Surgical Outcome of Peritoneal Dialysis Catheter Insertion in Pediatric Patients: An Experience in Iran

Abstract

Background: Early and late surgical complications of peritoneal dialysis (PD) come along with important and sometimes devastating morbidity, interference of medical care, decreased performance of dialysis, eventually increase the rate of mortality. The aim of our study was to evaluate the changes in the rate of surgical complications and the outcome of PD catheter insertion in a tertiary center in Iran since starting PD program. Methods: This was a retrospective cohort study conducted between 1993 and 2012. Inclusion criteria were all children aged 14 years or younger with chronic kidney disease who underwent peritoneal dialysis. Patients with acute peritoneal dialysis and those who were followed up for less than six months were excluded. eGRF was calculated using Schwartz formula. The surgical complications including catheter malfunction, leak, Dacron sheet extrusion, and hernia were considered. Catheter survival, rate of catheter changes, and rate of peritonitis were calculated in two time period. P value less than 0.05 was considered as statistically significant. Results: During a 19 year interval, 86 PD catheters were inserted in 50 patients, with a median (range) age of 22.5 (1 - 192) months. The most common underlying diseases were CAKUT (congenital anomaly of kidney and urinary tract, 32%), cystic kidney disease (26%), congenital nephrotic syndrome (16%), and hemolytic uremic syndrome (14%). Median eGFR at the time of operation was 7.8 (4 - 31.4 mL/min/1.73 m2). Catheters were inserted laparoscopically in 4.6%. Among surgical complications, 39% of patients developed hernia in median of five months after surgery, in addition catheter malfunction, dislocation, adhesion, or cuff extrusion developed in 22% of cases. The most common reasons for removal were catheter related (outflow failure, adhesion, cuff extrusion) (21%) and infection (peritonitis, tunnel infection) (17.4%). Reoperation for catheter related complication was required in 21 (42%) patients. However, the number and the cause of catheter exchange and the outcome of patients were not statistically significant in two time periods; The rate of outflow failure (77% vs. 25%), peritonitis rate (1 per 7.5 vs. 56.9 patient-months) and catheter reinsertion rate (1 per 30.8 vs. 63.7 patient-months) improved significantly from the time period before 2005 and afterward. The median (range) follow up of patients was 29 (6 - 126) months. Almost 20% transplanted, -26% were still on CAPD, 6% switched to hemodialysis, renal function recovered in 10%, and 38% died. Conclusions: This study shows that although improvement in our technique has been accomplished and complications related to technique of insertion are declining; catheter and patient outcomes still are far from standard.