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.

中文翻译：

---

389 例 STEC-HUS 儿童的急性腹膜透析、并发症和结局：多中心经验

背景

产志贺毒素大肠埃希菌感染 (STEC-HUS)引起的溶血性尿毒症综合征儿童急性肾损伤 (AKI) 的处理是支持性的；然而，40% 到 60% 的病例需要肾脏替代治疗 (KRT)。本研究的目的是分析急性 PD 治疗继发于 STEC-HUS 的 AKI 儿童的手术并发症，尤其是腹膜炎和临床结局。

方法

这是一项在 37 个阿根廷中心进行的多中心回顾性研究。我们审查了 2015 年 1 月至 2019 年 2 月期间住院的 389 名 STEC-HUS 儿童需要 PD 的医疗记录。

结果

与 PD 相关的并发症包括导管功能障碍 ( n = 93, 24%)、腹膜炎 ( n = 75, 19%)、液体渗漏 ( n = 45, 11.5%)、出血事件 ( n = 23, 6%) 和高血糖( n = 8, 2%)。在多变量分析中，预防性使用抗生素与降低腹膜炎风险独立相关（风险比 0.49，IC 95% 0.29-0.81；p = 0.001），而开放式手术导管插入与更高风险独立相关。风险比 2.8，IC 95% 1.21–6.82；p= 0.001)。3.8% 的患者因腹膜炎、严重渗漏或机械并发症而终止 PD。由于该技术无效，没有患者需要转换到其他 KRT 方式。由于与 PD 无关的肾外并发症（神经和心脏受累），2.8% 的患者在急性期死亡。

结论

急性 PD 是一种安全有效的 STEC-HUS 儿童 AKI 管理方法。应考虑在插入 PD 导管之前使用预防性抗生素以降低腹膜炎的发生率。