Keswani M, Redpath Mahon AC, Richardson T, et al; SCOPE Investigators. Risk Factors for Early Onset Peritonitis: the SCOPE Collaborative. Pediatr Nephrol. 2019 Apr 9. doi: 10.1007/s00467-019-04248-0.
Peritoneal dialysis (PD) for children with end-stage kidney disease awaiting transplantation improves child and family lifestyle compared to in-center maintenance hemodialysis. In this study conducted by the SCOPE (Standardizing Care to improve Outcomes in Pediatric End-stage kidney disease) collaborative of over 1100 catheter insertions following a procedure “bundle” (guidelines for care), the key finding was that early use of the catheter before 14 days after placement was associated with peritonitis in the first 14 days after placement compared to later onset (odds ratio=1.9; 95% CI 1.2-3.1; p<0.001).
The SCOPE collaborative compiles a national database from pediatric centers; the study period for this analysis was October 2011-November 2017. Using multivariable models, early peritonitis (EP) (occurring in the first 14 days after catheter insertion) was the primary outcome; factors associated with early PD catheter use were also assessed. Among 1106 unique catheter insertions, 93 were associated with 98 episodes of EP; about one-third of cases were culture-negative, and one-quarter had gram-positive infections, about one-fifth had gram-negative infections. Of 1065 catheters for which timing of first use was reported, 32% were used within 14 days of insertion. Importantly, sex, race, underlying reason for end-stage renal disease and surgical technique for catheter placement were not associated with early PD catheter use. However, the youngest patients (<1 year old) had higher odds of early catheter use (OR=2.5, CI 1.7-3.6; p<0.001). Surgical techniques influenced early catheter use as well, including use of plastic adapters (rather than titanium), having sutures placed at the exit site of the PD catheter, and having a dressing change in the first 7 days after catheter placement. These modifiable risk factors might lead to a reduction in EP for our pediatric patients needing maintenance dialysis therapy while awaiting a kidney transplant. Promulgation of these data among both pediatric nephrologists and the surgeons who place catheters for PD may lead to improved survival of those catheters and improvement in overall patient outcomes in subsequent studies by the scientists in the SCOPE collaborative.