308

(PTH), raising the possibility that hypermagnesemia may contribute to adynamic bone disease
[75], the 0.50 mmol/L (1.2 mg/dL) concentration
dialysate may generally be preferable.
Hypomagnesemia may develop in patients utilizing 0.25  mmol/L (0.6  mg/dL) magnesium concentration [74].

Other Complications
Hemoperitoneum
The presence of blood in PD effluent is called
hemoperitoneum. This is a benign complication
of chronic PD.  Only a very small amount of
bleeding is required to make dialysate appear
bloody. As little as 1 mL of whole blood injected
into 2  L of an effluent bag can make the fluid
readily blood tinged, and injection of 7  mL of
blood can make the entire volume as red as fruit
juice.

Pathogenesis
Hemoperitoneum has a wide differential diagnosis. Blood tinging of dialysate is commonly seen
after PD catheter placement, as a result of direct
vascular and visceral damage. It rapidly clears
with a few in-and-out exchanges. The most common and benign cause of hemoperitoneum in
adolescent girls is menstruation. Two theories are
proposed to explain its mechanism. First, endometrial tissue, if present in the peritoneum, will
shed simultaneously with uterine endometrium.
Secondly, shed endometrial tissue and blood
moves out of the cervix through the fallopian
tubes in a retrograde fashion. Peritoneal bleeding
starts a few days before vaginal menstrual flow.

Other causes of hemoperitoneum in adolescent
girls are ovulation (with a typical mid-cycle timing of occurrence) and ruptured ovarian cysts.
Trauma (including strenuous exercising), procedures to the abdominal area, bleeding disorders, or anticoagulation therapy can also
predispose to hemoperitoneum. Bleeding into a
hepatic or renal cyst with rupture into the peritoneal cavity, acute and chronic pancreatitis, sclerosing peritonitis, and peritoneal calcification in

S. A. Bakkaloğlu and C. B. Sethna

patients with severe CKD-associated mineral-­
bone disorder are further, less frequent causes of
hemoperitoneum [2].

Diagnosis
The extent of bleeding and associated symptoms
are of primary importance in determining further
evaluation. If bleeding is very mild, self-limited,
and not associated with other symptoms, the
patient may not require further evaluation. This is
especially likely if the patient is menstruating. If
the bleeding is severe, recurrent, and/or associated with pain and fever, urgent evaluation is
required to exclude underlying intra-abdominal
pathology, such as cyst rupture or a vascular
catastrophe. Findings on physical examination
such as a rebound or guarding do not occur with
benign intraperitoneal bleeding and should be
treated as a surgical emergency. In this setting,
peritoneal fluid cell count, culture and sensitivity,
and peritoneal amylase level (>50 μU/L suggests
an intra-abdominal process) should be obtained.
Peritoneal dialysate hematocrit >2% suggests an

intraperitoneal pathology. All of the possible disorders in this setting are cause for great concern,
and merit surgical consultation and consideration
of early laparoscopy or laparotomy [2].
Abdominal imaging by CT, ultrasound, or
MRI may also be indicated. A CT scan of the
abdomen and pelvis should be performed if ultrasound is negative or inconclusive. In patients
with persistent bleeding, isotope-labeled RBC
scan can be done to localize the site of bleeding,
which can then be selectively embolized. Contrast
agents should be avoided in patients with preserved residual function. Angiography is the last
option that may be required for more definitive
diagnosis [2].
Management
Treatment of the underlying cause is essential,
and curative management may require emergent
evaluation and care. Menstruating adolescent
girls should be reassured that asymptomatic
hemoperitoneum is benign and that it will likely
resolve spontaneously. Rapid flushes and instillation of heparin in the dialysate to prevent catheter
clotting are usually done. Infusing cool dialysate


17  Noninfectious Complications of Peritoneal Dialysis in Children

(i.e., room temperature) may also be helpful.
Most commonly, the hemoperitoneum will clear
after one to three rapid flushes. In severe conditions, extensive diagnostic studies and required
surgical interventions should be done as indicated [2, 76].

Acute Pancreatitis

Acute pancreatitis (AP) is characterized by
inflammation of the pancreas, which presents
with acute onset of epigastric abdominal pain
accompanied by epigastric tenderness on physical exam. The incidence rate of AP in children on
PD was reported to be 6.2 per 1000 person-years
in the Italian Registry of Pediatric Chronic
Dialysis [77]. The risk of AP is higher in hemodialysis patients compared to PD, and patients on
dialysis appear to be at a higher risk for AP than
the general population.

