Kidney Week

Abstract: FR-PO714

Advantages of Acute Peritoneal Dialysis in Children: Lessons from a Large Escherichia coli O157:H7 Outbreak in Calgary

Session Information

• Pediatric Nephrology - 1
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1900 Pediatric Nephrology

Authors

• Al Dhawi, Naji, Alberta Children's Hospital, Calgary, Alberta, Canada

Naji Al Dhawi, MD

• Samuel, Susan M., Alberta Children's Hospital, Calgary, Alberta, Canada

Susan M. Samuel, MD, MSc

• Hamiwka, Lorraine A., Alberta Children's Hospital, Calgary, Alberta, Canada

Lorraine A. Hamiwka, MD

• Wade, Andrew W., Alberta Children's Hospital, Calgary, Alberta, Canada

Andrew W. Wade, MD, PhD

• Archibald, Alyssa Jill, Alberta Children's Hospital, Calgary, Alberta, Canada

Alyssa Jill Archibald, MD

• Grisaru, Silviu, Alberta Children's Hospital, Calgary, Alberta, Canada

Silviu Grisaru, MD

Introduction

Technical innovations in extracorporeal kidney replacement equipment have significantly expanded the availability of these modalities for children and small infants with oligo-anuric acute kidney injury (AKI), rapidly replacing the traditional preference for acute peritoneal dialysis (APD) in this age group. In September 2023, an unprecedented outbreak of O157:H7 Shiga toxin-producing E. coli (STEC), predominantly affecting daycare children aged 2 to 4 years, occurred in Calgary, AB, Canada. Infections were acquired from contaminated food item provided by a central kitchen to multiple daycares. This report aims to highlight the advantages of APD during this outbreak.

Case Description

356 children tested positive for Shiga toxin 1 and 2, having been infected with an E. coli O157:H7 pathogen. Approximately 250 exhibited symptoms of gastroenteritis, and 27 children developed hemolytic uremic syndrome (STEC-HUS), characterized by anemia, thrombocytopenia, and acute kidney injury. A consistent management approach to oligo-anuria associated with (STEC-HUS) was applied. Transfusions of packed red cells were performed as necessary; however, platelet transfusions were avoided, and antibiotics were reserved for prophylactic prevention of peritonitis and management of other confirmed infections. Within 4 days (September 4 – 8), seven swan neck PD catheters were inserted by two pediatric urologists in children who developed oligo-anuria secondary to STEC-HUS. Continuous PD was performed in 8 children on pediatric wards for an average of 10.3 ± 2.4 days. Two children experienced serious extrarenal complications, but there were no fatalities, and all affected children recovered normal estimated glomerular filtration rates by three months post-infection.

Discussion

In children, APD remains an effective form of acute kidney replacement therapy (KRT), that is accessible outside intensive care units. Since this is an important advantage in an outbreak scenario, pediatric centers should maintain skills and capacity necessary to initiate APD in large numbers of children. In addition, outcomes of childhood oligo-anuric STEC-HUS may be influenced by the choice of acute KRT modality, a hypothesis that needs to be explored in prospective clinical trials.