Continuous Ambulatory Peritoneal Dialysis Catheter Research Articles

Outcomes and trends in continuous ambulatory peritoneal dialysis: a retrospective analysis at Najaf Centers (2014-2022)

Introduction. Continuous ambulatory peritoneal dialysis (CAPD) offers an alternative renal replacement therapy for patients with end-stage renal disease (ESRD), combining the benefits of mobility and a home-based treatment regime. Since its introduction at Najaf Center's Al-Sader Nephrology Center in 2011, techniques have evolved from open laparotomy to laparoscopic methods, starting officially in 2018. This study aims to evaluate patient outcomes, trends in CAPD techniques, and factors contributing to mortality. Methods. This retrospective study collected data from 643 patients who initiated CAPD between 2014 and 2022 at Najaf Governate's three centers. The study focused on demographic data, technique survival, transitions to other dialysis modalities, patient outcomes, mortality, and trends and complications associated with various CAPD catheter insertion techniques (open laparotomy, percutaneous insertion, and laparo­scopic). Out of these, 211 patients died, and 432 continued with CAPD or switched to other modalities. Twenty patients received a kidney transplant, 189 transitioned to hemodialysis and 130 remained on CAPD. Result. Technique-wise, laparoscopic insertions showed higher patency rates and fewer early complications, while percutaneous insertions had higher instances of needing revisions, and open methods were most associated with infection complications. The technique success rate was highest for laparoscopic CAPD (79.5%), followed by percutaneous CAPD (45.6%) and open laparotomy (46.5%). Conclusion. CAPD is a vital renal replacement therapy, yet it carries risks, including mortality. This study's insights into the causes of death, technique efficiency, and patient outcomes are crucial for enhancing patient care and clinical practices in CAPD. The shift from open laparotomy to laparoscopic techniques at Najaf Centers mirrors a broader trend in medical practice favoring minimally invasive procedures, which have shown better outcomes in this study.

One-year outcomes of percutaneous continuous ambulatory peritoneal dialysis catheter insertion by nephrologists: First experience from Sri Lanka

Introduction: Continuous ambulatory peritonealdialysis (CAPD) via a catheter placed in the peritoneum is an established mode of renal replacement therapy. CAPD catheters are placed using either percutaneous or surgical techniques. Percutaneous method is less invasive and avoids the need for general anaesthesia, surgical space, and expertise. This study was conducted to measure one-year outcomes of percutaneous CAPD catheter insertions performed by a nephrology team; the first experience from Sri Lanka.Methods: We retrospectively studied 96 patients in two centers, who underwent percutaneous CAPD catheter insertion over two years with a follow-up period of minimum one year. The catheter was placed using modified Seldinger technique under local anesthesia with ultrasound guidance.Results: Majority were males (78.1%) with a median age of 56 years. Most were on haemodialysis (HD) (85.4%) prior to CAPD catheter insertion. The commonest reason for opting for CAPD was to avoid hospital visits for HD (54.2%). During the follow-up of one year, 85.4% were free of complications. Frequent non-infectious complications were catheter removal (12.5%), visceral injury (4.2%), primary insertion failure (4.2%), and catheter dysfunction (2.1%). Pre-training peritonitis was found in 2.1% with an overall peritonitis rate of 0.4 episodes per patient a year. There was no significant association between catheter-related complications and gender (p=0.68), previous abdominal surgery (p=0.54), diabetes mellitus (p=0.84), and hypertension (p=0.46). One-year catheter survival was 92%.Discussion: One-year outcomes of percutaneous CAPD catheter insertion by nephrologists were efficacious and safe with low complication rates. Hence, CAPD catheter insertion by well-trained nephrologists should be encouraged. Further studies comparing percutaneous versus surgical catheter placement are warranted.

The prophylactic omentectomy procedure in reducing the complication rate of continuous ambulatory peritoneal dialysis in pediatric: A systematic review and meta-analysis.