Pathogenesis
Patients with ESKD may be at increased risk for
AP due to the decreased catabolism of gastric
hormones that may lead to hypersecretion of the
pancreatic enzyme trypsin. Trypsin hypersecretion is thought to induce morphologic changes in
the pancreas that could make the pancreas more
susceptible to inflammation. In addition, it has
been hypothesized  – but not proven  – that PD
may directly contribute to the risk for
AP.  Dialysate fluid containing glucose and calcium may theoretically irritate the pancreas.
Hyperglycemia, hypercalcemia, as well as hypertriglyceridemia are known causes of AP in the
general population. Furthermore, it has been suggested that repeated episodes of peritonitis may
release enzymes that irritate and cause inflammation of the pancreas.
Diagnosis
The diagnosis of AP may be difficult to distinguish from peritonitis in children on PD. Patients
with AP present with an acute onset of severe epigastric abdominal pain. Pain will often radiate to
the back, which may be relieved by sitting forward. AP is usually accompanied by nausea and

309


vomiting. On physical examination, there is tenderness to palpation in the epigastric region or
there may be diffuse abdominal tenderness.
Abdominal distension and hypoactive bowel
signs may be present due to underlying ileus.
Patients with severe AP often present with fever,
dyspnea, tachypnea, and hypotension.
Diagnostic criteria for AP include two of the
following: (1) characteristic epigastric pain or
pain radiating to the back, (2) elevated serum
lipase or amylase to three times the upper limit of
normal, or (3) radiographic evidence of AP by
CT, MRI, or ultrasound. Reliance on serum pancreatic marker criteria may not be possible in
children on PD, since amylase and lipase are
often elevated above three times the upper limit
in asymptomatic patients. The elevation in pancreatic enzymes is due to decreased urinary
excretion and the minimal clearance of the
enzymes by PD [78]. In children treated with icodextrin, amylase may be reduced due to the competitive inhibition by icodextrin on the amylase
assay [79]. Therefore, radiologic studies may be
required to aid in the diagnosis of AP.  Focal or
diffuse enlargement of the pancreas is suggestive
of AP. Imaging may also be required later in the
clinical course to evaluate for necrotizing pancreatitis and other complications.

Management
Treatment of AP is mainly supportive with recommendations for bowel rest, intravenous fluids
or parenteral nutrition, and pain control.
Prophylactic antibiotics can be considered for
prevention/treatment of necrotizing pancreatitis.
Continuation of PD during AP is often possible.
Surgical treatment may be necessary in cases of

necrotizing pancreatitis or pseudocyst.
Prognosis
Most episodes of AP are mild and most patients
recover without complications or recurrence;
however, AP can be severe with complications.
Complications include pancreatic pseudocyst,
necrosis, systemic inflammatory response syndrome, and organ failure. Mortality reported
among adult dialysis patients varies from 8% to
58%. A culmination of 32 children on dialysis


310

from pediatric series reported in the literature
demonstrated the prevalence of mortality to be
22% [77].

References
1.McCormick BB, Bargman JM.  Noninfectious complications of peritoneal dialysis: implications for
patient and technique survival. J Am Soc Nephrol.
2007;18:3023–5.
2.Saha TC, Singh H.  Noninfectious complications of
peritoneal dialysis. South Med J. 2007;100:54–8.
3.Kim JE, Park SJ, Oh JY, Kim JH, Lee JS, Kim PK,
Shin JI.  Noninfectious complications of peritoneal
dialysis in Korean children: a 26-year single-center
study. Yonsei Med J. 2015;56:1359–64.
4.Bakkaloglu SA, Ekim M, Tumer N, Soylu K.  The
effect of CAPD on the lipid profile of pediatric
patients. Perit Dial Int. 2000;20:568–71.

