1. Long Term Peritoneal Dialysis In Children – Frequent Complications Conclusions: Peritoneal Dialysis is the method of choice for pediatric patients, with excellent performance in the medium term (2-3 years). It can be used in the longer term, but the evolution of the patient is burdened by the large number of complications like malnutrition or metabolic bone disorder. Peritoneal Dialysis should be used as an intermediate step therapy for children with End Stage Renal Disease (ESRD) that must be the preceding step for the kidney transplantation program. This is the only logical solution to these children. Based on our data, we can conclude that a careful selection of patients included in chronic PD as well as an extensive patient/family training program can lead to lowering the rate of infectious complications related to this renal replacement method. This is a very important goal that allows us to use this method as long as possible in view of a future kidney transplantation, which nowadays is a major challenge in Romania due to the lack of donors. Conclusions: Peritoneal Dialysis is the method of choice for pediatric patients, with excellent performance in the medium term (2-3 years). It can be used in the longer term, but the evolution of the patient is burdened by the large number of complications like malnutrition or metabolic bone disorder. Peritoneal Dialysis should be used as an intermediate step therapy for children with End Stage Renal Disease (ESRD) that must be the preceding step for the kidney transplantation program. This is the only logical solution to these children. Based on our data, we can conclude that a careful selection of patients included in chronic PD as well as an extensive patient/family training program can lead to lowering the rate of infectious complications related to this renal replacement method. This is a very important goal that allows us to use this method as long as possible in view of a future kidney transplantation, which nowadays is a major challenge in Romania due to the lack of donors. AUTHORS Dr. Cristina Stoica * Dr. Adrian Lungu * Dr. Ovidiu Limoncu * AUTHORS Dr. Cristina Stoica * Dr. Adrian Lungu * Dr. Ovidiu Limoncu * INTRODUCTION Peritoneal Dialysis (PD) as extra renal purification method is most commonly used in children with End Stage Renal Disease (ESRD). Its efficiency depends on the quality of the peritoneum, the studies proving that it works properly about 3-5 years. In spite of its advantage compared to hemodialysis (HD), PD presents a number of complications, of which the infectious episodes are the most important and frequent These infectious complications include peritoneal catheter exit-site and tunnel infections and peritonitis. Peritonitis remains the major cause of patient morbidity and mortality with a rate that is inversely related to patient age [1]. INTRODUCTION Peritoneal Dialysis (PD) as extra renal purification method is most commonly used in children with End Stage Renal Disease (ESRD). Its efficiency depends on the quality of the peritoneum, the studies proving that it works properly about 3-5 years. In spite of its advantage compared to hemodialysis (HD), PD presents a number of complications, of which the infectious episodes are the most important and frequent These infectious complications include peritoneal catheter exit-site and tunnel infections and peritonitis. Peritonitis remains the major cause of patient morbidity and mortality with a rate that is inversely related to patient age [1]. References 1. Warady BA, Alexander SR, Watkins S, Kohaut E, Harmon WE. Optimal care of the pediatric end-stage renal disease patient on dialysis. AmJ Kidney Dis 1999, 33:567-583. 2. Levy J, Morgan J, Brown E. Oxford Handbook of Dialysis. Oxford University Press 2001, 330-348. 3. The CARI Guidelines – Caring for Australians with Renal Impairment Evidence for Peritonitis Treatment and Prophylaxis (August 2003), available at http://www.kidney.org.au/CARI, accessed on 12 March 2005 4. Nissenson AR, Fine RN. Dialysis Therapy 3rd Edition, Hanley&Belfus Inc. 2002, 239-250. 5. Twardowski ZJ. PD catheter exit site infections: prevention, diagnosis, treatment and future directions. SeminDial 5:305-315, 1992. 6. Twardowski ZJ (ed): Peritoneal catheter exit-site morphology and pathology: prevention, diagnosis and treatment of exit site infections. PeritDialInt 16 (suppl 3): 1-117,1996. 7. Shetty H, Gokal R. Treatment of infections in peritoneal dialysis. In: Peritoneal Dialysis Today, Contributions to Nephrology 140: 187-193, 2003. 8. Perez-Fontan M, Garcia-Falcon T, Roasles M, et al. Treatment of Staphilococcus aureus nasal carriers in CAPD with Mupirocin: long-term results, AmJKidney D 22: 708-712, 1993. 9. Warady BA, Schaefer F, Holloway M et al. 2000. Consensus guidelines for the treatment of peritonitis in pediatric patients receiving peritoneal dialysis. Perit Dial Int 20: 610-24. 