RISKS OF PERITONEAL MEMBRANE FAILURE IN CHILDREN UNDERGOING LONG-TERMPERITONEAL-DIALYSIS

Children undergoing long-term peritoneal dialysis are at risk for memb rane injury, necessitating conversion to hemodialysis. We analyzed the incidence and risk factors for membrane failure (inadequate ultrafilt ration with or without peritoneal adhesions and decreased peritoneal s urface area) in 68 children maintained with peritoneal dialysis for mo re than 3 months at our institution. The overall incidence of membrane failure was 16.2% (11/68). Kaplan-Meier estimates of peritoneal membr ane survival were 88% at 24 months, 72% at 36 months, 65% at 48 months , and 52% at 60 months. Logistic regression analysis demonstrated that the risk of membrane failure increased with the number of episodes of peritonitis (odds ratio 1.61). The rate of peritonitis was 1 per 7.02 patient months in children who developed membrane failure compared wi th 1 per 9.18 patient months in children without membrane failures but the rate of peritonitis was not predictive of membrane failure (P = 0 .09). Multiple logistic regression analysis demonstrated that peritoni tis caused by Pseudomonas aeruginosa or alpha streptococcal organisms were independent predictors of membrane failure. We conclude that peri toneal membrane survival declines substantially with time on peritonea l dialysis and that membrane failure is associated with peritonitis, p articularly peritonitis caused by Pseudomonas aeruginosa and alpha str eptococcal organisms. The mechanism(s) of membrane injury are unknown but may be related to the inflammatory response initiated during perit onitis.