#6921 INFECTIOUS PERITONITIS DURING PEDIATRIC PERITONEAL DIALYSIS

Abstract

Abstract Background and Aims Peritoneal dialysis (PD) is the dialysis treatment modality of choice used to treat pediatric patients with end-stage kidney disease (ESKD), thanks to its various benefits. However, infectious complications, mainly infectious peritonitis (IP), can occur, leading to morbidity, mortality and technique's failure. In this study, we aimed to describe the deferent infectious complications observed in children on PD and to investigate the risk factors for the occurrence of IP. Method In this study, we retrospectively collected the records of 99 patients who were treated with PD within the last eleven years (2010-2020) in the department of pediatrics of the University Hospital Charles Nicolle in Tunis. We adopted the terminology of the International Society of Peritoneal Dialysis (ISPD) to define peritonitis and its outcome. Analysis examining possible predictive factors of IP were performed using parametric and non-parametric tests and multivariate logistic regression in multivariate analysis. Results Ninety-nine patients were on PD during our study period, of which 65 patients had a total of 120 episodes of IP. The incidence of IP was 0.41 episodes per patient/year. The average time to onset of the first episode of IP was 1.2 years [3 days – 5.54 years]. Clinical signs of IP were dominated by abdominal pain (78.3%) and fever (50.4%). The PD effluent was cloudy in 78.3% of cases. Peritoneal dialysis fluid culture was positive in 33.3% of episodes with a predominance of gram-positive germs (62.8%). The evolution of this IP was favourable in 91.5% of cases with a response to antibiotics. 7% of episodes were relapsing of which five were during the first episode of IP. IP recurrence occurred in one patient. A catheter change was required over 16 episodes of IP, and hemodialysis sessions were necessary in 27 patients, temporary in 10 patients. The multivariate study identified the following predictive factors of IP: poor adherence to treatment (OR=3.851; 95%CI: 1.369-10.837; P = .011) and weight less than 15 Kg (OR=6.314; 95%CI: 1.333- 29.897; P = .02). Conclusion Considering the high risk of peritonitis in children on PD, it is imperative to establish a primary prevention based on training of the child's caregivers and families. Continous quality improvement program and PD technique must systematically reviewed in every peritonitis episode. Nutritional management of children prior to the start of PD is necessary to limit the risk of IP.