Delayed compared with immediate use of peritoneal catheter in pediatric peritoneal dialysis.

Delayed use of the peritoneal catheter may be one method of reducing catheter-related complications in chronic peritoneal dialysis (PD); however, the risks and benefits of immediate as compared with delayed use have not been examined in children. We retrospectively analyzed 33 peritoneal catheter placements in 27 children between 1997 and 2000. Eleven catheters were used for PD immediately following insertion (group I); 22 catheters were used only after a delay averaging 20 days (group D). Characteristics of the children in the two groups were similar. Catheter-related complications within the first 3 months after placement--including dialysate leak, fibrin plug, outflow obstruction, cuff extrusion, herniation, exit-site and tunnel infection, peritonitis, and catheter revision and replacement--were evaluated. Rates of individual complications in the two groups were similar, but several trends were noted. Dialysate leaks were more common in group I (rate of 0.36 in group I vs 0.09 in group D), and infectious complications were more common in group D (rate of exit-site or tunnel infection of 0.14 in group D vs 0.09 in group I; rate of peritonitis of 0.36 in group D vs 0.18 in group I). We conclude from this small study that delayed use of the peritoneal catheter does not appear to convey significant advantages over immediate use; however, immediate use may be associated with more frequent dialysate leaks. On the other hand, delayed use may be associated with a greater risk of infection. Further studies involving larger numbers of children will be necessary to confirm these findings.

Duke Scholars

Author Uptal Dinesh Patel Medicine, Nephrology