5. Verrina E, Edefonti A, Gianoglio B, Rinaldi S, Sorino
P, Zacchello G, Lavoratti G, Maringhini S, Pecoraro
C, Calevo MG, Turrini Dertenois L, Perfumo F.  A
multicenter experience on patient and technique survival in children on chronic dialysis. Pediatr Nephrol.
2004;19:82–90.
6.Honda M. The 1997 report of the Japanese National
Registry data on pediatric peritoneal dialysis patients.
Perit Dial Int. 1999;19(Suppl 2):S473–8.
7. Vidal E, Edefonti A, Murer L, Gianoglio B, Maringhini
S, Pecoraro C, Sorino P, Leozappa G, Lavoratti G,
Ratsch IM, Chimenz R, Verrina E, Italian Registry
of Paediatric Chronic Dialysis. Peritoneal dialysis
in infants: the experience of the Italian Registry of
Paediatric Chronic Dialysis. Nephrol Dial Transplant.
2012;27:388–95.
8. Rinaldi S, Sera F, Verrina E, Edefonti A, Gianoglio B,
Perfumo F, Sorino P, Zacchello G, Cutaia I, Lavoratti
G, Leozappa G, Pecoraro C, Rizzoni G, Italian
Registry of Pediatric Chronic Peritoneal Dialysis.
Chronic peritoneal dialysis catheters in children:
a fifteen-year experience of the Italian Registry of
Pediatric Chronic Peritoneal Dialysis. Perit Dial Int.
2004;24:481–6.
9.Borzych-Duzalka D, Aki TF, Azocar M, White C,
Harvey E, Mir S, Adragna M, Serdaroglu E, Sinha
R, Samaille C, Vanegas JJ, Kari J, Barbosa L, Bagga
A, Galanti M, Yavascan O, Leozappa G, Szczepanska
M, Vondrak K, Tse KC, Schaefer F, Warady BA,
International Pediatric Peritoneal Dialysis Network
Registry. Peritoneal dialysis access revision in children: causes, interventions, and outcomes. Clin J Am

Soc Nephrol. 2017;12:105–12.
10.Aksu N, Yavascan O, Anil M, Kara OD, Erdogan H,
Bal A. A ten-year single-centre experience in children
on chronic peritoneal dialysis  – significance of percutaneous placement of peritoneal dialysis catheters.
Nephrol Dial Transplant. 2007;22:2045–51.

S. A. Bakkaloğlu and C. B. Sethna
11.Bakkaloglu SA, Ekim M, Sever L, Noyan A, Aksu N,
Akman S, Elhan AH, Yalcinkaya F, Oner A, Kara OD,
Caliskan S, Anarat A, Dusunsel R, Donmez O, Guven
AG, Bakkaloglu A, Denizmen Y, Soylemezoglu O,
Ozcelik G.  Chronic peritoneal dialysis in Turkish
children: a multicenter study. Pediatr Nephrol.
2005;20:644–51.
12.Radtke J, Lemke A, Kemper MJ, Nashan B, Koch
M.  Surgical complications after peritoneal dialysis
catheter implantation depend on children’s weight. J
Pediatr Surg. 2016;51:1317–20.
13.Carpenter JL, Fallon SC, Swartz SJ, Minifee PK,

Cass DL, Nuchtern JG, Pimpalwar AP, Brandt
ML.  Outcomes after peritoneal dialysis catheter
placement. J Pediatr Surg. 2016;51:730–3.
14.LaPlant MB, Saltzman DA, Segura BJ, Acton RD,
Feltis BA, Hess DJ. Peritoneal dialysis catheter placement, outcomes and complications. Pediatr Surg Int.
2018;34:1239–44.
15.Radtke J, Schild R, Reismann M, Ridwelski RR,

Kempf C, Nashan B, Rothe K, Koch M. Obstruction
of peritoneal dialysis catheter is associated with