The role of the omentectomy procedure on Continuous Ambulatory Peritoneal Dialysis (CAPD) catheter placement in pediatric patients has been differently evaluated in the literature, with some studies showing improvement while others showing no difference. Our study aims to define the advantages of omentectomy compared to a procedure without omentectomy. The literature searching in online databases (PubMed/MEDLINE, Cochrane Library, EMBASE, Scopus, and ClinicalTrial.gov) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, has been registered on PROSPERO (CRD42023412846). The protocol was performed through April 2023 and focused on pediatric patients treated with an omentectomy procedure and related complications. The risk of bias in each study was assessed using the risk of bias for the non-randomized control trials (ROBINS-I). The effect estimates were extracted as risk ratios with 95% confidence intervals (CI). The heterogeneity of the studies was considered as high heterogeneity if I2 values above 50% or p < 0.05. In the total of 676 articles identified in the database searching for screening, nine studies with 775 patients met the criteria for inclusion. The omentectomy procedure significantly showed a lower incidence of catheter obstruction compared to the control group, (OR 0.24 [95% CI, 0.12-0.49], p < 0.0001, I2 = 0%). Moreover, omentectomy demonstrated a similar trend in the rate of removal or reinsertion of the catheter with high heterogeneity, OR 0.25 [95% CI, 0.12-0.51), p = 0.0002, I2 = 70%). The omentectomy procedure showed a lower incidence of catheter obstruction and complications leading to removal or reinsertion of the catheter.

Modified Single Port Laparoscopic Peritoneal Dialysis Catheter Insertion - Initial Experience and Outcome from a Tertiary Care Centre

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are emerging as a major health related issues in developing countries. The increasing numbers require rapid adaptation of existing health-care policies. The number of patients requiring renal care is only bound to increase in coming years with the increasing incidence and prevalence of diabetes. Continuous ambulatory peritoneal dialysis (CAPD) catheter placement is performed on end-stage renal disease (ESRD) patients. There is abundant literature regarding post-operative outcomes and re-operative rates following CAPD. We report our initial experience of modified single port laparoscopic technique of placing CAPD catheters using a single port through the Palmer’s point and discuss our surgical outcomes. Methods: This was a retrospective review (2019-2020) of patients undergoing CAPD catheter placement at SMVD Narayana Superspecialty Hospital. Outcome analysis focused on patient related outcomes, including early (&lt; 30 days) versus late (≥ 30 days) complication and re-operation rates. Results: A total of 30 patients with ESRD, (mean ASA score = 3.3) were included in the study who underwent modified single port laparoscopic (n = 30) CAPD catheter placement (mean follow-up = 180 days). The total complication rate with the procedure was 43%, with re-operation rate of 20%. CAPD catheter non-function occurred in 06 patients (20% of total). CAPD catheter migrations occurred in 03 patients (10% of total). CAPD catheter related infections occurred in 05 patients (16% of total), and 02 required re-operation; 03 patients were treated successfully with culture directed antibiotics. There were 2 deaths during the study period, one due to peritonitis and other due to underlying cardiac disease. There was no surgical mortality in the study group. Conclusion: Although CAPD catheter placement in patients with ESRD are technically un-complicated to accomplish, long term results suggest as many as one in three patients will struggle with some form of catheter malfunction or infection. Our modified technique and the results have led to changes in our CAPD catheter placement technique, as well as the post-operative patient care algorithm.

Perioperative management of patient with pre-existing deep vein thrombosis for laparoscopic peritoneal dialysis catheter insertion: a case report

BackgroundA patient with chronic kidney disease and recurrent catheter-related thrombosis.Case presentationThe patient had femoral vein thrombosis and was scheduled for laparoscopically assisted continuous ambulatory peritoneal dialysis catheter insertion. The chief concerns during the perioperative period were the risk of pulmonary thromboembolism, limited venous access, and risk of bleeding as the patient was on anticoagulation therapy. Meticulous attention was paid to history, clinical examination, and to the ongoing treatment with regard to risk of systemic thrombosis.ConclusionsManagement was tailored according to risk of thrombosis and bleeding during perioperative period along with identification adverse events associated with anticoagulation and preparedness for management of pulmonary embolism.

