Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong, Hong Kong.
Medical University of Gdansk, Gdansk, Poland.
Pediatr Nephrol. 2020 Jan;35(1):119-126. doi: 10.1007/s00467-019-04372-x. Epub 2019 Oct 30.
This study aimed to evaluate outcome of children on chronic peritoneal dialysis (PD) with a concurrent colostomy.
Patients were identified through the International Pediatric Peritoneal Dialysis Network (IPPN) registry. Matched controls were randomly selected from the registry. Data were collected through the IPPN database and a survey disseminated to all participating sites.
Fifteen centers reported 20 children who received chronic PD with a co-existing colostomy. The most common cause of end stage kidney disease was congenital anomalies of the kidney and urinary tract (n = 16, 80%). The main reason for colostomy placement was anorectal malformation (n = 13, 65%). The median age at colostomy creation and PD catheter (PDC) insertion were 0.1 (IQR, 0-2.2) and 2.8 (IQR 0.2-18.8) months, respectively. The colostomies and PDCs were present together for a median 18 (IQR, 4.9-35.8) months. The median age at PDC placement in 46 controls was 3.4 (IQR, 0.2-7.4) months of age. Fourteen patients (70%) developed 39 episodes of peritonitis. The annualized peritonitis rate was significantly higher in the colostomy group (1.13 vs. 0.70 episodes per patient year; p = 0.02). Predominant causative microorganisms were Staphylococcus aureus (15%) and Pseudomonas aeruginosa (13%). There were 12 exit site infection (ESI) episodes reported exclusively in colostomy patients. Seven colostomy children (35%) died during their course of PD, in two cases due to peritonitis.
Although feasible in children with a colostomy, chronic PD is associated with an increased risk of peritonitis and mortality. Continued efforts to reduce infection risk for this complex patient population are essential.
本研究旨在评估同时伴有结肠造口术的儿童进行慢性腹膜透析（PD）的治疗结果。
通过国际儿科腹膜透析网络（IPPN）登记处确定患者。从登记处随机选择匹配的对照。通过 IPPN 数据库和向所有参与站点分发的调查收集数据。
15 个中心报告了 20 名接受慢性 PD 治疗并同时存在结肠造口术的儿童。终末期肾病的最常见原因是肾脏和泌尿道先天异常（n = 16，80%）。结肠造口术的主要原因是肛门直肠畸形（n = 13，65%）。结肠造口术和 PD 导管（PDC）插入的中位年龄分别为 0.1（IQR，0-2.2）和 2.8（IQR，0.2-18.8）个月。结肠造口术和 PDC 同时存在的中位时间为 18（IQR，4.9-35.8）个月。46 名对照患者中 PDC 放置的中位年龄为 3.4（IQR，0.2-7.4）个月。14 名患者（70%）发生了 39 次腹膜炎。结肠造口术组的腹膜炎年发生率明显较高（1.13 与 0.70 例/患者年；p = 0.02）。主要致病微生物为金黄色葡萄球菌（15%）和铜绿假单胞菌（13%）。仅在结肠造口术患者中报告了 12 例出口部位感染（ESI）发作。7 名结肠造口术儿童（35%）在 PD 过程中死亡，其中 2 例死于腹膜炎。
尽管在结肠造口术患儿中是可行的，但慢性 PD 与腹膜炎和死亡率增加相关。继续努力降低这一复杂患者群体的感染风险至关重要。
