SEATTLE—Rapid use of peritoneal dialysis (PD) catheters in children when required urgently is possible, according to study findings presented at the 2016 Annual Dialysis Conference.
Randall Jenkins, MD, of Oregon Health and Sciences University in Portland (OSHU), and colleagues explained that pediatric patients needing urgent dialysis typically have been treated with hemodialysis or continuous renal replacement therapy because of difficulty achieving rapid and effective PD. “Mechanical complications of peritoneal dialysis catheters are common, often leading to leaking or obstructed catheters,” they stated in their study abstract. “In [the] absence of such complications, peritoneal dialysis might be employed more frequently, particularly in small children or when chronic dialysis will be ultimately needed.”
The investigators reported on a series of 34 pediatric patients in whom PD catheters were used within 24 hours of placement. Eight catheters were placed in chronic patients needing dialysis urgently, 24 were placed in patients with acute renal failure, and 2 were placed in acute patients who became chronic. Dialysis was uneventful in 21 patients (62%), according to the researchers. Leaking, both internal and external, occurred in 6 patients in the first week. Of these, 3 were treated successfully with surgical revision. The problem in the remaining 3 patients resolved spontaneously. Hemodialysis was used for a few days in 2 of the patients. Late leaks developed in 3 patients, all related to tugging on the catheter. All leaks resolved spontaneously. Other complications developed in 4 patients, all of whom required hemodialysis. In addition, 1 patient with peritonitis had a catheter replaced and another had a PD catheter revised because of adhesions.
“These results show it is possible to use peritoneal dialysis catheters within 24 hours of placement in urgent clinical situations,” the authors wrote. “It would be useful for surgeons to employ a technique which would allow rapid use of peritoneal dialysis, particularly when there are relative contraindications to hemodialysis, such as small size.”