ESPN 54th Annual Meeting

ESPN 2022


 
Global Trends in Peritoneal Dialysis-Associated Peritonitis in Children: Findings from the International Pediatric Peritoneal Dialysis Network (IPPN).
DAGMARA BORZYCH-DUZALKA 1 LISA SARTZ 1 BRUNO RANCHIN 1 NIKOLETA PRINTZA 2 DOROTA DROZDZ 3 SEVCAN BAKKALOGLU 4 TUULA HOLTTA 5 HEIKO BILLING 6 KOEN VAN HOECK 7 OVIDIU BRUMARIU 8 LISA SARTZ 9 NAKYSA HOOMAN 10 RAYNER LOZA MUNARRIZ 11 WILLIAM WONG 12 BRADLEY WARADY 13 FRANZ SCHAEFER 14

1- MEDICAL UNIVERSITY OF GDANSK, GDANSK, POLAND
2- HIPPOKRATION GENERAL HOSPITAL, ARISTOTLE UNIVERSITY, THESSALONIKI, GREECE.
3- JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE, KRAKOW, POLAND
4- GAZI UNIVERSITY FACULTY OF MEDICINE, ANKARA, TURKEY
5- HELSINKI UNIVERSITY HOSPITAL, HELSINKI, FINLAND.
6- CHILDREN UNIVERSITY HOSPITAL, TUEBINGEN, GERMANY
7- UNIVERSITY HOSPITAL ANTWERP, BELGIUM
8- ST.MARIA CHILDRENS HOSPITAL, IASI, ROMANIA
9- BARNKLINIKEN, LUND, SWEDEN
10- IRAN UNIVERSITY OF MEDICAL SCIENCES, TEHARAN, IRAN
11- CAYETANO HEREDIA HOSPITAL, LIMA, PERU
12- STARSHIP CHILDRENS HOSPITAL, AUCKLAND, NEW ZEALAND,
13- CHILDRENS MERCY HOSPITAL, KANSAS CITY, USA
14- CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE, HEIDELBERG UNIVERSITY, HEIDELBERG, GERMANY.
 
Introduction:

Peritonitis remains a frequent complication of peritoneal dialysis in children. We described the peritonitis rate, etiology, clinical presentation, and outcome experienced by patients followed in the IPPN registry

Material and methods:

 Review of prospectively collected data submitted to the IPPN registry (www.pedpd.org) at 137 pediatric dialysis centers in 44 countries between 04/2007 and 01/2022.

Results:

 A total of 2107 peritonitis episodes and 170 relapses were reported in 1179 out of 4289 patients during 5498 patient years follow-up, i.e. an annualized peritonitis rate of 0.38 per patient. Peritonitis rates varied by region and country and were lowest in Asia (0.23) and highest in ANZAC and Eastern Europe (0.81, 0.5). Peritonitis rates steadily decreased in all world regions, from 0.5 per patient year prior to 2012 to 0.28 after 2016.  46% of the episodes were caused by gram-positive, 25% by gram-negative, 4% by fungal and 1% by multiple organisms, whereas 24% were culture negative, without significant variation over time. S.aureus and S.epidermidis were the most frequently isolated organisms and culture negative peritonitis was most common in Turkey and Latin America. Multivariate mixed model analysis identified the following risk factors for peritonitis: younger age (OR 0.97, CI 0.95-0.98, p<0.0001), presence of an ostomy (OR 1.44, CI 1.17-1.76, p=0.0004), impaired cognitive development (OR 1.48, CI 1.22-1.79, p<0.0001), low serum albumin level (0.98, CI 0.97-0.99, p=0.005), and exposure to high dialysate glucose (OR 1.23, CI 1.08-1.41, p=0.03). 15% of the total variability was attributable to center effects and 6% to region-specific effects. Full functional recovery was achieved in 82% of cases, without regional variation.

Conclusions:

 The prevention and management of peritonitis resulted in their worldwide reduction over the last 15 years, with no significant variation in microbiology. Modifiable risk factors include malnutrition, exposure to high dialysate glucose and center experience.