Peritoneal Dialysis Catheter Research Articles

Associations between initial dialysis access types and death from dialysis withdrawal in incident patients with kidney failure

Abstract Background Patients receiving haemodialysis via central venous catheter (HD-CVC) have been shown to have an increased risk of all-cause mortality. It is unclear whether death from dialysis withdrawal is associated with the high mortality risk observed in patients initiated on HD-CVC. Methods Using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we examined the association between initial dialysis access (HD-CVC, haemodialysis via arteriovenous fistula [HD-AVF], and peritoneal dialysis [PD] via PD catheter [PD-PDC]) and death from dialysis withdrawal in adult patients starting dialysis in Australia between 2005 and 2022, analysed by time-stratified adjusted Cox regression with propensity score matched cohorts. Results Of 47 412 incident patients followed for a median of 2.65 years (interquartile range 1.19–4.87), 8170 (17%) died from dialysis withdrawal. Compared to patients initiated on HD-AVF, patients initiated on HD-CVC were more likely to experience death from dialysis withdrawal in the first 3 years after dialysis initiation, but not after 3 years (adjusted hazard ratios 2.43 [95% confidence interval 1.95–3.02], 2.06 [1.67–2.53], 1.57 [1.40–1.76], 1.06 [0.97–1.15] for 0–6 months, >6–12 months, >1–3 years, and > 3 years after dialysis initiation, respectively). Comparison between patients initiated on HD-CVD and PD-PDC showed similar estimates. No difference in withdrawal risk was observed between patients initiated on HD-AVF and PD-PDC. Conclusions Patients initiated on HD-CVC were twice as likely to experience early death from dialysis withdrawal compared to patients who had initiated dialysis with HD-AVF or PD-PDC. The increased risks diminished over time and were not observed after three years on dialysis.

Acute appendicitis and secondary peritonitis in a patient with end-stage renal failure and a dormant peritoneal dialysis catheter

Peritoneal dialysis (PD) is a common renal replacement therapy for patients with end-stage renal disease (ESRD). Despite its benefits, PD-related peritonitis remains a severe complication, often associated with significant morbidity and mortality. Although most cases of PD-related peritonitis are due to touch contamination, intra-abdominal infections, such as appendicitis, are less common but can result in severe outcomes. We present a case of severe peritonitis secondary to perforated appendicitis in a patient with a dormant PD catheter. A 41-year-old male with ESRD, previously on PD, presented with a 36-hour history of fever, chills, nausea, and abdominal pain. Despite transitioning to hemodialysis, the patient had retained his PD catheter, which had not been used for months. On admission, the patient was septic with evidence of peritonitis. Blood cultures were positive for Escherichia coli, while PD catheter cultures were negative. An abdominal CT scan revealed a gangrenous perforated appendix. The patient underwent an emergency laparoscopic appendectomy and PD catheter removal, resulting in significant clinical improvement. Perforated appendicitis in ESRD patients with a PD catheter can result in severe peritonitis with life-threatening complications, including sepsis and cardiac events. This case underscores the importance of maintaining a high index of suspicion for intra-abdominal causes of peritonitis in PD patients, even when the PD catheter is dormant. Timely diagnosis, empiric antibiotic therapy, and prompt surgical management are essential to reduce mortality in these patients.

The incidence of inflow and drain pain and associated risk factors for patients on peritoneal dialysis