Continuous ambulatory peritoneal dialysis catheter insertion by open technique: 20-year experience from a single center.

Continuous ambulatory peritoneal dialysis (CAPD) catheter placement is a part of renal replacement therapy. We describe our 20-year experience in using the open technique and assess its safety, efficacy, and outcome in the treatment of end-stage renal disease patients. In a retrospective study, we analyzed data of all patients who had a CAPD catheter placed using our open dissection technique using local anesthesia over the previous 20 years, with minimum 1 year of follow-up. Intraoperative data, postoperative data, and complications were noted. A total of 1410 cases were included in the study. The mean duration of follow-up was 72 ± 18 months (range 12-120 months). The mean operative time was 19 ± 7.5 min and mean hospital stay was 3 ± 1 days. No major intraoperative complications were noted. We observed a peritonitis rate of 0.49 episodes/patient/year. The most common reason for permanent catheter removal was refractory peritonitis in 21%, followed by flow failure in 7%, and ultrafiltration failure in 6.5%. The death-censored technical survival rate was 94.3%, 83.2%, 75.9%, 69.2%, and 60.6% patients at 1 year, 2 years, 3 years, 4 years, and 5 years, respectively. The open dissection method of peritoneal dialysis catheter insertion using local anesthesia at well-experienced center is a simple, painless, and uncomplicated procedure with excellent outcomes. Optimal exposure, judicious use of energy source, and using appropriate technique provide good technical success rate with lesser complications.

Does Laparoscopic Omentectomy Reduce CAPD Catheter Malfunction: A Three-arm Pilot Randomized Trial.

Introduction:Catheter malfunction secondary to omental wrapping is a frequent complication of continuous ambulatory peritoneal dialysis (CAPD). Of the various methods of peritoneal dialysis catheter insertion (PDCI), open surgical insertion under local anesthesia is most widely practiced. Laparoscopic omentectomy is often undertaken as a salvage procedure in case of malfunctioning catheters. However, there is no randomized controlled trial (RCT) to evaluate the role of prophylactic laparoscopic omentectomy on catheter function. This pilot RCT was undertaken to evaluate the impact of laparoscopic omentectomy on the incidence of catheter malfunction.Materials and Methods:Consecutive patients were randomized into three groups: laparoscopic PDCI with omentectomy (Group A), laparoscopic PDCI without omentectomy (Group B) and open surgical PDCI (Group C). The primary outcome was the incidence of catheter malfunction at 6 weeks and 3 months.Results:Forty-one patients completed follow-up, with 16, 11, and 14 patients in Groups A, B, and C, respectively. Incidence of catheter malfunction was 6.2%, 27.3%, and 14.3% in Groups A, B, and C, respectively, at 6 weeks and 6.2%, 36.4%, and 21.4% at 3 months, respectively. In patients with previously failed catheter insertion (n = 23), malfunction at 3 months was 8.3% (1/12) in patients who had omentectomy, compared with 45.5% (5/11) in those who did not (P = 0.069). Operating time was significantly higher (P < 0.001) in Group A.Conclusions:Laparoscopic omentectomy may be associated with a lower incidence of catheter malfunction, especially in patients with previously failed peritoneal dialysis catheter. Data from this pilot RCT can be used to design a large trial with an adequate number of patients.

