title: Chronic peritoneal dialysis catheters in children: a fifteen-year experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis.
abstract: OBJECTIVE
  To analyze data on 503 chronic peritoneal dialysis (CPD) catheters implanted between 1986 and 2000 in pediatric patients enrolled in the Italian Registry of Pediatric Chronic Peritoneal Dialysis (the Registry), comparing three different time periods: 1986-1990, 1991-1995, and 1996-2000.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  23 dialysis centers participating in the Registry.
  
  
  METHODS
  Data were collected from questionnaires filled in every year. The information for each peritoneal catheter included type, site and technique of insertion, exit-site orientation, exit-site care, complications, survival, and reason for removal.
  
  
  METHODS
  503 catheters were implanted in 363 pediatric patients aged younger than 15 years at the start of CPD: 97 catheters in patients under 2 years of age, 67 in patients aged 2-5 years, and 339 in patients over 5 years of age. Mean patient age at onset of CPD was 8.0 +/- 5.1 years. All catheters were surgically implanted and omentectomy was performed in 82.4% of cases. The catheters used were Tenckhoff [468 (93.0%): 443 double cuff, 25 single cuff] and double-cuffed Valli [35 (7.0%)]. The entry site was in the midline in 153 cases (30.4%) and paramedian in 350 (69.6%).
  
  
  RESULTS
  During 9048 dialysis-months we observed 451 catheter-related complications, yielding an incidence of 1 episode/20.1 CPD-months: 330 catheter infections (exit-site and/or tunnel infections), 26 leakages, 26 dislocations, 24 obstructions, 22 cuff extrusions, 6 hemoperitoneums, 17 others. 171 catheters were removed due to catheter-related causes; exit-site and/or tunnel infections were the main cause for removal (75.4%), followed by obstruction, dislocation, outer-cuff extrusion, and leakage. Younger children (< 2 years) had a higher risk of infectious causes of catheter removal compared to children aged 2-5 years (p = 0.004) and over 5 years of age (p = 0.002). During the 15-year observation period, a significant reduction in the incidence of leakage was observed and risk of leakage was lower in catheters with paramedian entry site compared to catheters with midline entry site. Removal and replacement of peritoneal catheters during the same surgical operation was performed in 76.3% of catheter removals. Catheter survival rate was 78.1% at 12 months, 58.5% at 24 months, 43.8% at 36 months, and 34.6% at 48 months. No difference in catheter survival was observed in younger children (< 2 years) compared with the two other age groups: < 2 years versus 2-5 years hazard ratio 0.7, 95% confidence interval (95%CI) 0.4-1.2; < 2 years versus > 5 years hazard ratio 0.8, 95%CI 0.5-1.1.
  
  
  CONCLUSIONS
  In this survey, we observed better catheter survival in comparison with data reported by the Registry in 1998. Catheter survival improved especially in younger children (< 2 years), a group that previously had a decreased catheter survival rate compared to older age groups. In addition to the progressive increase in experience acquired by dialysis centers, this upward trend may also be related to greater use of double-cuffed catheters, with paramedian exit site, and a higher frequency of omentectomy.
authors.affiliation: Department of Nephrology and Urology, Bambino Gesù Children's Research Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy. rinaldi@opbg.net
authors.forename: Stefano
authors.initials: S
authors.lastname: Rinaldi
authors.forename: Francesco
authors.initials: F
authors.lastname: Sera
authors.forename: Enrico
authors.initials: E
authors.lastname: Verrina
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
authors.forename: Bruno
authors.initials: B
authors.lastname: Gianoglio
authors.forename: Francesco
authors.initials: F
authors.lastname: Perfumo
authors.forename: Palma
authors.initials: P
authors.lastname: Sorino
authors.forename: Graziella
authors.initials: G
authors.lastname: Zacchello
authors.forename: Ignazio
authors.initials: I
authors.lastname: Cutaia
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Lavoratti
authors.forename: Giovanna
authors.initials: G
authors.lastname: Leozappa
authors.forename: Carmine
authors.initials: C
authors.lastname: Pecoraro
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Rizzoni
mesh_terms: D000293:Adolescent; D002404:Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007558:Italy; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors