ACB K4-151, Nephrology, BC Children's Hospital, 4480 Oak St, Vancouver, B.C., V6H 3V4, Canada.
Pediatr Nephrol. 2013 Feb;28(2):315-9. doi: 10.1007/s00467-012-2303-9. Epub 2012 Sep 14.
The aim of this study was to inform best evidence-based practice by collating and disseminating the experiences of members of the International Pediatric Peritoneal Dialysis Network with children having concurrent ventriculoperitoneal shunts (VPS) and peritoneal dialysis catheters (PDC).
An online questionnaire was created and distributed to all 135 centers participating in the International Pediatric Peritoneal Dialysis Network; the overall response rate was 56 %.
A total of 18 patients with a concurrent VPS and PDC were reported. The children were 0-12 (mean 6.8) years old at the time of placement of the second indwelling device (PDC or VPS). In 15 cases, the PDC was inserted post-VPS. On average, the two catheters were present concurrently for 23 (range 1-60) months. There were 20 episodes of peritonitis observed in 11 of the 18 patients during a period of 392 months at risk, which is a peritonitis rate of 1/19.6 months. Only one patient developed both a VPS infection and an episode of peritonitis, and these events were temporally unrelated. No episodes of an ascending shunt infection or meningitis occurred in association with any episode of peritonitis, and no other complications of catheter dysfunction were described.
The rate of peritonitis, the absence of any documented ascending or descending infections and the lack of catheter dysfunction during the period of observation suggests that the presence of, or need for, a VPS should not preclude PD as a safe option for children requiring renal replacement therapy.
本研究旨在通过汇集和传播国际儿科腹膜透析网络成员在同时存在脑室-腹腔分流术（VPS）和腹膜透析导管（PDC）的儿童中的经验，为最佳循证实践提供信息。
创建了一个在线问卷并分发给参与国际儿科腹膜透析网络的所有 135 个中心；总体回复率为 56%。
报告了总共 18 例同时存在 VPS 和 PDC 的患者。这些儿童在放置第二个留置装置（PDC 或 VPS）时年龄为 0-12 岁（平均 6.8 岁）。在 15 例中，PDC 是在 VPS 之后插入的。两个导管同时存在的平均时间为 23 个月（范围 1-60 个月）。在 392 个月的风险期内，18 例患者中的 11 例发生了 20 次腹膜炎，腹膜炎发生率为 1/19.6 个月。只有 1 例患者同时发生 VPS 感染和腹膜炎发作，且这些事件在时间上无关联。没有任何一例与腹膜炎相关的 VPS 感染或脑膜炎，也没有描述其他导管功能障碍的并发症。
在观察期间，腹膜炎的发生率、没有任何记录的上行或下行感染以及导管功能障碍的缺乏表明，VPS 的存在或需要不应排除 PD 作为需要肾脏替代治疗的儿童的安全选择。
