Advantages of Acute Peritoneal Dialysis in Children: Lessons from a Large Escherichia coli O157:H7 Outbreak in Calgary
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".