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.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgments
We thank Prof. Jorge R. Ferraris (University of Buenos Aires), for his assistance, thoughtful suggestions, and critical review and the Pediatric Nephrology Committee of the Argentinean Pediatric Society for their support and confidence.
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All authors contributed to the study conception, design, and data collection. Material preparation and analysis were performed by Paula A. Coccia and Maria Celeste Puga. The first draft of the manuscript was written by Paula A. Coccia, Laura F. Alconcher, Flavia B. Ramirez, Alejandro Balestracci, and Angela D C. Suárez. All the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.
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This was a multicentric, observational, retrospective and cross-sectional study. The Review Boards and Ethics Committees of the hospitals approved this study. The requirement to obtain informed consent was waived by the institutional review boards.
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Coccia, P.A., Ramírez, F.B., Suárez, A.D.C. et al. Acute peritoneal dialysis, complications and outcomes in 389 children with STEC-HUS: a multicenter experience. Pediatr Nephrol 36, 1597–1606 (2021). https://doi.org/10.1007/s00467-020-04876-x
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DOI: https://doi.org/10.1007/s00467-020-04876-x