catheter type and independent of omentectomy: a
comparative data analysis from a transplant surgical
and a pediatric surgical department. J Pediatr Surg.
2018;53:640–3.
16.Phan J, Stanford S, Zaritsky JJ, DeUgarte DA.  Risk
factors for morbidity and mortality in pediatric
patients with peritoneal dialysis catheters. J Pediatr
Surg. 2013;48:197–202.
17.Hagen SM, Lafranca JA, IJzermans JN, Dor FJ.  A
systematic review and meta-analysis of the influence of peritoneal dialysis catheter type on complication rate and catheter survival. Kidney Int.
2014;85:920–32.
18.Imani PD, Carpenter JL, Bell CS, Brandt ML, Braun
MC, Swartz SJ. Peritoneal dialysis catheter outcomes
in infants initiating peritoneal dialysis for end-stage
renal disease. BMC Nephrol. 2018;19:231.
19.Ladd AP, Breckler FD, Novotny NM. Impact of primary omentectomy on longevity of peritoneal dialysis catheters in children. Am J Surg. 2011;201:401–4;
discussion 404–405.
20. Nikibakhsh AA, Mahmoodzadeh H, Vali M, Enashaei
A, Asem A, Yekta Z.  Outcome of immediate use of
the permanent peritoneal dialysis catheter in children
with acute and chronic renal failure. Iran J Pediatr.
2013;23:171–6.
21.Zhang Q, Jiang C, Zhu W, Sun C, Xia Y, Tang T, Wan
C, Shao Q, Liu J, Jin B, Zhang M. Peritoneal catheter
fixation combined with straight upward tunnel and
low implant position to prevent catheter malfunction.
Nephrology (Carlton). 2018;23:247–52.
22. Stringel G, McBride W, Weiss R. Laparoscopic placement of peritoneal dialysis catheters in children. J
Pediatr Surg. 2008;43:857–60.
23.Chen Y, Shao Y, Xu J. The survival and complication

rates of laparoscopic versus open catheter placement
in peritoneal dialysis patients: a meta-analysis. Surg
Laparosc Endosc Percutan Tech. 2015;25:440–3.


17  Noninfectious Complications of Peritoneal Dialysis in Children
24.Xie H, Zhang W, Cheng J, He Q. Laparoscopic versus open catheter placement in peritoneal dialysis
patients: a systematic review and meta-analysis. BMC
Nephrol. 2012;13:69.
25.Strippoli GF, Tong A, Johnson D, Schena FP, Craig
JC.  Catheter type, placement and insertion techniques for preventing peritonitis in peritoneal
dialysis patients. Cochrane Database Syst Rev.
2004;(4):CD004680.
26.van Laanen JHH, Cornelis T, Mees BM, Litjens

EJ, van Loon MM, Tordoir JHM, Peppelenbosch
AG.  Randomized controlled trial comparing open
versus laparoscopic placement of a peritoneal dialysis
catheter and outcomes: the CAPD I trial. Perit Dial
Int. 2018;38:104–12.
27.Crabtree JH, Fishman A.  A laparoscopic method

for optimal peritoneal dialysis access. Am Surg.
2005;71:135–43.
28.Hu JC, Chiu KY, Wang SS, Chen CS, Ho HC, Yang
CK, Chen CC, Wang SC, Lin CY, Hung SC, Cheng
CL, Li JR.  A modified application of peritoneal
dialysis catheter implantation: a revolution from the
laparoscope- to the nephroscope-assisted surgery. J
Endourol. 2018;32:502–8.

29. Rahim KA, Seidel K, McDonald RA. Risk factors for
catheter-related complications in pediatric peritoneal
dialysis. Pediatr Nephrol. 2004;19:1021–8.
30.Donmez O, Durmaz O, Ediz B, Cigerdelen N,

Kocak S.  Catheter-related complications in children on chronic peritoneal dialysis. Adv Perit Dial.
2005;21:200–3.
31.Macchini F, Valade A, Ardissino G, Testa S, Edefonti
A, Torricelli M, Luzzani S. Chronic peritoneal dialysis
in children: catheter related complications. A single
centre experience. Pediatr Surg Int. 2006;22:524–8.
32.Ozyer U, Harman A, Aytekin C, Boyvat F, Ozdemir
N.  Correction of displaced peritoneal dialysis
catheters with an angular stiff rod. Acta Radiol.
2009;50:139–43.
33.Ratajczak A, Lange-Ratajczak M, Bobkiewicz A,

Studniarek A. Surgical management of complications
with peritoneal dialysis. Semin Dial. 2017;30:63–8.
34. Zorzanello MM, Fleming WJ, Prowant BE. Use of tissue plasminogen activator in peritoneal dialysis catheters: a literature review and one center’s experience.
Nephrol Nurs J. 2004;31:534–7.
35.Krishnan RG, Moghal NE. Tissue plasminogen activator for blocked peritoneal dialysis catheters. Pediatr
Nephrol. 2006;21:300.
36.Sakarcan A, Stallworth JR. Tissue plasminogen activator for occluded peritoneal dialysis catheter. Pediatr
Nephrol. 2002;17:155–6.
37.Leblanc M, Ouimet D, Pichette V. Dialysate leaks in
peritoneal dialysis. Semin Dial. 2001;14:50–4.
38. Hooman N, Esfahani ST, Mohkam M, Derakhshan A,
Gheissari A, Vazirian S, Mortazavi F, Ghane-Sherbaff
F, Falak-Aflaki B, Otoukesh H, Madani A, Sharifian-­

