Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for early dialysate leakage around the exit site after catheter placement in pediatric peritoneal dialysis: a single-center experience

  • Original article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

Dialysate leakage, a major complication in peritoneal dialysis (PD), causes difficulty in continuing PD. However, literature evaluating risk factors for leakage in detail and the appropriate break-in period to avoid leakage in pediatric patients is scarce.

Methods

We conducted a retrospective study on children aged < 20 years who underwent Tenckhoff catheter placement between April 1, 2002, and December 31, 2021, at our institution. We compared clinical factors between patients with and without leakage within 30 days of catheter insertion.

Results

Dialysate leakage occurred in 8 of 102 (7.8%) PD catheters placed in 78 patients. All leaks occurred in children with a break-in period of < 14 days. Leaks were significantly more frequent in patients with low body weight at the catheter insertion, single-cuffed catheter insertion, a break-in period ≤ 7 days, and a long PD treatment time per day. Only one patient who had leakage with a break-in period > 7 days was neonate. PD was suspended in four of the eight patients with leakage and continued in the others. Two of the latter had secondary peritonitis, one of whom required catheter removal, and leakage improved in the remaining patients. Three infants had serious complications from bridge hemodialysis.

Conclusions

A break-in period of > 7 days and if possible 14 days is recommended to avoid leakage in pediatric patients. Whereas infants with low body weight are at high risk of leakage, their difficulty in inserting double-cuffed catheter, hemodialysis complications, and possible leakage even under long break-in period make prevention of leakage challenging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

All data we have for this study are written in the manuscript, tables and figures.

References

  1. Rahim KA, Seidel K, McDonald RA. Risk factors for catheter-related complications in pediatric peritoneal dialysis. Pediatr Nephrol. 2004;19:1021–8.

    Article  PubMed  Google Scholar 

  2. Rinaldi S, Sera F, Verrina E, Edefonti A, Gianoglio B, Perfumo F, Sorino P, Zacchello G, Cutaia I, Lavoratti G, Leozappa G, Pecoraro C, Rizzoni G. Italian registry of pediatric chronic peritoneal dialysis chronic peritoneal dialysis catheters in children: a fifteen-year experience of the italian registry of pediatric chronic peritoneal dialysis. Perit Dial Int. 2004;24:481–6.

    Article  PubMed  Google Scholar 

  3. Aksoy GK, Ekim M, Bakkaloğlu SA, Coşkun S, Delibaş A, Conkar S, Yılmaz D, Kara A, Saygılı SK, Büyükkaragöz B, Yıldırım ZY, Çomak E, Gürgöze MK, Sever L, Noyan A, Bayazıt AK, Düşünsel R. Evaluation of non-infectious complications of peritoneal dialysis in children: a multicenter study. Pediatr Nephrol. 2021;36:417–23.

    Article  PubMed  Google Scholar 

  4. Macchini F, Valadè A, Ardissino G, Testa S, Edefonti A, Torricelli M, Luzzani S. Chronic peritoneal dialysis in children: catheter related complications A single centre experience. Pediatr Surg Int. 2006;22:524–8.

    Article  PubMed  Google Scholar 

  5. Patel UD, Mottes TA, Flynn JT. Delayed compared with immediate use of peritoneal catheter in pediatric peritoneal dialysis. Adv Perit Dial. 2001;17:253–9.

    CAS  PubMed  Google Scholar 

  6. Phan J, Stanford S, Zaritsky JJ, DeUgarte DA. Risk factors for morbidity and mortality in pediatric patients with peritoneal dialysis catheters. J Pediatr Surg. 2013;48:197–202.

    Article  PubMed  Google Scholar 

  7. Imani PD, Carpenter JL, Bell CS, Brandt ML, Braun MC, Swartz SJ. Peritoneal dialysis catheter outcomes in infants initiating peritoneal dialysis for end-stage renal disease. BMC Nephrol. 2018;19:231.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Radtke J, Lemke A, Kemper MJ, Nashan B, Koch M. Surgical complications after peritoneal dialysis catheter implantation depend on children’s weight. J Pediatr Surg. 2016;51:1317–20.