BackgroundThe high prevalence and prolonged duration of inflow pain and drain pain experienced by peritoneal dialysis (PD) patients following PD catheter implantation impact their quality of life. However, there is limited data on the frequency and predisposing factors of these pains in the Chinese population undergoing peritoneal dialysis.MethodsThis study encompassed individuals who underwent peritoneal dialysis catheter implantation at our institution from September 1, 2023, to March 31, 2024. Patients’ experiences of inflow pain and drain pain were evaluated using a questionnaire survey and the visual analog scale (VAS), with pain status followed up via telephone for 3 months post-surgery.ResultsA total of 141 patients were included in this study. Inflow pain occurred at rates of 56.0%, 20.9%, 16.9%, and 17.3% at 1-week, 1-month, 2-month, and 3-month postoperatively, respectively, while drain pain rates were 51.8%, 24.3%, 22.3%, and 19.5% for the same period. Slowing down the infusion rate of dialysate (57.0%) or stopping its drainage (60.3%) proved effective in reducing pain. Logistic regression analysis revealed that age (OR = 0.96, P = 0.02), gender (OR = 0.37, P = 0.03), and the method of PD catheter implantation (OR = 2.37, P = 0.04) were independent factors associated with inflow or drain pain within 1-week postoperatively.ConclusionThe occurrence of inflow pain and drain pain following peritoneal dialysis catheter implantation is notable. Age, gender, and the method of catheter implantation were identified as independent factors influencing the incidence of inflow or drain pain within the first postoperative week.

Real World Testing of a Clinical Strategy to Start Early Peritoneal Dialysis for High-Risk Newborns Following Cardiac Surgery.

The beneficial impact of peritoneal dialysis (PD) catheter placement following cardiopulmonary bypass in young infants has been demonstrated. But the indications to start early peritoneal dialysis are not agreed upon. This retrospective single center study was conducted to evaluate the performance of a clinical strategy for early PD start. PD catheters were placed in the operating room (OR) following cardiopulmonary bypass (CPB). Those with prolonged CPB times (>180 minutes), post-operative (post-op) oligo-anuria and/or inability to achieve negative fluid balance in post-op 24 hours were evaluated as high-risk and selected for early PD start (PD +). All PD + were started within the first post-op 24 hours. Primary outcomes were 5% fluid accumulation at post-op 48 hours and severe acute kidney injury (AKI) at post-op day 5. There were forty-nine newborns. Twenty-nine subjects were early PD (PD +) starts and twenty used the PD catheter as an abdominal drain (PD -). Baseline demographic data were similar. Both groups were oliguric during post-op first 8 hours (p= 0.906). The Early PD (+) group produced significantly less urine output during post-op day 1 (0.98 vs 3.02 ml/kg/hour; p= 0.001). At post-op 48 hours, early PD (+) group had similar prevalence of 5% fluid accumulation as early PD (-), 5 (16.7%) vs. 2 (7.41%), respectively (p= 0.427). Severe AKI incidence at post-op day 5 was similar between the groups (17.3% vs 5.0%; p=0.204). Time to extubation was longer for early PD (+) group compared to PD (-) group, 10.0 days [7.0;16.0] vs. 4.0 days [4.0;10.0] (p=0.017). Persistent oliguria and inability to achieve negative fluid balance during initial post-op 24 hours may identify those newborns who will benefit from early PD. The first post-operative 8 hours was indiscriminative for this strategy. PD start may ameliorate the disadvantage for the designated group.

Continuous ambulatory peritoneal dialysis technique failure in adult patients treated at a tertiary hospital in central South Africa: a retrospective analytical study

