Omentectomy reduces the need for peritoneal dialysis catheter revision in children: a study from the Pediatric Nephrology Research Consortium.
Catheter malfunction
Children
Omentectomy
Pediatric nephrology
Peritoneal dialysis
Stage 5 chronic kidney disease
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
04
03
2021
accepted:
19
05
2021
revised:
17
05
2021
pubmed:
16
6
2021
medline:
5
2
2022
entrez:
15
6
2021
Statut:
ppublish
Résumé
There are no multi-center studies examining omentectomy and peritoneal dialysis (PD) catheter revision in the pediatric dialysis population. We performed a retrospective study at eight centers within the Pediatric Nephrology Research Consortium (PNRC). Data review included all incident tunneled PD catheters placed between 1/1/2011 and 12/31/2016 in pediatric stage 5 chronic kidney disease (CKD 5) patients. The primary outcome was the need for catheter revision and/or replacement. Multivariable logistic regression was performed to evaluate predictors for catheter revision/replacement. Data from 184 children (62.5% male; median age 7.4 years) were analyzed. Omentectomy was completed in 63.6% (n = 117). Revision/replacement occurred in 34.2% (n = 63); median time to revision/replacement was 38.5 days after insertion. PD catheter revision/replacement catheter occurred in 23.9% who underwent omentectomy versus 52.2% without omentectomy (p = 0.0005). Children ≥ 6 years at the time of catheter insertion experienced fewer revisions/replacements (18.2% age ≥ 6 vs. 56.5% age < 6 years, p <0.001). After adjusting for covariates, omentectomy reduced the need for revision by 63%; revision was 3.66 times more likely in those < 6 years of age. This multi-center study demonstrates that omentectomy at the time of PD catheter insertion in pediatric patients is strongly associated with reduced likelihood of PD catheter revision. Omentectomy should be considered at the time of PD catheter insertion, especially in young children who are at high risk for PD catheter malfunction. A higher resolution version of the Graphical abstract is available as Supplementary information.
Sections du résumé
BACKGROUND
There are no multi-center studies examining omentectomy and peritoneal dialysis (PD) catheter revision in the pediatric dialysis population.
METHODS
We performed a retrospective study at eight centers within the Pediatric Nephrology Research Consortium (PNRC). Data review included all incident tunneled PD catheters placed between 1/1/2011 and 12/31/2016 in pediatric stage 5 chronic kidney disease (CKD 5) patients. The primary outcome was the need for catheter revision and/or replacement. Multivariable logistic regression was performed to evaluate predictors for catheter revision/replacement.
RESULTS
Data from 184 children (62.5% male; median age 7.4 years) were analyzed. Omentectomy was completed in 63.6% (n = 117). Revision/replacement occurred in 34.2% (n = 63); median time to revision/replacement was 38.5 days after insertion. PD catheter revision/replacement catheter occurred in 23.9% who underwent omentectomy versus 52.2% without omentectomy (p = 0.0005). Children ≥ 6 years at the time of catheter insertion experienced fewer revisions/replacements (18.2% age ≥ 6 vs. 56.5% age < 6 years, p <0.001). After adjusting for covariates, omentectomy reduced the need for revision by 63%; revision was 3.66 times more likely in those < 6 years of age.
CONCLUSIONS
This multi-center study demonstrates that omentectomy at the time of PD catheter insertion in pediatric patients is strongly associated with reduced likelihood of PD catheter revision. Omentectomy should be considered at the time of PD catheter insertion, especially in young children who are at high risk for PD catheter malfunction. A higher resolution version of the Graphical abstract is available as Supplementary information.
Identifiants
pubmed: 34128096
doi: 10.1007/s00467-021-05150-4
pii: 10.1007/s00467-021-05150-4
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
3953-3959Informations de copyright
© 2021. IPNA.