    Article  PubMed  Google Scholar 

  9. Stewart CL, Acker SN, Pyle LL, Kulungowski A, Cadnapaphornchai M, Bruny JL, Karrer F. Factors associated with peritoneal dialysis catheter complications in children. J Pediatr Surg. 2015;51:159–62.

    Article  PubMed  Google Scholar 

  10. Cribbs RK, Greenbaum LA, Heiss KF. Risk factors for early peritoneal dialysis catheter failure in children. J Pediatr Surg. 2010;45:585–9.

    Article  PubMed  Google Scholar 

  11. Ladd AP, Breckler FD, Novotny NM. Impact of primary omentectomy on longevity of peritoneal dialysis catheters in children. Am J Surg. 2011;201:401–4.

    Article  PubMed  Google Scholar 

  12. Leblanc M, Ouimet D, Pichette V. Dialysate leaks in peritoneal dialysis. Semin Dial. 2001;14:50–4.

    Article  CAS  PubMed  Google Scholar 

  13. Ratajczak A, Lange-Ratajczak M, Bobkiewicz A, Studniarek A. Surgical management of complications with peritoneal dialysis. Semin Dial. 2017;30:63–8.

    Article  PubMed  Google Scholar 

  14. Xieyi G, Xiaohong T, Xiaofang W, Zi L. Urgent-start peritoneal dialysis in chronic kidney disease patients: a systematic review and meta-analysis compared with planned peritoneal dialysis and with urgent-start hemodialysis. Perit Dial Int. 2021;41:179–93.

    Article  PubMed  Google Scholar 

  15. Htay H, Johnson DW, Craig JC, Teixeira-Pinto A, Hawley CS, Cho Y. Urgent-start peritoneal dialysis versus conventional-start peritoneal dialysis for people with chronic kidney disease. Cochrane Database Syst Rev. 2020;12:012913.

    Google Scholar 

  16. Figueiredo A, Goh BL, Jenkins S, Johnson DW, Mactier R, Ramalakshmi S, Shrestha B, Struijk D, Wilkie M. International society for peritoneal dialysis clinical practice guidelines for peritoneal access. Perit Dial Int. 2010;30:424–9.

    Article  PubMed  Google Scholar 

  17. Caring for Australians with Renal Impairment (CARI). The CARI guidelines. Evidence for peritonitis treatment and prophylaxis: timing of commencement of dialysis after peritoneal dialysis catheter insertion. Nephrology (Carlton). 2004 9(3): 76–7.

  18. Dombros N, Dratwa M, Feriani M, Gokal R, Heimbürger O, Krediet R, Plum J, Rodrigues A, Selgas R, Struijk D, Verger C. EBPG expert group on peritoneal dialysis european best practice guidelines for peritoneal dialysis 3 peritoneal access. Nephrol Dial Transpl. 2005;20(9):8–12.

    Google Scholar 

  19. LaPlant MB, Saltzman DA, Segura BJ, Acton RD, Feltis BA, Hess DJ. Peritoneal dialysis catheter placement, outcomes and complications. Pediatr Surg Int. 2018;34:1239–44.

    Article  PubMed  Google Scholar 

  20. Hijazi R, Abitbol CL, Chandar J, Seeherunvong W, Freundlich M, Zilleruelo G. Twenty-five years of infant dialysis: a single center experience. J Pediatr. 2009;155:111–7.

    Article  PubMed  Google Scholar 

  21. Borzych-Duzalka D, Aki TF, Azocar M, White C, Harvey E, Mir S, Adragna M, Serdaroglu E, Sinha R, Samaille C, Vanegas JJ, Kari J, Barbosa L, Bagga A, Galanti M, Yavascan O, Leozappa G, Szczepanska M, Vondrak K, Tse KC, Schaefer F, Warady BA. International Pediatric Peritoneal Dialysis Network (IPPN) registry peritoneal dialysis access revision in children causes, interventions, and outcomes. Clin J Am Soc Nephrol. 2017;12:105–12.