Dorcheh M, Mahdavi A, Esmaeile M, Naseri M,
Azhir A, Merikhi A, Mohseni P, Ataei N, Fallahzadeh
MH, Basiratnia M, Hosseini-Al-Hashemi G. The out-

311

come of Iranian children on continuous ambulatory
peritoneal dialysis: the first report of Iranian National
Registry. Arch Iran Med. 2009;12:24–8.
39. Sojo ET, Grosman MD, Monteverde ML, Bailez MM,
Delgado N. Fibrin glue is useful in preventing early
dialysate leakage in children on chronic peritoneal
dialysis. Perit Dial Int. 2004;24:186–90.
40.

Aranda RA, Romao Junior JE, Kakehashi E,
Domingos W, Sabbaga E, Marcondes M, Abensur
H. Intraperitoneal pressure and hernias in children on
peritoneal dialysis. Pediatr Nephrol. 2000;14:22–4.
41.Fischbach M, Warady BA.  Peritoneal dialysis prescription in children: bedside principles for optimal
practice. Pediatr Nephrol. 2009;24:1633–42; quiz
1640, 1642.
42.Jander A, Nowicki M, Tkaczyk M, Makulska

I, Zwolinska D, Latoszynska J, Boguszewska-­
Baczkowska A, Grenda R, Balasz-Chmielewska
I, Zagozdzon I, Zaluska-Lesniewska I, Zurowska
A, Stefaniak E, Zachwieja J, Leszczynska B,
Roszkowska-Blaim M, Zachwieja K, Pietrzyk
JA, Wiercinski R, Zoch-Zwierz W, Stankiewicz

R.  Chronic peritoneal dialysis in infants  – preliminary results of the multicenter survey. Przegl Lek.
2006;63(Suppl 3):72–4.
43.Tom CM, Dubina ED, Simms ER, de Virgilio C,

Moazzez A.  Outcomes of combined hernia repair
and peritoneal dialysis catheter placement: a NSQIP
analysis. Am Surg. 2018;84:1604–7.
44.Bargman JM.  Complications of peritoneal dialysis

related to increased intraabdominal pressure. Kidney
Int Suppl. 1993;40:S75–80.
45.Schmitt CP, Zaloszyc A, Schaefer B, Fischbach

M. Peritoneal dialysis tailored to pediatric needs. Int J
Nephrol. 2011;2011:940267.
46.Bakkaloglu SA, Ekim M, Tumer N, Gungor A,

Yilmaz S.  Pleurodesis treatment with tetracycline in
peritoneal dialysis-complicated hydrothorax. Pediatr
Nephrol. 1999;13:637–8.
47.Borzych D, Ley S, Schaefer F, Billing H, Ley-­

Zaporozhan J, Schenk J, Schmitt CP.  Dialysate
leakage into pericardium in an infant on long-term
peritoneal dialysis. Pediatr Nephrol. 2008;23:335–8.
48.Camilleri B, Glancey G, Pledger D, Williams P. The
icodextrin black line sign to confirm a pleural leak
in a patient on peritoneal dialysis. Perit Dial Int.
2004;24:197.
49.Szeto CC, Chow KM. Pathogenesis and management

of hydrothorax complicating peritoneal dialysis. Curr
Opin Pulm Med. 2004;10:315–9.
50. Kim YL. Update on mechanisms of ultrafiltration failure. Perit Dial Int. 2009;29(Suppl 2):S123–7.
51.Raby AC, Gonzalez-Mateo GT, Williams A, Topley
N, Fraser D, Lopez-Cabrera M, Labeta MO. Targeting
Toll-like receptors with soluble Toll-like receptor 2
prevents peritoneal dialysis solution-induced fibrosis.
Kidney Int. 2018;94:346–62.
52.Chung SH, Heimburger O, Lindholm B.  Poor outcomes for fast transporters on PD: the rise and fall of
a clinical concern. Semin Dial. 2008;21:7–10.