10. Schaefer F, Klaus G, Muller-Wiefel DE et al. 1999. Intermittent versus continuous intraperitoneal glycopeptide/ceftazidime treatment in children with peritoneal dialysis- associated peritonitis. The Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS). J Am Soc Nephrol 10: 136-45 11. Keane WF, Bailie GR, et al. PD peritonitis treatment recommendations: 2000 update. PeritDialInt 20: 2000; 396-411. 12. Lui SL, Lo CY, Choi BY, et al. Optimal treatment and long-term outcome of tuberculous peritonitis complicating CAPD. AmJKidneyD 28: 747-751, 1996. References 1. Warady BA, Alexander SR, Watkins S, Kohaut E, Harmon WE. Optimal care of the pediatric end-stage renal disease patient on dialysis. AmJ Kidney Dis 1999, 33:567-583. 2. Levy J, Morgan J, Brown E. Oxford Handbook of Dialysis. Oxford University Press 2001, 330-348. 3. The CARI Guidelines – Caring for Australians with Renal Impairment Evidence for Peritonitis Treatment and Prophylaxis (August 2003), available at http://www.kidney.org.au/CARI, accessed on 12 March 2005 4. Nissenson AR, Fine RN. Dialysis Therapy 3rd Edition, Hanley&Belfus Inc. 2002, 239-250. 5. Twardowski ZJ. PD catheter exit site infections: prevention, diagnosis, treatment and future directions. SeminDial 5:305-315, 1992. 6. Twardowski ZJ (ed): Peritoneal catheter exit-site morphology and pathology: prevention, diagnosis and treatment of exit site infections. PeritDialInt 16 (suppl 3): 1-117,1996. 7. Shetty H, Gokal R. Treatment of infections in peritoneal dialysis. In: Peritoneal Dialysis Today, Contributions to Nephrology 140: 187-193, 2003. 8. Perez-Fontan M, Garcia-Falcon T, Roasles M, et al. Treatment of Staphilococcus aureus nasal carriers in CAPD with Mupirocin: long-term results, AmJKidney D 22: 708-712, 1993. 9. Warady BA, Schaefer F, Holloway M et al. 2000. Consensus guidelines for the treatment of peritonitis in pediatric patients receiving peritoneal dialysis. Perit Dial Int 20: 610-24. 10. Schaefer F, Klaus G, Muller-Wiefel DE et al. 1999. Intermittent versus continuous intraperitoneal glycopeptide/ceftazidime treatment in children with peritoneal dialysis- associated peritonitis. The Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS). J Am Soc Nephrol 10: 136-45 11. Keane WF, Bailie GR, et al. PD peritonitis treatment recommendations: 2000 update. PeritDialInt 20: 2000; 396-411. 12. Lui SL, Lo CY, Choi BY, et al. Optimal treatment and long-term outcome of tuberculous peritonitis complicating CAPD. AmJKidneyD 28: 747-751, 1996. Dr. Madalina Tomozei * Dr. Alexandra Niculae * Dr. Mariana Vasilescu * Dr. Madalina Tomozei * Dr. Alexandra Niculae * Dr. Mariana Vasilescu * * Fundeni Clinical Institute, Bucharest, Romania – Pediatric Dialysis and Nephrology Department Objective: Analysis of complications caused by the method of dialysis and End Stage Renal Disease in patients on peritoneal dialysis (PD). Methods: A retrospective study including patients who underwent PD more than three years in the Fundeni Clinical Institute - Pediatric Nephrology Department, Bucharest, Romania (2009-2013). 20 of the 72 children in the Pediatric Nephrology Department were treated with PD longer than 3 years. Results: We divided the complications into two categories: End Stage Renal Disease related and Peritoneal Dialysis related. End Stage Renal Disease related complications: Renal anemia – 100%, Hypertension – 65%, Growth failure – 55%, Secondary Hyperparathyroidism – 55%, Osteodystrophia – 65%. Peritoneal Dialysis related complications: Peritonitis – 55%, Exit site infections – 30%, Hyperglycemia – 40%, Hernias – 20%, Mechanical complications: 20%. Objective: Analysis of complications caused by the method of dialysis and End Stage Renal Disease in patients on peritoneal dialysis (PD). Methods: A retrospective study including patients who underwent PD more than three years in the Fundeni Clinical Institute - Pediatric Nephrology Department, Bucharest, Romania (2009-2013). 20 of the 72 children in the Pediatric Nephrology Department were treated with PD longer than 3 years. Results: We divided the complications into two categories: End Stage Renal Disease related and Peritoneal Dialysis related. End Stage Renal Disease related complications: Renal anemia – 100%, Hypertension – 65%, Growth failure – 55%, Secondary Hyperparathyroidism – 55%, Osteodystrophia – 65%. Peritoneal Dialysis related complications: Peritonitis – 55%, Exit site infections – 30%, Hyperglycemia – 40%, Hernias – 20%, Mechanical complications: 20%. Type of Peritoneal Dialisys APD16 CAPD56 Sex of the patients Male39 Female33 The number of patients who required chronic PD (grouped on age intervals) 0-1 yrs1-3 yrs3-6 yrs6-12 yrs>12 yrs ♀0351213 ♂14614 Total17112627 Contact: Dr. Adrian Lungu +40722131950, adilungu@mediakompass.ro