BackgroundContinuous ambulatory peritoneal dialysis (CAPD) is one of the kidney replacement therapy (KRT) modalities used in patients with kidney failure. It is the preferred modality in most resource-limited settings as it is more accessible and cost-effective. CAPD technique failure remains a challenge and is associated with an increased risk of morbidity and mortality. We aimed to describe the sociodemographic and clinical characteristics, CAPD survival rate and the reasons for CAPD technique failure over a five-year period among adult patients on CAPD at a tertiary hospital in South Africa.MethodsWe conducted a retrospective analytical study reviewing files of patients with end-stage kidney disease (ESKD) whose peritoneal dialysis (PD) catheter was removed, or who died with a functioning PD catheter while on the PD program at Universitas Academic Hospital in Bloemfontein, South Africa, from 01 January 2015 until 31 December 2019. The demographic, clinical and laboratory data were collected from patients' medical records. Clinical outcomes were technique failure and survival.ResultsNinety-one patient records met the inclusion criteria of whom 51 (56.0%) were male. The median age at commencement of PD was 40 years (interquartile range [IQR] 18–58). Fifty-one (57.3%) patients were single and 64 (70.0%) were unemployed. Hypertension was the leading cause of ESKD (n = 47; 51.6%), followed by human immunodeficiency virus- (HIV-) associated conditions (n = 18; 19.8%). Technique failure rates at 1-, 2-, 3-, 4- and 5-years post-PD initiation were 31.9%, 35.2%, 13.2%, 8.8% and 11.0%, respectively. The 5-year survival rate was 63.7% (n = 58), with a median survival time of 26 months (IQR 1–54). Peritonitis was the leading cause of technique failure (n = 52; 57.1%), and almost a third (n = 29 (31.9%)) had a fatal outcome. Younger age and using the Dianeal® PD system were associated with an increased likelihood of technique failure. No other sociodemographic, laboratory and clinical factors were associated with the development of technique failure or death.ConclusionsPD-associated peritonitis is the primary cause of technique failure, followed by sudden unexpected death occurring at home. Preventive measures need to be adhered to in order to avoid high rates of peritonitis.

A modified open surgical revision technique for malfunctioning peritoneal dialysis catheter

Backgrounds: The malfunction of peritoneal dialysis (PD) catheter is still an intractable problem. A modified open surgical revision technique with suturing fixation and without catheter removal for malfunctioning catheter was developed to evaluated the efficacy and safety between simultaneous catheter replacement technique. Methods: A total of 167 PD patients with malfunctioning catheter were retrospectively reviewed. For the salvage of PD catheters, patients underwent modified open surgical revision (group A) or simultaneous catheter replacement (group B). The baseline characteristics before operation, perioperative condition, complications and outcomes were compared between both groups. Results: Patients of group A showed significantly shorter operative time (67.4 ± 22.1 versus 82.8 ± 21.1 min, p = 0.009), less postoperative pain score within 24 h (median 0.0 versus 2.0, p < 0.001), quicker start of PD (1.06 ± 0.31 versus 1.89 ± 0.89 days, p < 0.001), shorter length of stay (9.89 ± 5.11 versus 12.55 ± 7.37 days, p = 0.020) than group B. In terms of complications, the incidence of recurred catheter malfunction in group A was significantly lower than those in group B (1/114 versus 12/53, p < 0.001). There were no significant differences in mechanical complications (bloody effluent, dialysate leakage, and hernia) and early peritonitis between the groups. The group A patients had a favorable catheter survival rate compared with group B (log-rank, p = 0.004). Conclusions: Our modified open surgical revision technique is a safe, simple and fast method, and offers a better outcome with minimal risk of recurrence of catheter malfunction without additional cost and equipment. This technique is worthy of clinical application.

Peritoneal Dialysis Catheter Placement on the Right Side of the Falciform Ligament to Prevent Obstruction by the Omentum.

We describe a simple and reproducible technique for neonatal peritoneal dialysis catheter insertion following cardiac surgery which prevents the catheter from becoming blocked by the omentum.

Percutaneous implantation of the catheter for peritoneal dialysis by the nephrologist

Percutaneous implantation of the catheter for peritoneal dialysis by the nephrologist

Tsukamurella conjunctivitidis peritonitis diagnosed by 16S rRNA gene sequencing in a patient undergoing peritoneal dialysis.