    Article  PubMed  Google Scholar 

  22. Sojo ET, Grosman MD, Monteverde ML, Bailez MM, Delgado N. Fibrin glue is useful in preventing early dialysate leakage in children on chronic peritoneal dialysis. Perit Dial Int. 2004;24:186–90.

    Article  CAS  PubMed  Google Scholar 

  23. Hisamatsu C, Maeda K, Aida Y, Yasufuku M, Ninchoji T, Kaito H, Nozu K, Iijima K, Nishijima E. A novel technique of catheter placement with fibrin glue to prevent pericatheter leakage and to enable no break-in period in peritoneal dialysis. J Pediatr Urol. 2015;11:299–300.

    Article  PubMed  Google Scholar 

  24. Dachy A, Bacchetta J, Sellier-Leclerc AL, Bertholet-Thomas A, Demède D, Cochat P, Nobili F, Ranchin B. Long-term outcomes of peritoneal dialysis started in infants below 6 months of age: An experience from two tertiary centres. Nephrol Ther. 2020;16:424–30.

    Article  PubMed  Google Scholar 

  25. Sadowski RH, Harmon WE, Jabs K. Acute hemodialysis of infants weighing less than five kilograms. Kidney Int. 1994;45:903–6.

    Article  CAS  PubMed  Google Scholar 

  26. Raina R, Vijayaraghavan P, Kapur G, Sethi SK, Krishnappa V, Kumar D, Bunchman TE, Bolen SD, Chand D. Hemodialysis in neonates and infants: a systematic review. Semin Dial. 2018;31:289–99.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Enago Crimson Interactive Pvt. Ltd. for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Taishi Nada, Koichi Kamei, Mai Sato, Kentaro Nishi, Masao Ogura & Shuichi Ito

  2. Department of Pediatrics, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan

    Taishi Nada

  3. Department of Pediatrics, Yokohama City University Hospital, 3-9 Hukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan

    Shuichi Ito

Authors
  1. Taishi Nada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Koichi Kamei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mai Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kentaro Nishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masao Ogura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shuichi Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors were physicians treating the patients in this report. TN prepared the manuscript and performed data collection and analysis. KN and MO edited and reviewed the manuscript. MS and SI revised the manuscript. KK oversaw the work as the corresponding author and revised the manuscript. All authors checked and approved the final manuscript.

Corresponding author

Correspondence to Koichi Kamei.

Ethics declarations

Conflict of interest

Koichi Kamei has received research funding from the Public Foundation of Vaccination Research Center, and the Taiju Life Social Welfare Foundation; donations from Chugai Pharmaceutical Co. Ltd., Teijin Pharma Ltd., Kyowa Kirin Co. Ltd., Shionogi & Co. Ltd., Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma Co. Ltd, and Otsuka Pharmaceutical Co. Ltd.; and lecture fees from Terumo Co. Ltd., Baxter Ltd., and Zenyaku Kogyo Co., Ltd. The other authors have declared no competing interest.

Research involving human participants

This cohort study was approved by the Ethics Committee of the National Center for Child Health and Development (approval number: 2021–218). It was conducted in accordance with the principles of the Declaration of Helsinki and Ethical Guidelines for Medical and Biological Research Involving Human Subjects issued by the Ministry of Health, Labor, and Welfare, Japan.

Informed consent

Informed consent for the participants was not required in agreement with the above-mentioned guidelines.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nada, T., Kamei, K., Sato, M. et al. Risk factors for early dialysate leakage around the exit site after catheter placement in pediatric peritoneal dialysis: a single-center experience. Clin Exp Nephrol 27, 791–799 (2023). https://doi.org/10.1007/s10157-023-02365-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-023-02365-7

Keywords

Search

Navigation