title: Pleuro-peritoneal or pericardio-peritoneal leak in children on chronic peritoneal dialysis-A survey from the European Paediatric Dialysis Working Group.
abstract: BACKGROUND
  Pleural or pericardial effusions secondary to pleuro-peritoneal fistula (PPF) and pericardio-peritoneal fistula (PcPF) are rare but serious complications of peritoneal dialysis (PD).
  
  
  METHODS
  We conducted a 10-year survey across all participating centres in the European Paediatric Dialysis Working Group to review the incidence, diagnostic techniques, therapeutic options and outcome of children on chronic PD with PPF and/or PcPF.
  
  
  RESULTS
  Of 1506 children on PD there were ten cases (8 of PPF, 1 each of PcPF and PPF + PcPF), with a prevalence of 0.66%. The median age at presentation was 1.5 [inter-quartile range (IQR) 0.4-2.4] years, and nine children were <3 years. The time on PD before onset of symptoms was 4.3 (IQR 1.3-19.8) months. Eight children had herniae and seven had abdominal surgery in the preceding 4 weeks. Symptoms at presentation were respiratory distress, reduced ultrafiltration and tachycardia. PD was stopped in all children; three were managed conservatively and thoracocentesis was performed in seven (with pleurodesis in 3). PD was restarted in only three children, in two of them with success.
  
  
  CONCLUSIONS
  In conclusion, PPF and PcPF are rare in children on chronic PD, but are associated with significant morbidity, requiring a change of dialysis modality in all cases. Risk factors for PPF development include age of <3 years, herniae and recent abdominal surgery.
authors.affiliation: Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. Stephanie.dufek@gosh.nhs.uk.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dufek
authors.affiliation: Renal Unit, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. tuula.hollta@hus.fi.
authors.forename: Tuula
authors.initials: T
authors.lastname: Holtta
authors.affiliation: Renal Unit, Hospital de Hautepierre, Strasbourg, France. michel.fischbach@chru-strasbourg.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Fischbach
authors.affiliation: Renal Unit, Hospital Cruces, Barakaldo, Vizcaya, Spain. gariceta@vhebron.net.
authors.forename: Gema
authors.initials: G
authors.lastname: Ariceta
authors.affiliation: Renal Unit, Vilnius University, Vilnius, Lithuania. augustina.jankauskiene@mf.vu.lt.
authors.forename: Augustina
authors.initials: A
authors.lastname: Jankauskiene
authors.affiliation: Renal Unit, Vilnius University, Vilnius, Lithuania. rimante.cerkauskiene@mf.vu.lt.
authors.forename: Rimante
authors.initials: R
authors.lastname: Cerkauskiene
authors.affiliation: Renal Unit, Center for Pediatric & Adolescent Medicine, Heidelberg, Germany. claus.peter.schmitt@med.uni-heidelberg.de.
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Schmitt
authors.affiliation: Renal Unit, Center for Pediatric & Adolescent Medicine, Heidelberg, Germany. betti.schaefer@med.uni-heidelberg.de.
authors.forename: Betti
authors.initials: B
authors.lastname: Schaefer
authors.affiliation: Renal Unit, University Hospital of Vienna, Vienna, Austria. christoph.aufricht@meduniwien.ac.at.
authors.forename: Christoph
authors.initials: C
authors.lastname: Aufricht
authors.affiliation: Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. liz.wright@gosh.nhs.uk.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wright
authors.affiliation: Renal Unit, "A & P Kyriakou" Children's Hospital, Athens, Greece. cjstefanidis@gmail.com.
authors.forename: Constantinos J
authors.initials: CJ
authors.lastname: Stefanidis
authors.affiliation: Renal Unit, Ankara University Hospital, Ankara, Turkey. ekim@medicine.ankara.edu.tr.
authors.forename: Mesiha
authors.initials: M
authors.lastname: Ekim
authors.affiliation: Renal Unit, Gazi University Hospital, Ankara, Turkey. sevcan@gazi.edu.tr.
authors.forename: Sevcan
authors.initials: S
authors.lastname: Bakkaloglu
authors.affiliation: Renal Unit, KfH Pediatric Kidney Center, Marburg, Germany. klaus@mailer.uni-marburg.de.
authors.forename: Günter
authors.initials: G
authors.lastname: Klaus
authors.affiliation: Renal Unit, Gdansk University Medical School, Gdansk, Poland. azur@amg.gda.pl.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zurowska
authors.affiliation: Renal Unit, University Hospital Motol, Prague, Czech Republic. karel.vondrak@lfmotol.cuni.cz.
authors.forename: Karel
authors.initials: K
authors.lastname: Vondrak
authors.affiliation: Renal Unit, UZ Gent, Gent, Belgium. johan.vandewalle@uzgent.be.
authors.forename: Johan
authors.initials: J
authors.lastname: Vande Walle
authors.affiliation: Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. aedefonti@hotmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
authors.affiliation: Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. Rukshana.Shroff@gosh.nhs.uk.
authors.forename: Rukshana
authors.initials: R
authors.lastname: Shroff
mesh_terms: D001202:Ascitic Fluid / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D005402:Fistula / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D010490:Pericardial Effusion / Q000453:epidemiology / Q000209:etiology*; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010996:Pleural Effusion / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D011795:Surveys and Questionnaires
keywords: Children; Pericardial effusion; Pericardio-peritoneal fistula; Peritoneal dialysis; Pleural effusion; Pleuro-peritoneal fistula