Peritoneal dialysis (PD)-associated peritonitis remains a serious and life-threatening complication in patients undergoing PD. Majority of peritonitis cases are caused by bacteria, with coagulase-negative Staphylococcus being the most common cause. Tsukamurella species are obligate aerobic gram-positive bacilli found in various environments; however, peritonitis caused by Tsukamurella species in association with PD is rare, with few reports of infections caused by T. conjunctivitidis, including PD-associated peritonitis. We describe a rare case of peritonitis caused by T. conjunctivitidis in a patient undergoing PD. A 62-year-old man undergoing PD was referred to our hospital for fever and abdominal pain lasting for 4days and was diagnosed with PD-associated peritonitis based on abdominal pain, cloudy effluent, elevated white blood cell count in the peritoneal fluid, and presence of gram-positive rods in the effluent culture. Yellow-grayish, dry, membrane-like colonies were observed on a blood agar plate. The isolated strain was identified as T. conjunctivitidis through 16S rRNA gene sequencing. Because the PD-associated peritonitis was refractory to antibiotics, the PD catheter was removed, and the patient was switched to hemodialysis on day 21 of admission. Clinicians should consider peritonitis caused by T. conjunctivitidis as a differential diagnosis in cases where diagnosis using routine examination is challenging. Notably, 16S rRNA gene sequencing is a useful diagnostic tool for identifying T. conjunctivitidis. Further analyses of similar cases are required to understand the characteristics of such infections and establish adequate diagnostic methods and treatment regimens.

Comparative analysis of complications and technique survival in peritoneal dialysis catheter insertion: single purse-string suture vs. double purses-string suture

Objective Single- and double-purse-string suture methods are both widely used in open surgical catheterization for peritoneal dialysis. This study aimed to compare the post-insertion complications and technical survival of the two methods. Methods This retrospective study matched 142 patients who underwent peritoneal catheterization using the single- (Group S) or double- (Group D) purse-string suture method. Baseline clinical data and complications were recorded, and technical and patient survival rates were evaluated over 3 years. Results There were no significant intergroup differences in terms of infection complication rates (S, 2.8% vs. D, 5.6%, p = 0.377) or non-infection complication rates (2.1% vs. 2.8%, p = 1.000) within the first month post-insertion. The Kaplan–Meier estimates of technical survival at 1, 2, and 3 years were 96.3%, 90.4%, and 85.9% in group S and 89.9%, 86.7%, and 84.8% in group D, respectively (log-rank test, p = 0.439). Additionally, patient survival rates were comparable between groups over the 3-year follow-up (log-rank test, p = 0.647). Conclusions This study revealed that the single- and double-purse-string suture catheter insertion methods have similar post-insertion complication and technical survival rates. These data suggest that the single-purse-string suture method can be adopted as standard practice for peritoneal dialysis catheter placement.

A rare case of refractory ascites due to aortic regurgitation delaying peritoneal dialysis catheter removal after renal transplantation

Introduction Removing the peritoneal dialysis (PD) catheter after transplantation is necessary in order to improve quality of life after transplantation. However, there is no consensus on the best timeframe of PD-catheter removal in transplanted patients. Early removal can lead to the absence of dialysis access in case of graft failure. However, late removal is associated with significant infectious risk given the immunosuppression. Herein, we describe an exceptional case of refractory ascites secondary to aortic regurgitation in a cirrhotic patient, delaying the removal of his PD catheter. Case reportWe describe the case of a 49-year old patient, with Child B cirrhosis and end-stage kidney disease on chronic peritoneal dialysis who benefited from kidney transplantation. The scheduled PD catheter flushes were marked by the drainage of ascitic fluid, leading to the postponement of the PD catheter removal. The ascites, thought to be secondary to his long-known cirrhosis, was refractory to optimal drug treatment and the PD catheter was used to remove ascites periodically. As a transjugular intrahepatic portosystemic shunt was planned, a severe aortic regurgitation was diagnosed. After aortic valve replacement, the ascites completely disappeared, and the PD catheter could be removed.DiscussionHeart failure represents only 3% of all refractory ascites. Furthermore, left-side heart failure causing ascites but without signs of right-side heart failure has only been described once in the medical literature. Patients with ascites and kidney failure on PD can safely be managed through the PD catheter instead of recurrent paracentesis. However, in transplanted patients especially, keeping the catheter in place brings significant infectious risk. ConclusionWe described an unusual case of refractory ascites after renal transplantation, due to aortic valve regurgitation. This case highlights the importance of weighing the pros and cons of early PD catheter removal, as PD catheter might be useful as a means of removing ascites.

Percutaneous versus surgical catheter insertion for peritoneal dialysis: a systematic review and meta-analysis of randomized controlled trials.