Références
White CT, Gowrishankar M, Feber J, Yiu V (2006) Clinical practice guidelines for pediatric peritoneal dialysis. Pediatr Nephrol 21:1059–1066
doi: 10.1007/s00467-006-0099-1
Nicholson ML, Burton PR, Donnelly PK, Veitch PS, Walls J (1991) The role of omentectomy in continuous ambulatory peritoneal dialysis. Perit Dial Int 11:330–332
doi: 10.1177/089686089101100407
Reissman P, Lyass S, Shiloni E, Rivkind A, Berlatzky Y (1998) Placement of a peritoneal dialysis catheter with routine omentectomy--does it prevent obstruction of the catheter? Eur J Surg 164:703–707
doi: 10.1080/110241598750005606
Sanderson MC, Swartzendruber DJ, Fenoglio ME, Moore JT, Haun WE (1990) Surgical complications of continuous ambulatory peritoneal dialysis. Am J Surg 160:561–566
doi: 10.1016/S0002-9610(05)80746-9
Borzych-Duzalka D, Aki TF, Azocar M, White C, Harvey E, Mir S, Adragna M, Serdaroglu E, Sinha R, Samaille C, Vanegas JJ, Kari J, Barbosa L, Bagga A, Galanti M, Yavascan O, Leozappa G, Szczepanska M, Vondrak K, Tse KC, Schaefer F, Warady BA (2017) Peritoneal dialysis access revision in children: causes, interventions, and outcomes. Clin J Am Soc Nephrol 12:105–112
doi: 10.2215/CJN.05270516
Cribbs RK, Greenbaum LA, Heiss KF (2010) Risk factors for early peritoneal dialysis catheter failure in children. J Pediatr Surg 45:585–589
doi: 10.1016/j.jpedsurg.2009.06.019
Ladd AP, Breckler FD, Novotny NM (2011) Impact of primary omentectomy on longevity of peritoneal dialysis catheters in children. Am J Surg 201:401–404 discussion 404-405
doi: 10.1016/j.amjsurg.2010.08.022
Phan J, Stanford S, Zaritsky JJ, DeUgarte DA (2013) Risk factors for morbidity and mortality in pediatric patients with peritoneal dialysis catheters. J Pediatr Surg 48:197–202
doi: 10.1016/j.jpedsurg.2012.10.035
Carpenter JL, Fallon SC, Swartz SJ, Minifee PK, Cass DL, Nuchtern JG, Pimpalwar AP, Brandt ML (2016) Outcomes after peritoneal dialysis catheter placement. J Pediatr Surg 51:730–733
doi: 10.1016/j.jpedsurg.2016.02.011
Imani PD, Carpenter JL, Bell CS, Brandt ML, Braun MC, Swartz SJ (2018) Peritoneal dialysis catheter outcomes in infants initiating peritoneal dialysis for end-stage renal disease. BMC Nephrol 19:231
doi: 10.1186/s12882-018-1015-1
Haggerty S, Roth S, Walsh D, Stefanidis D, Price R, Fanelli RD, Penner T, Richardson W, SAGES Guidelines Committee (2014) Guidelines for laparoscopic peritoneal dialysis access surgery. Surg Endosc 28:3016–3045
doi: 10.1007/s00464-014-3851-9
Öğünç G (2001) Videolaparoscopy with omentopexy: a new technique to allow placement of a catheter for continuous ambulatory peritoneal dialysis. Surg Today 31:942–944
doi: 10.1007/s005950170042
Attaluri V, Lebeis C, Brethauer S, Rosenblatt S (2010) Advanced laparoscopic techniques significantly improve function of peritoneal dialysis catheters. J Am Coll Surg 211:699–704
doi: 10.1016/j.jamcollsurg.2010.08.010
Oğünç G, Tuncer M, Oğünç D, Yardimsever M, Ersoy F (2003) Laparoscopic omental fixation technique versus open surgical placement of peritoneal dialysis catheters. Surg Endosc 17:1749–1755
doi: 10.1007/s00464-002-8586-3
Swartz RD (1985) Chronic peritoneal dialysis: mechanical and infectious complications. Nephron 40:29–37
doi: 10.1159/000183423
Rinaldi S, Sera F, Verrina E, Edefonti A, Gianoglio B, Perfumo F, Sorino P, Zacchello G, Cutaia I, Lavoratti G, Leozappa G, Pecoraro C, Rizzoni G (2004) Chronic peritoneal dialysis catheters in children: a fifteen-year experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis. Perit Dial Int 24:481–486
doi: 10.1177/089686080402400515
Kavalakkat JP, Kumar S, Aswathaman K, Kekre NS (2010) Continuous ambulatory peritoneal dialysis catheter placement: Is omentectomy necessary? Urol Ann 2:107–109
doi: 10.4103/0974-7796.68858
Vidal E, Edefonti A, Murer L, Gianoglio B, Maringhini S, Pecoraro C, Sorino P, Leozappa G, Lavoratti G, Ratsch IM, Chimenz R, Verrina E (2012) Peritoneal dialysis in infants: the experience of the Italian Registry of Paediatric Chronic Dialysis. Nephrol Dial Transplant 27:388–395
doi: 10.1093/ndt/gfr322
Wong YS, Pang KKY, Ma ALT, Tong PC, Tam YH (2019) A standardized technique of laparoscopic placement of peritoneal dialysis catheter with omentectomy and closure of patent processus vaginalis: a 3-in-1 minimally invasive surgical approach in children. J Pediatr Surg 55:1914–1919
doi: 10.1016/j.jpedsurg.2019.09.033
Zurowska A, Feneberg R, Warady BA, Zimmering M, Monteverde M, Testa S, Calyskan S, Drozdz D, Salusky I, Kemper MJ, Ekim M, Verrina E, Misselwitz J, Schaefer F (2008) Gram-negative peritonitis in children undergoing long-term peritoneal dialysis. Am J Kidney Dis 51:455–462
doi: 10.1053/j.ajkd.2007.11.011
Lane JC, Warady BA, Feneberg R, Majkowski NL, Watson AR, Fischbach M, Kang HG, Bonzel KE, Simkova E, Stefanidis CJ, Klaus G, Alexander SR, Ekim M, Bilge I, Schaefer F (2010) Relapsing peritonitis in children who undergo chronic peritoneal dialysis: a prospective study of the international pediatric peritonitis registry. Clin J Am Soc Nephrol 5:1041–1046
doi: 10.2215/CJN.05150709