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Kidney Week

Abstract: TH-PO780

Colostomy in Children on Chronic Peritoneal Dialysis

Session Information

  • Pediatric CKD
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Chan, Yu hin Eugene, Hong Kong Children's Hospital, Hong Kong, Hong Kong
  • Borzych-duzalka, Dagmara, Medical University of Gdansk, Gdansk, Poland
  • Schaefer, Franz S., University of Heidelberg, Heidelberg, BW, Germany
  • Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States

Group or Team Name

  • International Pediatric Peritoneal Dialysis Network
Background

The aim of this study was to evaluate the outcome of children on chronic peritoneal dialysis (PD) with a concurrent colostomy.

Methods

Patients were identified through the International Pediatric Peritoneal Dialysis Network (IPPN) registry. Age-matched controls were randomly selected from the registry. Data were collected through the IPPN database and a survey disseminated to all participating sites.

Results

15 centers reported 20 children who received chronic PD with a co-existing colostomy. The commonest cause of end-stage kidney disease was congenital anomalies of kidney and urinary tract (n=16, 80%). The main reason for placement of a colostomy was anorectal malformation (n=13, 65%). The median age at colostomy creation and PD catheter (PDC) insertion were 0.1 [IQR, 0-2.2] and 2.8 [IQR 0-2.2] months, respectively. The colostomies and PDCs were present together for a median 18 [IQR, 4.9-35.8] months. The median age at PDC placement in 46 controls was 4.2 [IQR, 3.6-10.8] months.

14 patients (70%) developed 39 episodes of peritonitis. The annualized peritonitis rate was significantly higher in the colostomy group (1.13 vs 0.70 episodes per patient year; p=0.02). Predominant causative microorganisms were staphylococcus aureus (15%) and pseudomonas aeruginosa (13%). There were 10 exit site infections (ESI) episodes reported exclusively in colostomy patients. Seven children (35%) died during their course of PD, in two cases due to peritonitis.

Conclusion

Although chronic PD is feasible in children with a colostomy, it is associated with an increased risk of peritonitis, ESI, and mortality. Continued efforts to reduce the infection risk for this complex patient population are essential.