Peritoneal dialysis catheter infections and peritonitis in children: a report of the North American Pediatric Renal Transplant Cooperative Study

Peritonitis and catheter-related infections remain the two most-common caus es of peritoneal dialysis (PD) treatment failure. To define the frequency a nd risks associated with exit site/tunnel infections (ESI/TI), as well as p eritonitis, in pediatric patients on PD, we undertook a retrospective cohor t study of patients initiated on PD in the North American Pediatric Renal T ransplant Cooperative Study (NAPRTCS). We examined demographic data and PD catheter characteristics of 1,258 patients, aged less than or equal to 21 y ears, initiated on PD from 1992 to 1997. We examined the frequency and comp lications of ESI/TI occurring within 30 days, 6 months, and 1 year of follo w-up. For peritonitis episodes, we examined patient risk factors for perito nitis. Almost 11% of patients had an ESI/TI at 30 days, 26% between 30 days and 6 months, and 30% between 6 months and 1 year of follow-up. There was no increased risk of ESI/TI associated with patient age, race, or catheter characteristics. Peritonitis occurred in dialysis patients at a rate of 1 e pisode per 13.2 patient months. Proportional hazards regression analysis de monstrated that black race, single-cuffed catheters, and upward pointing ex it sites were independent risk factors for peritonitis in the pediatric PD population. Patients with ESI/TI had twice the risk of those without these infections of developing peritonitis or needing access revision, and an alm ost threefold increased risk of hospitalization for access complications/ma lfunction. ESI/TI occurs commonly in pediatric PD patients. These infection s cause significant morbidity, through risk of peritonitis, access revision , and hospitalization for catheter complications. Further study of potentia lly modifiable risk factors for ESI/TI in pediatric end-stage renal disease patients is warranted.