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Background Patients on peritoneal dialysis (PD) may develop PD-related complications that necessitate abdominal surgery. However, when to resume PD and how to prescribe PD fluid after surgery in pediatric patients are unknown. Methods Patients on PD who underwent small-incision abdominal surgery between May 2006 and October 2021 were included in this retrospective observational study. The complications after surgery and characteristics of patients with PD fluid leakage were analyzed. Results Thirty-four patients were included. They underwent 45 surgical procedures, including 23 inguinal hernia repairs, 17 PD catheter repositioning or omentectomy, and 5 others. The median time to resume PD was 1.0 (IQR, 1.0-3.0) days, and the median PD exchange volume at the initiation of PD after surgery was 25 (IQR, 20-30) ml/kg/cycle. PD-related peritonitis occurred in two patients after omentectomy and one after inguinal hernia repair. There was no PD fluid leakage or hernia recurrence among the 22 patients who had a hernia repair. Peritoneal leakage occurred in 3 of the 17 patients who had PD catheter repositioning or an omentectomy and was treated conservatively. No patients who resumed PD 3 days after small-incision abdominal surgery with less than half of PD volume had fluid leakage. Conclusions Our findings demonstrated that PD could be resumed within 48 h of inguinal hernia repair with no PD fluid leakage or hernia recurrence in pediatric patients. In addition, resuming PD 3 days after a laparoscopic procedure with less than half of the usual dialysate volume might reduce the risk of PD fluid leakage. Graphical abstract, Author(s): Yuta Inoki [sup.1] , Kentaro Nishi [sup.1] , Kei Osaka [sup.1] , Tomoya Kaneda [sup.1] , Misaki Akiyama [sup.1] , Mai Sato [sup.1] , Masao Ogura [sup.1] , Koichi [...]

Background Comprehensive training of children on peritoneal dialysis (PD) and their caregivers is crucial to minimize peritonitis risk. Few studies have evaluated the impact of training on infection, so many published recommendations rely on expert opinion. This study uses data from the SCOPE collaborative to examine the impact of compliance with 4 components of PD training on the risk for peritonitis. Methods A retrospective cohort study of children enrolled in the SCOPE collaborative between 2011 and 2021 who received training prior to initiating PD. Compliance with 4 training components were assessed: performance of a home visit, 1:1 training, delaying training [greater than or equal to] 10 days after PD catheter insertion and average individual training session length [less than or equal to] 3 h. Univariate and multivariable generalized linear mixed modeling were used to assess relationships between peritonitis [less than or equal to] 90 days after PD training and median days to peritonitis and compliance with each component as well as all-or-none compliance. Results Among 1450 trainings, 51.7% had median session length [less than or equal to] 3 h, 67.1% delayed training [greater than or equal to] 10 days after catheter insertion, 74.3% had a home visit and 94.6% had 1:1 training. Only 333 trainings (23%) were compliant with all 4 training components. There was no statistically significant association between compliance with individual components, or all-or-none compliance and either the percentage of catheters with peritonitis [less than or equal to] 90 days after training end or median days to peritonitis. Conclusion No associations between 4 PD training components and risk for peritonitis were found. SCOPE requires monthly review of PD catheter practices which may have decreased the impact of training non-compliance. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information, Author(s): Brandy Begin [sup.1] , Troy Richardson [sup.2] , Jennifer Ehrlich [sup.3] , Bradley A. Warady [sup.4] , Alicia M. Neu [sup.5] Author Affiliations: (1) grid.5288.7, 0000 0000 9758 5690, [...]

Background Peritonitis is an important complication and cause of morbidity in patients undergoing peritoneal dialysis (PD). Corynebacterium species, often considered skin and mucosal contaminants, are a rare cause of PD-associated peritonitis and have been acknowledged in published guidelines for the diagnosis and treatment of PD peritonitis only over the last decade. Case-Diagnosis/Treatment We present two children with difficult-to-treat episodes of PD peritonitis due to Corynebacterium amycolatum. Episodes were associated with fever, abdominal pain and cloudy dialysate, high dialysate polymorphonuclear leukocyte counts, and elevated serum C-reactive protein and procalcitonin concentrations. Symptoms persisted beyond 5 days in 4 of 5 peritonitis episodes, and peritonitis relapsed despite in vitro sensitivity of the bacterial isolates to guideline-recommended antibiotics. C. amycolatum was cultured from the PD catheter tip despite 4 weeks of intraperitoneal glycopeptide therapy and clinical peritonitis resolution suggestive of efficient biofilm formation. Our systematic literature search identified three previous (adult) case descriptions of C. amycolatum peritonitis, all with repeat episodes by the same organism. The incidence of C. amycolatum as a cause of PD peritonitis has not yet been established but is likely underreported due to challenges in species differentiation. Conclusions C. amycolatum is a rarely identified cause of refractory and/or relapsing PD peritonitis. Species differentiation of non-diphtheriae Corynebacterium isolates is critical, and prolonged antibiotic treatment, preferably with a glycopeptide antibiotic, is recommended, with a low threshold for PD catheter change or removal in case of repeat peritonitis., Author(s): Shameer M. Habeeb [sup.1] , Haneen Yamin [sup.1] , Eva Simkova [sup.1] , Hazem S. Awad [sup.1] , Entesar A. Alhammadi [sup.1] [sup.2] , Loai A. Eid [sup.1] [sup.2] [...]

Background Acid-base balance is maintained by kidney excretion of titratable acids and bicarbonate reabsorption. Metabolic alkalosis is uncommon in dialysis-treated patients. The aim of this retrospective study was to assess the rate of metabolic alkalosis in pediatric patients treated with peritoneal dialysis. Methods Medical records of children treated with peritoneal dialysis in Shaare Zedek Medical Center from January 2000 to June 2021 were reviewed and compared with young adults currently treated with peritoneal dialysis. Demographic, clinical, and peritoneal dialysis characteristics were extracted from the medical records. Results Thirty chronic peritoneal dialysis patients were included in our study, seven under 2 years, 13 between 2 and 18 years, and 10 adults. 90.3% of the measurements in infants showed metabolic alkalosis compared to 32.3% in the 2-18-year group and none in the adult group. Higher size-adjusted daily exchange volume, lack of urine output, and high lactate-containing dialysate were associated with metabolic alkalosis. Alkalosis was not explained by vomiting, diuretic therapy, or carbonate-containing medications. High transport membrane, low dietary protein, and malnutrition, all previously reported explanations for metabolic alkalosis, were not found in our study. Conclusions Metabolic alkalosis is common in infants treated with peritoneal dialysis as opposed to older children and adults. High lactate-containing dialysate is a possible explanation. Higher size-adjusted daily dialysate exchange volume, which may reflect higher bicarbonate absorption, is another independent predictor of alkalosis. Acid-base status should be closely followed in infants, and using a dialysis solution with lower bicarbonate or lactate level should be considered. Graphical abstract A higher resolution version of the graphical abstract is available as Supplementary Information, Author(s): Shimrit Tzvi-Behr [sup.1] , Alon Bnaya [sup.2] [sup.3] , Rachel Becker-Cohen [sup.1] [sup.3] , Choni Rinat [sup.1] [sup.3] , Jenny Weinbrand-Goichberg [sup.1] , Sapir Choshen [sup.1] , Linda Shavit [...]

Author(s): Nithiakishna Selvathesan [sup.1] [sup.2] , Subhrata Verma [sup.1] , Rishil Patel [sup.1] , Elizabeth Harvey [sup.1] , Amanda Dickens [sup.2] Author Affiliations: (1) grid.17063.33, 0000 0001 2157 2938, Division [...]