title: Peritoneal Dialysis Access Revision in Children: Causes, Interventions, and Outcomes.
abstract: Little published information is available about access failure in children undergoing chronic peritoneal dialysis. Our objectives were to evaluate frequency, risk factors, interventions, and outcome of peritoneal dialysis access revision.
  
  
  
  Data were derived from 824 incident and 1629 prevalent patients from 105 pediatric nephrology centers enrolled in the International Pediatric Peritoneal Dialysis Network Registry between 2007 and 2015.
  
  
  
  In total, 452 access revisions were recorded in 321 (13%) of 2453 patients over 3134 patient-years of follow-up, resulting in an overall access revision rate of 0.14 per treatment year. Among 824 incident patients, 186 (22.6%) underwent 188 access revisions over 1066 patient-years, yielding an access revision rate of 0.17 per treatment year; 83% of access revisions in incident patients were reported within the first year of peritoneal dialysis treatment. Catheter survival rates in incident patients were 84%, 80%, 77%, and 73% at 12, 24, 36, and 48 months, respectively. By multivariate logistic regression analysis, risk of access revision was associated with younger age (odds ratio, 0.93; 95% confidence interval, 0.92 to 0.95; P<0.001), diagnosis of congenital anomalies of the kidney and urinary tract (odds ratio, 1.28; 95% confidence interval, 1.03 to 1.59; P=0.02), coexisting ostomies (odds ratio, 1.42; 95% confidence interval, 1.07 to 1.87; P=0.01), presence of swan neck tunnel with curled intraperitoneal portion (odds ratio, 1.30; 95% confidence interval, 1.04 to 1.63; P=0.02), and high gross national income (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.19; P=0.01). Main reasons for access revisions included mechanical malfunction (60%), peritonitis (16%), exit site infection (12%), and leakage (6%). Need for access revision increased the risk of peritoneal dialysis technique failure or death (hazard ratio, 1.35; 95% confidence interval, 1.10 to 1.65; P=0.003). Access dysfunction due to mechanical causes doubled the risk of technique failure compared with infectious causes (hazard ratio, 1.95; 95% confidence interval, 1.20 to 2.30; P=0.03).
  
  
  
  Peritoneal dialysis catheter revisions are common in pediatric patients on peritoneal dialysis and complicate provision of chronic peritoneal dialysis. Attention to potentially modifiable risk factors by pediatric nephrologists and pediatric surgeons should be encouraged.
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material .
authors.forename: Dagmara
authors.initials: D
authors.lastname: Borzych-Duzalka
authors.forename: T Fazil
authors.initials: TF
authors.lastname: Aki
authors.forename: Marta
authors.initials: M
authors.lastname: Azocar
authors.forename: Colin
authors.initials: C
authors.lastname: White
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Harvey
authors.forename: Sevgi
authors.initials: S
authors.lastname: Mir
authors.forename: Marta
authors.initials: M
authors.lastname: Adragna
authors.forename: Erkin
authors.initials: E
authors.lastname: Serdaroglu
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sinha
authors.forename: Charlotte
authors.initials: C
authors.lastname: Samaille
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Vanegas
authors.forename: Jameela
authors.initials: J
authors.lastname: Kari
authors.forename: Lorena
authors.initials: L
authors.lastname: Barbosa
authors.forename: Arvind
authors.initials: A
authors.lastname: Bagga
authors.forename: Monica
authors.initials: M
authors.lastname: Galanti
authors.forename: Onder
authors.initials: O
authors.lastname: Yavascan
authors.forename: Giovanna
authors.initials: G
authors.lastname: Leozappa
authors.forename: Maria
authors.initials: M
authors.lastname: Szczepanska
authors.forename: Karel
authors.initials: K
authors.lastname: Vondrak
authors.forename: Kei-Chiu
authors.initials: KC
authors.lastname: Tse
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
mesh_terms: D000367:Age Factors; D002404:Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007239:Infections / Q000150:complications; D007668:Kidney / Q000002:abnormalities; D008297:Male; D010030:Ostomy / Q000706:statistics & numerical data; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data*; D010538:Peritonitis / Q000150:complications; D012086:Reoperation / Q000706:statistics & numerical data*
keywords: Attention; Child; Follow-Up Studies; Humans; Ostomy; Peritoneum; Peritonitis; Registries; Surgeons; Survival Rate; catheter; children; dialysis access; nephrology; peritoneal dialysis; risk factors; vesico-ureteral reflux