Abstract
Background
Early institution of enteral feeding in paediatric end-stage kidney disease (ESKD) is recommended. For patients on peritoneal dialysis (PD) there is concern that gastrostomy tube (GT) insertion may be complicated by increased peritonitis, in particular fungal. Our unit favours early planned GT insertion, and for those with late presentation, there is prompt consideration of GT insertion following dialysis initiation. This study evaluates our rates of peritonitis with GT insertion following or concurrent with PD initiation.
Methods
This was a retrospective, single-centre, cross-sectional study of of 17 New Zealand children with ESKD who received PD in the period 2000–2011. Inclusion criteria were GT placement while on PD or initiation of PD within 72 h of GT insertion.
Results
There were no cases of fungal peritonitis among the 17 children; however, two cases of early peritonitis with organisms derived from the gastrointestinal tract were identified. No statistically significant difference was found between incident rates of bacterial peritonitis before GT placement (0.6 episodes per patient-year; 95 % confidence interval (CI) 0.26–1.18) and post-GT placement (1.21 episodes per patient-year; 95 % CI 0.69–1.97).
Conclusion
Fungal peritonitis has never been encountered by out unit during its many years of experience in GT placement in patients without advanced malnutrition. When children on PD have insufficient dietary intake to maintain appropriate growth velocity, enteral feeding should be initiated promptly. A GT is considered to be safe for long-term use in selected patients.
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Acknowledgements
We would like to thank Stella Friedlander, Paediatric Renal Dietician and the Paediatric Surgical Department at Starship Children’s Hospital who provide continued excellence of care for these patients. Peter Reed, Statistician Children’s Research Centre, is also thanked for his statistical expertise and guidance.
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No funding source was required for this study.
The authors have no financial or ethical conflicts of interest related to this manuscript.
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Prestidge, C., Ronaldson, J., Wong, W. et al. Infectious outcomes following gastrostomy in children receiving peritoneal dialysis. Pediatr Nephrol 30, 849–854 (2015). https://doi.org/10.1007/s00467-014-2951-z
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DOI: https://doi.org/10.1007/s00467-014-2951-z