WIP 54 - Outcomes after PD Catheter Placement in Neonates with End Stage Kidney Disease

Publication Number: WIP 54.7601

Maanasa Yarlagadda, Cincinnati Children's Hospital Medical Center, Blue Ash, OH, United States; Shannon Reinert, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Alexander Bondoc, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Donna J.. Claes, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Meredith P. Schuh, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Neonates with end stage kidney disease (ESKD) require kidney replacement therapy (KRT) shortly after birth and thus require dialysis access placement—most commonly peritoneal dialysis catheters (PD-C)—soon after birth. The most common complications of PD in pediatric patients are catheter malfunction and peritonitis, both of which are associated with the risk of PD failure. Patients less than one year of age are twice as likely to undergo PD-C revision than older children, but limited data exists regarding the risk of PD catheter complications specifically in neonates with ESKD. The presence of a gastrostomy tube (GT) increases the risk of peritonitis in pediatric patients. While it is recommended for GT to be placed before or concurrently with PD-C to decrease risk of peritonitis, this is not feasible in this population due to need for KRT shortly after birth. It is unclear if there are ways to mitigate risk of peritonitis and PD failure in the neonatal ESKD population to reduce the risk of PD failure.

Objective: We aim to describe our center’s PD-C related practices and outcomes in neonates who require KRT within the first 30 days of life, and to better identify risk factors for complications related to PD-C malfunction and peritonitis. This information will be used to create standardized care algorithms specific for this highly complex population with the goal of improving outcomes.

Design/Methods: This IRB approved single center retrospective chart review will include 28 neonates with ESKD born between Jan 1st, 2018, and Dec 31st, 2023, who initiated PD within the first 30 days of life. Data collection will include demographics; PD-C characteristics (straight vs. coiled), surgery-related data (omentectomy, peri-op antibiotic use), and timing of PD initiation; GT-placement related data (timing in relation to PD-C; pt age & weight); number and timing of PD-C revisions, peritonitis events, and dialysis modality at time of initial hospital discharge. Data will be analyzed by both patient and catheter in order to track infections with each catheter.