Laparoscopic continuous ambulatory peritoneal dialysis (CAPD) catheter insertion; a modified technique in low resource settings and early outcome

Chronic kidney disease [CKD] has become a major health issue worldwide. In Sri Lanka, the prevalence of CKD has increased rapidly in the recent past. The definite treatment is kidney transplantation. However, due to a variety of reasons, transplantation is either delayed or not possible. Dialysis is the management modality for those patients. Peritoneal dialysis is traditionally done via temporary lines for in-ward patients in Sri Lankan hospitals. There is an increasing trend to use CAPD catheters in major renal centres. CAPD lines are inserted by several techniques. In most centres in Sri Lanka CAPD is inserted by open surgery. Laparoscopic insertion is relatively new to local patients. In this article, a novel modified technique is described, and the early outcome is analyzed.

MO697TUBERCULOUS PERITONITIS WITH HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN A PATIENT ON CONTINUOUS AMBULATORY PERITONEAL DIALYSIS: A CASE REPORT

Abstract Background and Aims Tuberculosis is a leading cause of morbidity and mortality worldwide. Tuberculous peritonitis in patients on Continuous Ambulatory Peritoneal Dialysis (CAPD), though uncommon, has been reported from different parts of the world. Hemophagocytic lymphohistiocytosis (HLH) is a rare systemic inflammatory disorder characterized by uncontrolled proliferation of lymphocytes &amp; histiocytes and is reported to have high mortality. Secondary forms of HLH have been described for various diseases. Here, we report a case of HLH secondary to Tuberculous peritonitis in a patient of End Stage Renal Disease (ESRD) on CAPD. Method A 49 years old male ESRD patient, on CAPD presented with peritonitis and was initially managed with antibiotics. He required catheter explantation in view of refractory peritonitis and was switched to haemodialysis. The patient continued to have low grade fever, yellowish discharge from infra-umbilical CAPD catheter explantation surgical wound along with lower abdominal pain &amp; tenderness. He was lost to follow up and presented again after 1 month with fever, weight loss, multiple cutaneous ecchymotic spots and copious amount of yellowish discharge from infra-umbilical surgical wound. On examination, he had fever, conjunctival pallor, hepatosplenomegaly and a 5 cm infra-umbilical midline poorly healed discharging surgical scar with surrounding skin erythema and induration. Blood investigations revealed Hb 5.1 gm/dl, TLC 1500/uL, Plts 32000/uL, Ferritin 1053 ng/ml, TG 350 mg/dl, LDH 650 U/l, Bil T/D 1.3/1.0 mg/dl, OT/PT 160/174 IU/l, ALP 219 U/l, GGT 238 U/l, TP/Alb 5.2/2.5 gm/dl, APTT C/T 27.9/63.0, INR 1.27. NCCT abdomen revealed hepatosplenomegaly, loculated collection in right subphrenic region extending into the abdominal and pelvic cavity, anterior abdominal wall defect infero-right lateral to the umbilicus and generalised increased density in mesenteric fat. Diagnostic sub-phrenic fluid Aspirate analysis revealed a yellow turbid fluid with TLC 22300, ADA 106 U/L and positive Real Time PCR for Mycobacterium tuberculosis complex. Aspirate pyogenic and fungal cultures were sterile. Bone marrow evaluation revealed marked degree of histiocytic hemophagocytosis. Patient fulfilled six out of eight criteria for diagnosis of HLH. He was started on Anti Tubercular Treatment along with dexamethasone. He gradually became afebrile with resolution of infra-umbilical wound discharge, improvement in clinical and laboratory parameters. Results We report a case of HLH secondary to Tuberculous peritonitis in a patient of ESRD. The patient was on CAPD and required catheter explantation in view of Refractory peritonitis. Despite explantation and adequate antibiotics, he continued to have fever, discharge from surgical wound, pain abdomen, weight loss and poor appetite. Further evaluation revealed evidence of Tuberculous Peritonitis. In addition, the patient fulfilled six out of eight criteria for diagnosis of HLH. The patient was managed with Anti Tubercular Treatment along with Dexamethasone and he showed a gradual improvement in overall clinical and laboratory parameters. Conclusion Secondary HLH may occur after Tuberculous peritonitis in patient of ESRD on CAPD. Refractory peritonitis with hyperferritenemia, cytopenias, hypertriglyceridemia should raise the suspicion for HLH. Timely identification and treatment of HLH may improve patient outcomes.

