Boehm M et al. (2005) Risk factors for peritonitis in pediatric peritoneal dialysis: a single-center study. Pediatr Nephrol [10.1007/s00467-005-1953-2]

In pediatric peritoneal dialysis populations, the risk of developing peritoneal inflammation has been shown to be greatest in the youngest patients. A recently published retrospective analysis of data from Austria has confirmed this correlation, and identified other determinants of risk that are independent of age. Improved management of these age-independent risk factors could curb the growing incidence of peritonitis in this ever-younger dialysis population.

The medical records of 30 children who received peritoneal dialysis—primarily via single-cuff catheters—at the Children's University Hospital in Vienna were analyzed. Of the 13 who were younger than 2 years of age, 77% suffered at least one peritonitis episode, compared with only 30% of the 17 patients older than 2 years of age. Younger children were also more likely to suffer recurrent bouts of peritonitis.

Exit-site infections and low urine volume were found to independently predict peritonitis burden per patient. Low rates of residual glomerular filtration and normalized protein catabolism, as well as an automated procedure (as opposed to continuous ambulatory peritoneal dialysis), were also correlated with indices of poor peritonitis outcomes.

In light of their findings, Boehm and colleagues suggest that amendment of management programs might reduce the risk of children developing peritonitis during peritoneal dialysis. Although requiring confirmation in large prospective trials, introducing antimicrobial prophylaxis, optimizing nutritional status and increasing dialysis dose could improve the outlook for this young cohort of the dialysis community.