Peritoneal dialysis (PD) is used as a kidney replacement therapy for patients with kidney failure. Institutional practices vary considerably, and the optimal technique for insertion of PD catheters is unknown. This study compared the efficacy and safety of surgical versus percutaneous approaches to PD catheter insertion for patients with end-stage kidney disease. Electronic databases (MEDLINE, Embase, CENTRAL) were systematically searched and analysed for relevant randomized controlled trials (RCTs). Eligible RCTs for inclusion were those that compared surgical versus percutaneous approaches to catheter insertion for patients undergoing PD dialysis. Outcomes of interest were patient- and catheter-related complications. In this study risk of bias was assessed using the Cochrane Risk of Bias Tool for RCTs. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment and Evaluation (GRADE) approach. Four studies (397 participants) were included. With regards to surgical approaches, only one study evaluated laparoscopic insertion; all other studies reported on open surgical techniques. Percutaneous insertion techniques varied significantly between the studies. No difference in patient mortality was found (RR = 0.82, 95% CI = 0.43-1.57, I2 = 0%). Percutaneous techniques were associated with lower rates of early peritonitis (RR = 0.34, 95% CI = 0.12-0.91, I2 = 0%) and long-term catheter failure (RR = 0.69, 95% CI = 0.47-1.00, I2 = 0%) than surgical approaches. Percutaneous catheter insertion was also associated with reduced late peri-catheter leak rates (RR = 0.35, 95% CI = 0.12-0.98, I2 = 0%) and peri-procedural complications (RR = 0.25, 95% CI = 0.07-0.90, I2 = 0%). The overall risk of bias was moderate, and certainty of evidence was low or very low. Whilst percutaneous PD insertion techniques may have lower early and late complications compared to surgical technique, there was a lack of high-quality evidence comparing outcomes between contemporary percutaneous and surgical PD catheter insertion techniques. Future RCTs are required to compare the safety and efficacy of modern percutaneous with laparoscopic techniques.

Ultrasound-Guided Peritoneal Dialysis Catheter Placement: A Probing Review

Ultrasound-Guided Peritoneal Dialysis Catheter Placement: A Probing Review

Admissions Within the First Year After Kidney Transplantation: Evaluation of Risk Factors, Causes, and Outcomes

Objectives: The aim of this study was to evaluate causes of hospital admission within the 1st year after kidney transplantation in a public hospital. Methods: This is a retrospective cohort. Data were collected by medical record review. Inclusion criteria were age older than 18 years and kidney transplant. Exclusion criteria were double transplant, primary graft failure, and in-hospital death after transplant procedure. Outcomes included 4-year patient survival (primary outcome), 1-year graft failure, and graft function in 1 year. Results: A total of 130 patients were evaluated. There was a predominance of male sex, glomerulonephritis, history of hemodialysis, first kidney transplant, and deceased donor kidneys. Hospital admission in the 1st year occurred in 71.5%. There were three deaths at the first admission (two had cardiovascular causes). The most frequent causes of admission were infections, rejection, and surgical complications. Less common causes included elective procedures such as peritoneal dialysis catheter removal. There was no statistically significant association between categorical and continuous variables studied and the occurrence of hospital admission. Also, hospital admission did not influence primary outcome or 1-year graft failure rate. However, it was associated with lower graft function at 1 year (both by serum creatinine and by estimated glomerular filtration rate – p &lt; 0.05). Conclusion: There was a high incidence of hospital admission, and first admissions resulted in death in three patients (noninfectious causes). Considering the contribution of elective procedures to the high incidence of admission, we propose that hospital managers focus on improving the ability to solve such problems in the outpatient setting.