POS-629 PERITONEAL MEMBRANE HISTOPATHOLOGIC CHANGES CAUSED BY PERITONITIS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS: TWO CASE REPORTS

Long-term Peritoneal Dialysis (PD) causes morphologic and functional changes in the peritoneal membrane (PM) which is defined as peritoneal fibrosis, a known cause of loss of peritoneal ultrafiltration capacity. Inflammation, angiogenesis , and bioincompatible of peritoneal dialysis solution are a key event during the pathogenesis. Peritonitis remains a major problem in Peritoneal Dialysis. Excessive peritoneal inflammatory responses lead to mesothelial cell exfoliation and thickening of the submesothelial, resulting in peritoneal fibrosis and sclerosis. We report two cases of the patient in Continuous Ambulatory Peritoneal Dialysis (CAPD), focus on PM histopathologic changes. Case 1. A male, 47 years old, suffered from repeated peritonitis. After fourth episode of infection, the catheter was malfunction and removed. He was done on CAPD for 7 years with glucose base solution. Histopathologically, peritoneal membrane showed diffuse fibrosis and hyalinization, without mesothelial cell lining nor inflammatory cell infiltrate. He was transferred to hemodialysis. Case 2. A 28 years old male, came with chief complaint of fever, abdominal pain, and cloudy effluent in CAPD fluid. On third episode of peritonitis, Empirical treatment with cefotaxime intraperitoneal was done , however CAPD catheter was malfunctioned and removed. He was done on CAPD for 6 years with glucose base solution. The peritoneal membrane histopathology showed diffuse fibrosis and hyalinization, involving vessels, foci of lymphoplasmacytic cells infiltration, without mesothelial cell. He was transferred to hemodialysis. The success of PD was dependent on the structural and functional integrity of the PM. The mesothelium lines the PM and is the first line of defense against chemical / bacterial insult. Peritonitis remains a major complication of PD and cause of ultrafiltration/technique failure, morbidity and mortality. The mortality risk of PD-related peritonitis was 16-18%. Bioincompatible PD solution is also associated with production of proinflammatory and profibrotic cytokines. High peritoneal glucose exposure is associated with increased incidence of relapsing/recurrent peritonitis and conduct proinflammatory and profibrotic reactions in the peritoneal cavity leading to fibrosis and malfunction after 6-7 years. Peritoneal fibrosis was detected in 50% and 80% of PD patients within one and two years on PD. Pathological alterations in the vasculature of peritoneal include hyalinization of the blood vessels, vasculopathy, and submesothelial thickening.Figure 2Case 2.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Peritonitis episode altered peritoneal structure and functional. Neglected infection and repeated infection led to PD catheter removal. Glucose based solution may a contributing factor for membrane failure due to inflammation and fibrosis after 6-7 years.

Operative Technique for Laparoscopic Placement of Continuous Ambulatory Peritoneal Dialysis Catheter.

Background: Peritoneal dialysis (PD) is an increasingly utilized treatment modality for renal replacement therapy that affords medical and lifestyle benefits to the patient and financial savings to the health care system. Successful long-term use of PD is reliant upon an optimally functioning catheter. Many potential catheter-related complications can be avoided through utilizing optimal placement technique. As widespread use of PD as a renal replacement modality continues to increase, the need for a safe, standardized, catheter placement technique has become more evident. Objectives: To present a succinct synopsis of the rationale and elements of our current surgical management strategy for patients undergoing evaluation for PD and to provide a detailed stepwise description of our operative technique for PD catheter placement. This review describes potential pitfalls that may prevent optimal catheter function and describes each step taken to prevent potential complications. This description is combined with intraoperative photographs to highlight key steps. Conclusion: Following a defined reproducible stepwise approach, laparoscopic placement of continuous ambulatory peritoneal dialysis catheters can be performed safely and known potential complications hindering optimal catheter function can be addressed prophylactically.

