POS-678 OUTCOMES OF TENCKHOFF CATHETER INSERTION: A TWO-YEAR RETROSPECTIVE STUDY OF 380 PATIENTS

Abstract

Timely and effective insertion of Tenckhoff Catheters (TC) for Peritoneal Dialysis (PD) is the Achilles’ heel of a successful PD programme. Complications are varied and not uncommon during insertion. Retrospective descriptive study of all TC insertions in Nephrology Unit, Hospital Raja Permaisuri Bainun, Malaysia performed in 2019-2020. We describe the 1-month complications and 3-month outcomes in this cohort. We also compared the complication rates and outcomes of TCs inserted using the Seldinger vs peritoneoscope technique – both performed by nephrologists. A total of 413 TCs were inserted in year 2019-2020. Case notes were unable to be retrieved in 33 patients. The remaining 380 were included in analysis. Patients were predominantly males (57.9%), Malay in ethnicity (69%) with mean age of 53.9 (SD 14.59) and mean BMI of 26.03 (SD 5.23). Majority had hypertension (90.5%) and diabetes mellitus (66.8%). The most common disease leading to CKD were diabetes mellitus (65.5%) and hypertension (12.6%). One fifth of patients were converted from regular haemodialysis to PD – main reason was vascular access difficulty (86.8%). Prior history of TC insertions was reported in 17.1% of patients. The most frequent method of TC insertion was peritoneoscope (63.7%), followed by Seldinger (31.3%) and laparoscopic (4.7%). Catheter break-in at less than 2 weeks post insertion was 22.6%. Catheter survival was 89.2% at 1-month and 81.3% at 3-month post insertion. Patient survival was 97.1% at 3-month post insertion. One death occurred as a result of complication during TC insertion. Complications occurred in 36.3% of TC insertions at one month (Table 1). Multivariate analysis showed that when compared to patients age 40 and below, patients aged 41-59 and aged ≥60 had 49% and 58% less odds of developing complications respectively (p=0.026, 95%CI 0.29-0.9; p=0.005, 95% CI 0.23-0.77) . Patients with serum cholesterol ≥4.5mmol/L are 60% less likely to develop complications compared to those with <4.5mmol/L(p<0.0001, 95%CI 0.24, 0.65). Subgroup analysis comparing outcomes of Seldinger (n=119) and peritoneoscope (n=242) insertion revealed more catheter obstruction in the Seldinger subgroup (p=0.042). Kaplan-Meier survival analysis revealed no significant difference in overall catheter survival at 90 days between both techniques (p=0.085). Survival rate at 90 days were 76.5% for Seldinger technique and 83.9% for peritoneoscope technique. TC insertion is safe. Serious complications are rare. Most complications can be managed with good outcomes. Patients with lower serum cholesterol are more likely to develop complications, probably due to poorer nutritional status/inflammatory state. With proper patient selection, both Seldinger and peritoneoscope insertion techniques provide comparable outcomes.