312
53.Saxena R.  Pathogenesis and treatment of peritoneal
membrane failure. Pediatr Nephrol. 2008;23:695–703.
54.Schaefer F, Klaus G, Mehls O.  Peritoneal transport
properties and dialysis dose affect growth and nutritional status in children on chronic peritoneal dialysis.
Mid-European Pediatric Peritoneal Dialysis Study
Group. J Am Soc Nephrol. 1999;10:1786–92.
55.Canepa A, Verrina E, Perfumo F. Use of new peritoneal dialysis solutions in children. Kidney Int Suppl.
2008;(108):S137–44.
56.Michallat AC, Dheu C, Loichot C, Danner S,

Fischbach M. Long daytime exchange in children on
continuous cycling peritoneal dialysis: preservation of
drained volume because of icodextrin use. Adv Perit
Dial. 2005;21:195–9.
57.Htay H, Johnson DW, Wiggins KJ, Badve SV, Craig
JC, Strippoli GF, Cho Y. Biocompatible dialysis fluids
for peritoneal dialysis. Cochrane Database Syst Rev.

2018;10:CD007554.
58.Honda M, Warady BA.  Long-term peritoneal dialysis and encapsulating peritoneal sclerosis in children.
Pediatr Nephrol. 2010;25:75–81.
59. Stefanidis CJ, Shroff R. Encapsulating peritoneal sclerosis in children. Pediatr Nephrol. 2014;29:2093–103.
60.Brown EA, Bargman J, van Biesen W, Chang MY,
Finkelstein FO, Hurst H, Johnson DW, Kawanishi
H, Lambie M, de Moraes TP, Morelle J, Woodrow
G. Length of time on peritoneal dialysis and encapsulating peritoneal sclerosis – position paper for ISPD:
2017 update. Perit Dial Int. 2017;37:362–74.
61.Vidal E, Edefonti A, Puteo F, Chimenz R, Gianoglio
B, Lavoratti G, Leozappa G, Maringhini S, Mencarelli
F, Pecoraro C, Ratsch IM, Cannavo R, De Palo T,
Testa S, Murer L, Verrina E, Italian Registry of
Pediatric Chronic Dialysis. Encapsulating peritoneal
sclerosis in paediatric peritoneal dialysis patients: the
experience of the Italian Registry of Pediatric Chronic
Dialysis. Nephrol Dial Transplant. 2013;28:1603–9.
62.Hoshii S, Honda M.  High incidence of encapsulating peritoneal sclerosis in pediatric patients on peritoneal dialysis longer than 10 years. Perit Dial Int.
2002;22:730–1.
63. Shroff R, Stefanidis CJ, Askiti V, Edefonti A, Testa S,
Ekim M, Kavaz A, Ariceta G, Bakkaloglu S, Fischbach
M, Klaus G, Zurowska A, Holtta T, Jankauskiene
A, Vondrak K, Vande Walle J, Schmitt CP, Watson
AR, European Paediatric Dialysis Working Group.
Encapsulating peritoneal sclerosis in children on
chronic PD: a survey from the European Paediatric
Dialysis Working Group. Nephrol Dial Transplant.
2013;28:1908–14.
64.Ekim M, Fitoz S, Yagmurlu A, Ensari A, Yuksel


S, Acar B, Ozcakar ZB, Kendirli T, Bingoler B,
Yalcinkaya F.  Encapsulating peritoneal sclerosis in
paediatric peritoneal dialysis patients. Nephrology
(Carlton). 2005;10:341–3.
65.Kawaguchi Y, Saito A, Kawanishi H, Nakayama

M, Miyazaki M, Nakamoto H, Tranaeus
A. Recommendations on the management of encapsulating peritoneal sclerosis in Japan, 2005: diagnosis,

S. A. Bakkaloğlu and C. B. Sethna
predictive markers, treatment, and preventive measures. Perit Dial Int. 2005;25(Suppl 4):S83–95.
66. Bakkaloglu SA, Saygili A, Sever L, Noyan A, Akman
S, Ekim M, Aksu N, Doganay B, Yildiz N, Duzova A,
Soylu A, Alpay H, Sonmez F, Civilibal M, Erdem S,
Kardelen F. Assessment of cardiovascular risk in paediatric peritoneal dialysis patients: a Turkish Pediatric
Peritoneal Dialysis Study Group (TUPEPD) report.
Nephrol Dial Transplant. 2009;24:3525–32.
67.Bonthuis M, van Stralen KJ, Jager KJ, Baiko S,

