Abstract: FR-PO0928
Peritoneal Dialysis (PD) Catheter Complications: Primary PD vs. CKRT-to-PD in Neonates from COINED
Session Information
- Pediatric Nephrology: Genetic Diseases, Development, Neonatal Nephrology, Glomerular Diseases, and More
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Herman, Kathleen J., The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Pottanat, Neha D., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Petgrave, Yonique P., The University of Texas Southwestern Medical Center Medical School, Dallas, Texas, United States
- Alzarka, Bakri, University of Maryland Baltimore, Baltimore, Maryland, United States
- Rairikar, Mugdha, Texas Children's Hospital, Houston, Texas, United States
- Villegas, Leonela A., Connecticut Children's Medical Center, Hartford, Connecticut, United States
- Zahr, Rima S., The University of Tennessee Medical Center, Knoxville, Tennessee, United States
- Lyden, Elizabeth, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Muff-Luett, Melissa A., University of Nebraska Medical Center, Omaha, Nebraska, United States
- Sanderson, Keia, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
Background
Concern for PD catheter complications drives preferences for CKRT as the initial dialysis modality in neonates. In COINED, CKRT was most common initial dialysis modality. Over 25% of those neonates transitioned to PD during hospitalization, either for catheter healing or when renal recovery failed. Whether catheter complications differ between primary PD and CKRT-to-PD transition remains unknown. Our objective was to compare complications between neonates receiving primary PD versus CKRT-to-PD.
Methods
We analyzed COINED neonates with ESKD/AKI-D initiating dialysis ≤30 postnatal days, excluding CKRT with ECMO. We compared 30 neonates transitioning from CKRT-to-PD with 106 who received primary PD. The Primary outcome was PD catheter complications (exit site leak or peritonitis) within 90 postnatal days. We used Wilcoxon rank-sum and Fisher's Exact tests for bivariate analyses and logistic regression adjusting for dialysis indication, gestational age, and fluid overload at initiation.
Results
The CKRT-to-PD group had significantly longer time to PD initiation (median 28 vs 11 days, p<0.001). After adjustment, there was no significant difference in PD catheter complications within the first 90 days [aOR 2.06, 95% CI 0.73-5.82, p=0.17]. Peritonitis (13% vs 20%, p=0.59) and exit site leak [13% vs. 21%, p=0.44] complications were similar between groups. The CKRT-to-PD group had higher rates of concomitant G-tube placement (35% vs 7%, p<0.001).
Conclusion
Primary PD was not associated with increased odds of catheter-related complications compared to CKRT-to-PD transition, regardless of gestational age, dialysis indication, or degree of fluid overload at initiation. PD remains a safe primary dialysis modality, even in high-risk neonates. However, the high complication frequency in this population warrants further research into catheter design and placement.