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Pleuro-peritoneal or pericardio-peritoneal leak in children on chronic peritoneal dialysis—A survey from the European Paediatric Dialysis Working Group

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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.

Conclusion

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.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK

    Stephanie Dufek, Elizabeth Wright & Rukshana Shroff

  2. Renal Unit, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    Tuula Holtta

  3. Renal Unit, Hospital de Hautepierre, Strasbourg, France

    Michel Fischbach

  4. Renal Unit, Hospital Cruces, Barakaldo, Vizcaya, Spain

    Gema Ariceta

  5. Renal Unit, Vilnius University, Vilnius, Lithuania

    Augustina Jankauskiene & Rimante Cerkauskiene

  6. Renal Unit, Center for Pediatric & Adolescent Medicine, Heidelberg, Germany

    Claus Peter Schmitt & Betti Schaefer

  7. Renal Unit, University Hospital of Vienna, Vienna, Austria

    Christoph Aufricht

  8. Renal Unit, “A & P Kyriakou” Children’s Hospital, Athens, Greece

    Constantinos J. Stefanidis

  9. Renal Unit, Ankara University Hospital, Ankara, Turkey

    Mesiha Ekim

  10. Renal Unit, Gazi University Hospital, Ankara, Turkey

    Sevcan Bakkaloglu

  11. Renal Unit, KfH Pediatric Kidney Center, Marburg, Germany

    Günter Klaus

  12. Renal Unit, Gdansk University Medical School, Gdansk, Poland

    Aleksandra Zurowska

  13. Renal Unit, University Hospital Motol, Prague, Czech Republic

    Karel Vondrak

  14. Renal Unit, UZ Gent, Gent, Belgium

    Johan Vande Walle

  15. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Alberto Edefonti

Authors
  1. Stephanie Dufek
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  2. Tuula Holtta
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  3. Michel Fischbach
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  7. Claus Peter Schmitt
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  9. Christoph Aufricht
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  10. Elizabeth Wright
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  11. Constantinos J. Stefanidis
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  12. Mesiha Ekim
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  13. Sevcan Bakkaloglu
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  14. Günter Klaus
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  15. Aleksandra Zurowska
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  16. Karel Vondrak
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  17. Johan Vande Walle
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  18. Alberto Edefonti
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  19. Rukshana Shroff
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on behalf of the European Paediatric Dialysis Working Group

Corresponding author

Correspondence to Rukshana Shroff.

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Dufek, S., Holtta, T., Fischbach, M. et al. Pleuro-peritoneal or pericardio-peritoneal leak in children on chronic peritoneal dialysis—A survey from the European Paediatric Dialysis Working Group. Pediatr Nephrol 30, 2021–2027 (2015). https://doi.org/10.1007/s00467-015-3137-z

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  • DOI: https://doi.org/10.1007/s00467-015-3137-z

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