Prevalence of Patent Processus Vaginalis Diagnosed Using Laparoscopy during Peritoneal Dialysis Catheter Insertion and Subsequent Genital Edema: A Prospective Observational Study

Introduction: Inguinal hernia and genital edema are relatively common complications of peritoneal dialysis (PD). Although patent processus vaginalis (PV) is considered an important factor associated with these complications, the prevalence of patent PV at PD initiation and whether it leads to these complications has not been fully identified. Methods: A total of 71 patients were included in this study, 41 of whom underwent laparoscopy-assisted catheter placement. The remaining 30 patients did not undergo laparoscopy mainly because of a lack of patient consent. During laparoscopy, if a dimple or small canal toward the deep inguinal ring was observed, the groin was diagnosed as a patent PV. Results: Laparoscopy revealed that 9 of 41 patients (22%) had patent PV (male, 29.6%; female, 7.1%). Genital edema occurred in 2 of the nine patients with patent PV at 8.9 and 11.4 months after PD initiation, respectively. However, none of 32 patients without patent PV developed this complication. Two of 30 patients without laparoscopic inspection presented with genital edema at 6.7 and 12.4 months after PD initiation, respectively. Among the 71 patients, body mass index was significantly higher in patients with this complication than in those without (28.8 vs. 22.8, p 0.013). Conclusion: Although the number of patients with patent PV who manifested genital edema was small, our results suggest that patent PV at PD initiation may be an important contributor for genital edema in patients undergoing PD. Further studies are needed to determine whether the repair of patent PV could prevent subsequent genital edema.

Systematic literature review of the diagnosis, prognosis, and treatment of peritoneal dialysis-related infection caused by nontuberculous mycobacteria

The number of peritoneal dialysis (PD) catheter-related infections and peritonitis caused by nontuberculous mycobacteria (NTM) has been increasing. Nonetheless, the optimal timing for the relocation of the exit site, removal and reinsertion of the PD catheter, prognosis, and duration of antibiotic treatment remain unclear. This literature review aimed to investigate the epidemiology of patient characteristics and evaluate the most effective diagnostic and treatment strategies for PD catheter-related infections and peritonitis caused by NTM. The systematic literature review was conducted on published cases of PD catheter-related infection and peritonitis caused by NTM in PubMed, Embase, and Ichushi databases up to August 2022. A total of 335 cases (64.1%, male; mean age, 53.4 years; mean dialysis duration, 25.4 months) were analyzed. The most common causative agent of infection was Mycobacterium abscessus (40.1%), followed by Mycobacterium fortuitum (24.8%) and Mycobacterium chelonae (16.6%). With respect to diagnosis, 42.9%, 28.1%, and 29.0% of cases were diagnosed as PD catheter-related infection only, peritonitis only, and both, respectively. The initial cultures were positive for NTM only, positive for any other bacteria, and negative for NTM only in 56.5%, 19.8%, and 23.7% of cases, respectively. Ultimately, more than 80% of cases were treated with multiple antibiotics. PD catheter removal was performed in 55.4% of patients with PD catheter-related infections only and 85.5% of those with PD peritonitis. PD continuation or resumption was possible in 62.2% and 16.0% of patients, respectively. In conclusion, our findings indicate that it is advisable to perform acid-fast bacilli stain and culture in order to promptly identify NTM. PD catheter removal may be an essential management strategy during the early stages of NTM infection.

Association Between Transient Hemodialysis and Risk of Bleeding During Peritoneal Dialysis Catheterization.

Background: Although the risk of serious bleeding following peritoneal dialysis catheter insertion is low, pericannular bleeding can increase the risk of catheter-related infections and reduce catheter survival. We aimed to analyze the risk factors for bleeding complications during peritoneal dialysis catheter insertion and assess whether temporary preemptive hemodialysis before catheterization can reduce bleeding and improve catheter survival. Methods: We retrospectively analyzed bleeding complications and catheter survival in patients who underwent temporary hemodialysis prior to peritoneal dialysis catheter insertion. Cox regression analysis was performed to determine the risk factors for bleeding complications and catheter survival. Results: Among 336 patients, 216 and 120 comprised the non-hemodialysis and hemodialysis groups, respectively. No significant association was found between temporary hemodialysis and bleeding (hazard ratio: 1.6, 95% confidence interval: 0.87-2.95, p < 0.134). Multivariate analysis revealed an inverse association of platelet count (hazard ratio: 0.99, 95% confidence interval: 0.99-0.99, p < 0.048) and hemoglobin level (hazard ratio: 0.78, 95% confidence interval: 0.61-0.99, p < 0.04) with bleeding. A positive association was observed between international normalized ratio (hazard ratio: 2.24, 95% confidence interval: 1.19-4.19, p < 0.012) and bleeding. Conversely, temporary hemodialysis was not associated with catheter survival (hazard ratio: 1.64, 95% confidence interval: 0.63-4.25, p < 0.308). Conclusions: Temporary hemodialysis before peritoneal dialysis catheter insertion did not significantly affect bleeding risk in patients with a high risk of uremic bleeding.