Jahnukainen T, Laube GF, Podracka L, Seeman
T, Tyerman K, Ulinski T, Groothoff JW, Schaefer
F, Verrina E.  Dyslipidaemia in children on renal
replacement therapy. Nephrol Dial Transplant.
2014;29:594–603.
68.Buyan N, Bideci A, Ozkaya O, Ortac E, Bakkaloglu
S, Gonen S, Peru H, Soylemezoglu O, Cinaz P. Leptin
and resistin levels and their relationships with glucose metabolism in children with chronic renal
insufficiency and undergoing dialysis. Nephrology
(Carlton). 2006;11:192–6.
69.Canpolat N, Caliskan S, Sever L, Guzeltas A,


Kantarci F, Candan C, Civilibal M, Kasapcopur O,
Arisoy N. Glucose intolerance: is it a risk factor for
cardiovascular disease in children with chronic kidney disease? Pediatr Nephrol. 2012;27:627–35.
70.KDIGO. KDIGO clinical practice guideline for lipid
management in chronic kidney disease. Kidney Int
Suppl. 2013;3(3):259.
71.Kavey RE, Allada V, Daniels SR, Hayman LL,

McCrindle BW, Newburger JW, Parekh RS,
Steinberger J, American Heart Association Expert
Panel on Population and Prevention Science; the
Councils on Cardiovascular Disease in the Young,
Epidemiology and Prevention, Nutrition, Physical
Activity and Metabolism, High Blood Pressure
Research, Cardiovascular Nursing, and the Kidney
in Heart Disease; and the Interdisciplinary Working
Group on Quality of Care and Outcomes Research.
Cardiovascular risk reduction in high-risk pediatric
patients: a scientific statement from the American
Heart Association Expert Panel on Population and
Prevention Science; the Councils on Cardiovascular
Disease in the Young, Epidemiology and Prevention,
Nutrition, Physical Activity and Metabolism,
High Blood Pressure Research, Cardiovascular
Nursing, and the Kidney in Heart Disease; and the
Interdisciplinary Working Group on Quality of
Care and Outcomes Research. J Cardiovasc Nurs.
2007;22:218–53.
72.Factor KF. Potassium management in pediatric peritoneal dialysis patients: can a diet with increased

potassium maintain a normal serum potassium
without a potassium supplement? Adv Perit Dial.
2007;23:167–9.
73.Khan AN, Bernardini J, Johnston JR, Piraino

B. Hypokalemia in peritoneal dialysis patients. Perit
Dial Int. 1996;16:652.
74.Hutchinson AJ.  Serum magnesium and end-stage

renal disease. Perit Dial Int. 1997;17:327–9.


17  Noninfectious Complications of Peritoneal Dialysis in Children
75.

Wei M, Esbaei K, Bargman JM, Oreopoulos
DG.  Inverse correlation between serum magnesium and parathyroid hormone in peritoneal dialysis
patients: a contributing factor to adynamic bone disease? Int Urol Nephrol. 2006;38:317–22.
76.Greenberg A, Bernardini J, Piraino BM, Johnston JR,
Perlmutter JA. Hemoperitoneum complicating chronic
peritoneal dialysis: single-center experience and literature review. Am J Kidney Dis. 1992;19:252–6.
77.Vidal E, Alberici I, Verrina E, Italian Registry of

Pediatric Chronic Dialysis. Acute pancreatitis in

313

children on chronic maintenance dialysis. Pediatr
Nephrol. 2019;34(9):1501–12.
78.Bastani B, Mifflin TE, Lovell MA, Westervelt FB,

Bruns DE. Serum amylases in chronic and end-stage
renal failure: effects of mode of therapy, race, diabetes
and peritonitis. Am J Nephrol. 1987;7:292–9.
79.Wang R, Leesch V, Turner P, Moberly JB, Martis
L.  Kinetic analysis of icodextrin interference
with serum amylase assays. Adv Perit Dial.
2002;18:96–9.