Hernia repair and simultaneous continuous ambulatory peritoneal dialysis (CAPD) catheter implantation: feasibility and outcome.

Occurrence of abdominal wall hernias during and before peritoneal dialysis constitutes a pivotal role in treatment discontinuation, failure, and exclusion from this dialysis method. We herein present a single-center experience regarding a one-stage surgical strategy, including hernia repair and simultaneous peritoneal dialysis catheter implantation. Over a 4-year period, 123 patients underwent peritoneal dialysis catheter implantation and 23 patients (19%) had concomitant abdominal wall hernias and were enrolled in this monocentric prospective study. Data collection included recurrent and new-onset hernias, surgical site infection, 1-year and 2-year catheter survival. In 23 patients, 27 hernia repairs combined with peritoneal dialysis catheter implantation were performed. Median age was 52years (range, 30-85years) and 18/23 (78%) patients were male. There were no recurrent hernias and no early surgical site infections. Daily flushing was regularly started on the 1st to 3rd postoperative day. Five patients (22%) developed hernias on other anatomical sites, which required hernia repair and perioperative discontinuation of peritoneal dialysis. After a median follow-up of 37months (range, 28-87months), 96% of all implanted catheters were still working. Hernia repair and simultaneous peritoneal dialysis catheter implantation are associated with no recurrent hernias, an early start of peritoneal dialysis, a very low postoperative morbidity and very high 1-year and 2-year catheter survival.

An institutional experience in insertion of hemodialysis catheter and peritoneal dialysis catheter for children with end stage renal disease

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are major health care problems worldwide even in Pediatric population. The etiology of CKD in children with ESRD is varied. Most of them are started on peritoneal dialysis or hemodialysis before being considered for renal transplantation.The aims and objective of this study was to analyzed the patient group, methodology, results and outcomes of hemodialysis catheter insertion and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion for children with ESRD. The etiology of ESRD in children with CKD is also reviewed.Methods: All children with ESRD who underwent CAPD catheter and haemodialysis catheter insertion over a period of 5 years were included in the study. CAPD catheters were inserted by open and laparoscopic assisted methods. The procedures were done without image guidance due to logistical constraints in a limited resource scenario. Analysis of all relevant case records, operative notes and postoperative events were done.Results: A total of 40 patients who underwent CAPD and hemodialysis catheter insertions were analysed. The primary cases (no previous insertion of dialysis catheter) included 29 and secondary cases (history of previous insertion of dialysis catheter) were 7. Re-insertions (of the same type of dialysis catheter) were 2 in each group. No significant complications occurred in either group.Conclusions: Dialysis catheters for ESRD in Paediatric population can be inserted safely even without image guidance and with very few complications.

MON-070 NON-INFECTIOUS COMPLICATIONS OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS IN BANGLADESH: A SINGLE CENTRE EXPERIENCE

