Abstract No. 583 Urgent-start peritoneal dialysis catheter placement: outcomes of radiologic versus laparoscopic techniques

Abstract

The majority of patients with end stage renal disease start unplanned hemodialysis via central venous catheter which proved to have significant rates of complications. An alternative approach is the urgent-start peritoneal dialysis (PD). PD catheters can be inserted using radiologic or laparoscopic technique. The aim of the study is to compare the outcomes of the aforementioned PD catheter placement techniques. We retrospectively reviewed the medical records of 273 patients who had their first PD catheter placed between November 2012 and May 2017. We compared the outcomes of the catheters placed using radiologic technique (n = 26) with the catheters placed using laparoscopic technique (n = 16) in urgent start setting. The primary endpoint was complication-free catheter survival at 1,3 and 12 months. Secondary endpoints were overall catheter removal at 3 and 12 months and mean days-to-first complication. A total of 42 patients had an urgent start PD catheter placement. The baseline demographics and underlying medical conditions were not different between the 2 groups. In the radiologic group, the 1, 3 and 12 months complication-free catheter survival were 73%, 54% and 35% respectively, compared to 88% (p = 0.269), 81.3% (p = 0.072) and 56% (p = 0.169) respectively, in the laparoscopic group. The rate of catheter complications was not different between the two groups (p = 0.233). The catheter removal at 3 and 12 months in the radiologic group (15.4% and 23.1% respectively) and the laparoscopic group (6.3% and 18.8% respectively) was not different (p = 0.512). The mean days to first complication in the radiologic group [66.9 (SD = 101.4)] and laparoscopic group [126.6 (SD = 158.8)] was also not different (p = 0.182). Radiologic placement of PD catheters offers a clinically effective alternative to laparoscopic placement in the urgent start setting, with similar catheter survival and complication rates.