Tenckhoff catheters prove superior to cook catheters in pediatric acute peritoneal dialysis

Peritoneal dialysis (PD) is the most common form of renal replacement thera py in infants and young children with acute renal failure (ARF), The two mo st commonly used catheters for performing acute PD are the Cook catheter (C C), placed at the bedside, and the surgically placed Tenckhoff catheter (TC ), In the present study, we compared the complications and survival rates o f the two catheters, The records of 59 children (age, 1 day to 16.7 years) who underwent PD for ARF from March 1989 through June 1999 in our hospital were reviewed, The initial (primary) catheter was a TC in 22 patients and a CC in 37 patients. The age of the patients who received a primary TC (2.8 +/- 4.5 years) was no different than the age of those with a primary CC (1. 4 +/- 2.0 years; P = not significant), The duration of use (mean +/- SD) of TCs (16.5 +/- 14.2 days) was significantly greater than the duration of CC use (4.9 +/- 4.2 days; P < 0.001), Only two patients with a TC (9%) develo ped complications, whereas 18 patients with a CC (49%) developed complicati ons, 13 of whom required catheter replacement (P < 0.01), Thirty-five patie nts (59%) recovered renal function after undergoing dialysis for 11.5 +/- 8 .0 days, Twenty-three of those patients (66%) required dialysis for more th an 5 days. Only 4 patients with a primary CC had successful completion of d ialysis without catheter-associated complications compared with 15 patients with a primary TC, Kaplan-Meier survival analysis showed that by day 6 of dialysis, only 46% of primary CCs were functioning without complications co mpared with 90% of TCs that were free of complications. We conclude that th e use of a CC is associated with significantly more complications than a TC , and nearly one half of the CCs are likely to be nonfunctional beyond 5 da ys of dialysis, at a time when two thirds of the patients are still expecte d to be undergoing dialysis, Therefore, when possible, a TC should be the c atheter of choice when initiating acute PD in children. In those patients f or whom a CC is chosen as the initial catheter, an elective change to a TC should be considered once dialysis is expected to extend beyond 5 days, (C) 2000 by the National Kidney Foundation, Inc.