Continuous Ambulatory Peritoneal dialysis (CAPD) is increasingly getting popularity as a form of renal replacement therapy in end stage kidney disease (ESKD) patients of Bangladesh. Although CAPD may offer some advantages over Haemodialysis (HD) and is generally better tolerated, it is not without complications. Peritonitis is a well known complication of CAPD. However, non-infectious complications, though less common, are increasingly being recognized and can impact survival of this technique. The aim of this study was to evaluate the non-infectious complications of CAPD along with the outcome of patients performing CAPD in Bangladesh. This retrospective study was performed in a specialized kidney hospital in Dhaka, Bangladesh. Patients with end stage kidney disease who underwent percutaneous peritoneal dialysis catheter (double cuffed coiled Tenckhoff catheter) insertion by Seldinger technique over a period of one year from August 2017 to July 2018 were included. Patient’s files were reviewed and patients were interviewed by telephone calls. The nature and frequency of non-infectious complications and its impact on patients were analyzed. During the study period a total of 68 patients underwent CAPD catheter insertion and in one patient operation was abandoned due to bowel perforation. Average age of the patients was 56.7 ± 11.6 (24 to 90 years). Number of female patients was higher than male patients (48.5% vs 51.5%). Diabetic nephropathy was the most common (67.7%) cause of ESKD. The mean duration of follow up was 7.7 ± 3.4 months (1–15 months). CAPD was started on an average of 11.4 ± 3.0 (5 to 29) days after catheter insertion. Overall non-infectious complications were noted in 30.9% cases (21 out of 68). Pain was most commonly reported (19.7%) followed by haemoperitoneum (9.1%), leakage of fluids (7.6%) and malposition of catheter (1.5%). None of the patients suffered from hydrothorax, hernia or ultrafiltration failure during the study period. All the haemoperitoneum cases were secondary to anticoagulant use and resolved after omitting the anticoagulant for few days and daily flushes. Patients who had exit site leakage required temporary withdrawal of CAPD with or without temporary haemodialysis and/or secondary stitches but their CAPD was resumed after an interval. The patient with catheter malposition required catheter repositioning and CAPD could be performed after that. At the end of one year, 51 (75%) patients were continuing CAPD, five patients were shifted to haemodialysis due to either peritonitis (n=2) or financial problem (n=2) or non-compliance (n=1); one patient underwent renal transplantation and in one patient catheter was removed as renal function recovered. A total of 10 patients died during the study period, giving an overall mortality rate of 14.7%. Our study demonstrated that non-infectious complications affected about one third of the patients performing CAPD, though majority of those were managed conservatively. None of these complications affected catheter survival during the study period. Better understanding of the non-infectious complications of PD will help prevent, early recognize and manage them appropriately, making PD more acceptable and long lasting form of renal replacement therapy.

A study on the non-infectious complications of continuous ambulatory peritoneal dialysis

Introduction: Patients with end-stage renal disease (ESRD) are treated with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD).Non-infectious complications of CAPD are increasing in relative importance due to success in decreasing the rate of peritonitis. Aims and objectives: Our aim was to study the non-infectious complications in patients of ESRD on CAPD and to study the impact of the non-infectious complications in the survival of CAPD catheters. Materials and Methods: A prospective study has been conducted at Regional institute of medical science, Imphal in a total of 71patients of ESRD who are already on CAPD or newly diagnosed ESRD who have undergone CAPD catheter implantation. Their detailed history, clinical examination and relevant laboratory investigations were done and the different non-infectious complications were identified and analysed. Result: Out of the 71 patients studied 39 patients had complications like hypokalemia (15 patients), omental wrap (10 patients), catheter tip migration (6 patients), haemoperitonium (2 patients), hydrothorax (2patients), exit site leak(2patients), abdominal wall edema (1patient), catheter block(1patient). Conclusion: In our study the most common non-infectious complication was hypokalemia followed by omental wrap and catheter tip migration. Knowledge about the common prevalent non-infectious complications of CAPD alerts the treating doctor to take up the specific corrective steps at an earlier stage, thus preventing the morbidity associated with the same. We conclude that the majority of non-infectious complications in these patients were treatable and did not interfere with the catheter survival.

Outcomes of Laparoscopic and Open CAPD Catheter Placement: A Single-Center Experience

