26% were still on CAPD, 6% switched to hemodialysis, renal function recovered in 10%, , and38% died

Conclusions:

 This study shows that although improvement in our technique has been accomplished and complications related to technique of insertion are declining; management and care of the catheter in order to reduce peritonitis is still lacking and more should be done to educate nurses and parents and care givers in this regard.