[Infectious complications in children with end-stage renal disease on replacement therapy]

Rev Med Inst Mex Seguro Soc. 2015;53 Suppl 3:S246-52.
[Article in Spanish]

Abstract

Background: Annually, 5000 children younger than 20 years of age and 200 younger than two-years require treatment for chronic kidney disease (CKD). The objective was to estimate the incidence rate of infectious complications in children requiring renal replacement therapy.

Methods: Retrospective cohort. Patients with a minimum of three months of follow-up in programs of peritoneal dialysis and hemodyalisis were included. The incidence rate for infections associated to replacement therapy was calculated.

Results: 67 patients were analysed. In 88 %, initial therapy for CKD was peritoneal dialysis. A total of 52 episodes of peritonitis occured, with an incidence rate of 0.63 episodes/patient-year. Thirty children (48 %) never had an episode of peritonits during the folow-up. At six months, 90 % of the children had the same peritoneal dialysis catheter, decreasing to 84, 74 and 50 % at 12, 18 and 24 months, respectively. Forty-five children were on hemodialysis, 82 % preceded by peritoneal dialysis. Dialysis treatment time in 25 % of them was longer than 19 months. Twenty-two episodes of catheter-related bacteremia occurred, with an incidence rate of 1 episode/1000 catheter-days or 2.5/1000 hemodyalisis sesions. Twenty-nine patients received a transplant (43 %); two of them died. Median waiting time to transplant was 15 months.

Conclusions: Incidence rate of infectious complications was similar to the rates reported in the literature by other centers. At 20 months, half of the patients had at least one infectious complication.

Introducción: aproximadamente 5000 niños menores de 20 años y 200 menores de dos años inician anualmente tratamiento para enfermedad renal terminal (ERT). Se buscó estimar la incidencia de complicaciones infecciosas en niños con ERT en terapia sustitutiva. Métodos: cohorte retrospectiva, se incluyeron pacientes en los programas de diálisis peritoneal y hemodiálisis, con seguimiento mínimo de tres meses. Se calculó la densidad de incidencia para las infecciones asociadas a terapia sustitutiva. Resultados: se analizaron 67 pacientes. En 88 % la terapia inicial fue diálisis peritoneal. Se presentaron 52 eventos de peritonitis y la densidad de incidencia fue de 0.63 episodios/paciente por año. Treinta niños (48 %) nunca tuvieron peritonitis. A los seis meses de seguimiento 90 % de los niños continuaban con el mismo catéter, lo cual disminuyó a 84, 74 y 50 % a los 12, 18 y 24 meses, respectivamente. Cuarenta y cinco niños estuvieron en hemodiálisis, 82 % de ellos precedidos por diálisis peritoneal. El tiempo en hemodiálisis en 25 % fue mayor a 19 meses. Se presentaron 22 eventos de bacteriemia y la densidad de incidencia fue 1 episodio/1000 días-catéter ó 2.5/1000 sesiones de hemodiálisis. Se trasplantaron 29 pacientes (43 %), dos fallecieron. La mediana de espera para trasplante fue de 15 meses. Conclusiones: la incidencia de complicaciones infecciosas es similar a lo registrado en la literatura. A los 20 meses, la mitad de los pacientes tuvieron al menos una complicación infecciosa.

Keywords: Chronic kidney failure; Dialysis; Peritoneal dialysis.

MeSH terms

  • Adolescent
  • Bacteremia / epidemiology
  • Bacteremia / etiology*
  • Candidiasis / epidemiology
  • Candidiasis / etiology
  • Catheter-Related Infections / epidemiology
  • Catheter-Related Infections / etiology*
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Gram-Negative Bacterial Infections / epidemiology
  • Gram-Negative Bacterial Infections / etiology
  • Gram-Positive Bacterial Infections / epidemiology
  • Gram-Positive Bacterial Infections / etiology
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation
  • Male
  • Mexico
  • Peritonitis / epidemiology
  • Peritonitis / etiology*
  • Renal Dialysis / adverse effects*
  • Retrospective Studies
  • Risk Factors
  • Time Factors