Background: Continuous Ambulatory Peritoneal Dialysis (CAPD) catheter placement is typically a straightforward surgical procedure performed on chronically ill patients with end-stage renal disease (ESRD). Post-operative outcomes and reoperative rates vary greatly in the medical literature. We report our experience using both minimally invasive and open techniques in placing CAPD catheters and offer our surgical outcomes. Methods: This study is an IRB-approved, retrospective review (2005-2018) of all patients undergoing CAPD catheter placement at Mayo Clinic-Rochester. Analysis focused on specific patient outcomes, including early ( 30 days) complication and reoperation rates. Results: A total of 173 patients with ESRD (mean ASA score =3.1) underwent laparoscopic (n=22) and open (n=151) CAPD catheter placement (mean follow-up = 309 days; range: 1-3497 days). The total index operation complication rate was 41%. The total index reoperation rate was 37%and was similar in open and laparoscopic approaches. CAPD catheters malfunctioned in 19patients (11% of total) and each underwent reoperation. CAPD catheter infections occurred in30 patients (17% of total), and 24 required reoperation; 6 patients were treated successfully with antibiotics. CAPD catheter migrations occurred in 21 patients (12% of total) and all underwent reoperation. Conclusion: Although CAPD catheter placements in patients with ESRD are technically easy to accomplish, the long term outcomes suggest as many as one in three patients will struggle with catheter function or infection. This study has led to changes in our technical CAPD catheter placement procedures, as well as the post-operative patient care algorithm.

Transversus abdominis plane block to the rescue

Chronic kidney disease (CKD) is one of the most prevalent conditions worldwide. Patients with CKD require haemodialysis on a regular basis. Peritoneal dialysis is the procedure of choice for renal replacement therapy in patients with end stage renal disease (ESRD). A 43-year-old female patient, diagnosed with cardio renal syndrome (CRS) type 2 was scheduled for continuous ambulatory peritoneal dialysis catheter (CAPD) insertion. Considering the poor condition of her heart and kidneys, bilateral transversus abdominis plane (TAP) block (midline incision) along with monitored anaesthesia care (MAC) was administered thus reducing the perioperative complications.

Minimally invasive surgery for salvage of malfunctioning peritoneal dialysis catheters.

Background:Malfunction of continuous ambulatory peritoneal dialysis (CAPD) catheters is a frequent complication and has traditionally been treated with a laparotomy. We present our experience with minimally invasive surgical (laparoscopic and thoracoscopic) salvage of CAPD catheters.Materials and Methods:Between October 2003 and June 2013, 19 patients (13 males and 6 females with a mean age of 37 years [range 28–64]) underwent minimally invasive laparoscopic salvage of malfunctioning CAPD catheters. These catheters had been placed with either a percutaneous or open technique and had been in place for a mean of 4.5 months (range 2–18 months). All the salvage procedures were performed under general anaesthesia using one 10 mm and two or three 5 mm ports. The various manoeuvres undertaken to re-establish catheter function included correct positioning the catheter and anchoring it to the pelvic peritoneum, clearing the fibrin clot/sheath, freeing up the omentum/bowel/taenia coli. In addition, all patients underwent an omentopexy.Results:Laparoscopic salvage could be completed in 18 patients with good catheter inflow and outflow established at the end of the surgery and one patient underwent thoracoscopic salvage. The median operative time was 63 min (range 45–96 min) and median post-operative hospital stay was 2 days (range 2–5 days). Low volume dialysis was commenced the day after surgery and full volume dialysis by the 10th day. There were no intra- or post-operative complications. All the catheters were functioning at the end of 6-month follow-up.Conclusions:Minimally invasive surgery is a valid, safe and efficacious way of salvaging malfunctioning CAPD catheters. This modality reduces the chances of re-formation of adhesions, ensures rapid recovery, reduced wound-related complications and allows for early institution of peritoneal dialysis.

Laparoscopy for continuous ambulatory peritoneal dialysis catheter placement and management of malfunctioning peritoneal dialysis catheter.

Laparoscopy for continuous ambulatory peritoneal dialysis catheter placement and management of malfunctioning peritoneal dialysis catheter.

Anaesthetic Management of High Risk Chronic Kidney Disease Patient for Continuous Ambulatory Peritoneal Dialysis Catheter Insertion with Omentectomy

Anaesthetic Management of High Risk Chronic Kidney Disease Patient for Continuous Ambulatory Peritoneal Dialysis Catheter Insertion with Omentectomy