Acute
peritoneal dialysis (PD) is the preferred
therapy for renal replacement in children with post-diarrheal
hemolytic uremic syndrome (D+ HUS), but
peritonitis remains a frequent complication of this procedure. We reviewed data from 149 patients with D+ HUS who had undergone acute PD with the aim of determining the prevalence and risk factors for the development of
peritonitis. A total of 36 patients (24.2%) presented
peritonitis. The median onset of
peritonitis manifestations was 6 (range 2-18) days after the initiation of dialysis treatment, and Gram-positive microorganisms were the predominant bacterial type isolated (15/36 patients). The patients were divided into two groups: with or without
peritonitis, respectively. Univariate analysis revealed that a longer duration of the oligoanuric period, more days of dialysis,
catheter replacement, stay in the intensive care unit, and
hypoalbuminemia were significantly associated to the development of
peritonitis. The multivariate analysis, controlled by duration of PD, identified the following independent risk factors for
peritonitis:
catheter replacement [p = 0.037, odds ratio (OR) 1.33, 95% confidence interval (CI) 1.02-1.73], stay in intensive care unit (p = 0.0001, OR 2.62, 95% CI 1.65-4.19), and
hypoalbuminemia (p = 0.0076, OR 1.45, 95% CI 1.10-1.91). Based on these findings, we conclude that the optimization of the aseptic technique during
catheter manipulation and early
nutritional support are targets for the prevention of
peritonitis, especially in
critically ill patients.