Risk factors for catheter-related complications in pediatric peritoneal dialysis

Catheter-related complications, including infection, dialysate leak, and malfunction, are the principal causes of peritoneal dialysis (PD) failure. To determine risk factors predisposing to these complications, we conducted a retrospective study of 90 children on chronic PD who received 127 catheters from January 1990 to December 2000. There was a significant risk for dialysate leak when PD catheters were used early (less than or equal to14 days post placement) versus delayed use (>14 days). There was no significant difference in malfunction and infection rate between early and delayed use groups. Weight and height <5th percentile, low serum albumin, and history of abdominal surgery were not associated with an increased risk of complications. History of dialysis prior to catheter placement and presence of a gastrostomy tube (G-tube) were both associated with significant infection risk. Patients less than or equal to3 years old were more likely to have a G-tube and had an increased risk of infection. We conclude that delayed use of the PD catheter led to a lower incidence of dialysate leak but had no effect on infection rate. Young age, G-tube, and history of prior dialysis are risk factors for infection. Multi-center, prospective controlled studies involving larger numbers of children are important to confirm these findings.