THE ITALIAN REGISTRY OF PEDIATRIC CHRONIC PERITONEAL-DIALYSIS - A 10-YEAR EXPERIENCE WITH CHRONIC PERITONEAL-DIALYSIS CATHETERS

Objective: To analyze the data from 347 peritoneal catheters implanted in 249 pediatric patients aged less than or equal to 15 years at star t of chronic peritoneal dialysis (CPD). Design: Restrospective study o f the data collected between 1986 and 1995, in 20 dialysis centers, fr om the Italian Registry of Pediatric Chronic Peritoneal Dialysis. Data collection for each pediatric catheter included: catheter type, site and technique of insertion, complications, duration, and reason for re moval or replacement. Results: Fifty catheters were inserted in patien ts under 2 years of age, 50 in patients aged 2 - 5 years and 247 in pa tients over 5 years of age. Catheter types included 307 (88.5%) Tenckh off (286 double cuff, 21 single cuff) and 40 (11.5%), double-cuff, Val li-type catheters. All catheters were surgically implanted and omentec tomy was performed in 83.5% of cases; the entry-site was in the midlin e in 136 cases (39.2%) and paramedian in 211 (60.8%). During 6076 CPD months we observed 274 catheter-related complications: 182 catheter in fections (exit-site and/or tunnel infection), 23 leakages, 19 obstruct ions, 19 cuff-extrusions, 14 dislocations, 6 hemoperitoneum, 10 other (incidence of one complication every 21.8 dialysis-months). A signific ant reduction of catheter-related complications occurred in the last f ive years, compared with the first 5 years. One hundred and six cathet ers were removed due to catheter-related causes: infection (83 cases), obstruction (11), dislocation (4), outer-cuff extrusion (3), leakage (2), bowel incarceration (2), and bowel infarction (1). Catheter survi val was 72.2% at 12 months, 52.3% at 24 months, 32.8% at 36 months, an d 25.7% at 48 months. Significantly lower catheter survival was found in younger children (0 - 2 years) compared with two other age groups ( 2 - 5 years, and > 5 years). No significant correlation was found betw een catheter survival and catheter entry-site (midline vs paramedian). Conclusions: Catheter-related infections were confirmed to be the mos t common complication and most frequent cause of peritoneal catheter r emoval. In addition, catheter survival rate was worse in younger child ren, indicating that more effort should be made to improve peritoneal catheter survival particularly in this age group.