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Multicenter Study
. 2021 Jun;36(6):1597-1606.
doi: 10.1007/s00467-020-04876-x. Epub 2021 Jan 4.

Acute peritoneal dialysis, complications and outcomes in 389 children with STEC-HUS: a multicenter experience

Paula A Coccia  1 , Flavia B Ramírez  2 , Angela D C Suárez  3 , Laura F Alconcher  4 , Alejandro Balestracci  5 , Laura A García Chervo  6 , Iliana Principi  7 , Aída Vázquez  8 , Viviana M Ratto  9 , María Celia Planells  10 , Jorge Montero  11 , Mariana Saurit  12 , Maria Graciela Pérez Y Gutiérrez  13 , María Celeste Puga  14 , Elsa M Isern  15 , María Carolina Bettendorff  16 , Marcela V Boscardin  17 , Marta Bazán  18 , Mario A Polischuk  19 , Alejo De Sarrasqueta  20 , Adriana Aralde  21 , Diego B Ripeau  22 , Daniela C Leroy  23 , Nahir E Quijada  24 , Romina S Escalante  25 , Marta I Giordano  26 , Cristian Sánchez  27 , Verónica S Selva  28 , Alejandra Caminiti  29 , José María Ojeda  30 , Pablo Bonany  31 , Sandra E Morales  32 , Daniel Allende  33 , María Andrea Arias  34 , Andrea M Exeni  35 , Jésica D Geuna  36 , Larisa Arrúa  37
Affiliations
Multicenter Study

Acute peritoneal dialysis, complications and outcomes in 389 children with STEC-HUS: a multicenter experience

Paula A Coccia et al. Pediatr Nephrol. 2021 Jun.

Abstract

Background: Management of acute kidney injury (AKI) in children with hemolytic uremic syndrome induced by a Shiga toxin-producing Escherichia coli infection (STEC-HUS) is supportive; however, 40 to 60% of cases need kidney replacement therapy (KRT). The aim of this study was to analyze procedure complications, especially peritonitis, and clinical outcomes in children with AKI secondary to STEC-HUS treated with acute PD.

Methods: This is a multicenter retrospective study conducted among thirty-seven Argentinian centers. We reviewed medical records of 389 children with STEC-HUS hospitalized between January 2015 and February 2019 that required PD.

Results: Complications associated with PD were catheter malfunction (n = 93, 24%), peritonitis (n = 75, 19%), fluid leaks (n = 45, 11.5%), bleeding events (n = 23, 6%), and hyperglycemia (n = 8, 2%). In the multivariate analysis, the use of antibiotic prophylaxis was independently associated with a decreased risk of peritonitis (hazard ratio 0.49, IC 95% 0.29-0.81; p = 0.001), and open-surgery catheter insertion was independently associated with a higher risk (hazard ratio 2.8, IC 95% 1.21-6.82; p = 0.001). Discontinuation of PD due to peritonitis, severe leak, or mechanical complications occurred in 3.8% of patients. No patient needed to be transitioned to other modality of KRT due to inefficacy of the technique. Mortality during the acute phase occurred in 2.8% patients due to extrarenal complications (neurological and cardiac involvement), not related to PD.

Conclusions: Acute PD was a safe and effective method to manage AKI in children with STEC-HUS. Prophylactic antibiotics prior to insertion of the PD catheter should be considered to decrease the incidence of peritonitis.

Keywords: Acute kidney injury; Acute peritoneal dialysis; Children; Hemolytic uremic syndrome; Kidney replacement therapy; Peritonitis; Shiga toxin–producing Escherichia coli.

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References

    1. Mody RK, Gu W, Griffin PM, Jones TF, Rounds J, Shiferaw B, Tobin-D'Angelo M, Smith G, Spina N, Hurd S, Lathrop S, Palmer A, Boothe E, Luna-Gierke RE, Hoekstra RM (2015) Postdiarrheal hemolytic uremic syndrome in United States children: clinical spectrum and predictors of in-hospital death. J Pediatr 166:1022–1029. https://doi.org/10.1016/j.jpeds.2014.12.064 - DOI - PubMed
    1. Alconcher LF, Coccia PA, Suarez AC, Monteverde M, Pérez y Gutiérrez MG, Carlopio P, Missoni M, Balestracci A, Principi I, Ramirez FB, Estrella P, Micelli S, Leroy DC, Quijada NE, Seminara C, Giordano MI, Hidalgo Solís SB, Saurit M, Caminiti A, Arias A, Rivas M, Rizzo P, Liern M (2018) Hyponatremia: a new predictor of mortality in patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome. Pediatr Nephrol 33:1791–1798. https://doi.org/10.1007/s00467-018-3991-6 - DOI - PubMed
    1. Grisaru S, Morgunov MA, Samuel SM, Midgley JP, Wade AW, Tee JB, Hamiwka LA (2011) Acute renal replacement therapy in children with diarrhea-associated hemolytic uremic syndrome: a single center 16 years of experience. Int J Nephrol 2011:930539. https://doi.org/10.4061/2011/930539 - DOI - PubMed - PMC
    1. Adragna M, Balestracci A, GarcíaChervo L, Steinbrun S, Delgado N, Briones L (2012) Acute dialysis-associated peritonitis in children with D+ hemolytic uremic syndrome. Pediatr Nephrol 27:637–642 - DOI
    1. Goldstein SL, Currier H, Graf C, Cosio CC, Brewer ED, Sachdeva R (2001) Outcome in children receiving continuous venovenous hemofiltration. Pediatrics 107:1309–1312 - DOI

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