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Abstract: PO2284

Peritoneal Dialysis (PD) as the Primary Renal Replacement Modality in Pediatric Shiga Toxin-Producing Escherichia coli-Associated Hemolytic-Uremic Syndrome (STEC-HUS): A Single Center's 12-Year Experience

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Pottanat, Neha Dhingra, Indiana University Riley Hospital for Children, Indianapolis, Indiana, United States
  • Andreoli, Sharon P., Indiana University Riley Hospital for Children, Indianapolis, Indiana, United States
  • Miller, Chloe, Indiana University Riley Hospital for Children, Indianapolis, Indiana, United States
  • Khalid, Myda, Indiana University Riley Hospital for Children, Indianapolis, Indiana, United States
Background

Half to 2/3 of children with STEC-HUS require renal replacement therapy. The modality is chosen based on a center’s individual experience and its associated complications.

Methods

We performed a retrospective cohort analysis using electronic medical records and chart review of 80 patients with STEC-HUS identified through billing data from July 1, 2008 to May 30, 2020. Cases of Streptococcal pneumoniae associated HUS and atypical HUS were excluded.

Results

Dialysis was required in 47 patients (59%). Except for one patient, acute PD was chosen as the initial modality. 43 patients (91%) received PD successfully immediately after the catheter was placed. Four patients required a modality change to either hemodialysis (HD) or continuous renal replacement therapy (CRRT).

Leaking of dialysate around the catheter exit site was noted in only 5 patients, out of which only one underwent a catheter revision and resumed PD successfully, two were switched to HD, and two patients had renal recovery allowing for cessation of dialysis. Peritonitis occurred in a single patient but did not lead to a change in modality. In two patients, PD was unsuccessful due to severe intestinal ischemia/colitis, and these patients were switched to CRRT.

A central venous catheter (CVC) was often placed at the time of the PD catheter (40 patients). 46 patients had thrombocytopenia (<100,000/mm3) prior to PD catheter and/or CVC placement. Despite having a mean preoperative platelet count of 42,100/mm3, only 6 patients received a platelet transfusion. Furthermore, 15 patients with preoperative platelets between 15,000 – 35,000/mm3 did not have a bleeding event and did not receive a transfusion.

Conclusion

During a time when HD and CRRT have become the more preferred modalities for acute dialysis in children in the US, acute PD is safe and successful in STEC-HUS. We describe a low complication rate, despite immediate use of the PD catheter, indicating that acute PD can be performed before the exit site heals. Platelet transfusion carries the potential to worsen HUS. We demonstrate that children with STEC-HUS do not have bleeding complications despite low platelets at the time of PD catheter and CVC placement.