Relapsing peritoneal dialysis-associated peritonitis caused by Corynebacterium striatum: a case report.

Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD, and its prevention and treatment are important for reducing patient morbidity and mortality. Reports of PD-associated peritonitis caused by Corynebacterium spp. are limited, and PD-associated peritonitis caused by Corynebacterium striatum (C. striatum) is rare. Only two case reports are available, wherein improvement was only achieved after intraperitoneal administration of antibiotics. Here, we report a case of relapsing PD-associated peritonitis caused by C. striatum that did not improve with antibiotic therapy. In this case, the patient started PD due to end-stage renal failure with immunoglobulin A nephropathy. In addition, he had been diagnosed with bronchiectasis and was prescribed clarithromycin. Four days after PD induction, the patient developed culture-negative PD-associated peritonitis. Ceftazidime and cefazolin were subsequently administered intraperitoneally for a total of 14days, resulting in improvement in his condition. However, 3 and 5months after PD induction, he developed PD-associated peritonitis again, and C. striatum was detected in each culture. He was treated with intraperitoneal vancomycin for a total of 14days and improved; however, he developed PD-associated culture-negative peritonitis again 7months later. We diagnosed relapsing PD-associated peritonitis caused by C. striatum. PD catheter removal and reinsertion were performed, and he has not relapsed since. In conclusion, PD-associated peritonitis caused by C. striatum may have a poor prognosis; therefore, PD catheter removal is recommended, especially in patients with a history of repeated PD-related peritonitis due to C. striatum.

Risk factors, management and outcomes for peritoneal dialysis access damage

Objectives: Peritoneal dialysis (PD) access damage is an uncommon complication of PD. This study aimed to describe the characteristics, management and outcomes of PD access damage. Methods: This retrospective study included patients who suffered from PD access damage between January 2018 and January 2024 at the PD Center of West China Hospital. Patient characteristics and access damage information were collected from medical records. Results: A total of 128 PD patients without PD access damage were included in the control group. A total of 45 patients (51% male; aged 58 ± 14 years) suffered from 49 cases of PD access damage. Multivariate logistic analysis revealed that previous peritonitis [odds ratio (OR) 3.93; 95% confidence interval (CI) 1.56 to 9.94] and assisted PD (OR 4.20; 95% CI 1.25 to 14.12) were risk factors, while catheter belt use (OR 0.16; 95% CI 0.06 to 0.44) and training frequency per year (0.34; 95% CI 0.19 to 0.64) were protective factors against PD access damage. Managements included cutting and repairing (N = 24), transfer set replacement (N = 11), catheter removal (N = 9) and catheter replacement (N = 4). Thirty-nine patients continued with PD after access repair and were followed up for a median of 35 months. The repaired access functioned well during follow-up. Conclusions: In conclusion, to avoid PD access damage, catheter belt and routine retraining are recommended. Once PD access damage is identified, patients should clamp the catheter, take prophylactic antibiotics and resort to the treatment team. The treatment team should evaluate PD access and handle it according to a clinical protocol.

Colostomy formation in a peritoneal dialysis patient.

This case report discusses the complex management of a 46-year-old man with poorly controlled type 1 diabetes mellitus, stage 5 chronic kidney disease, and severe neuropathic complications, which led to bilateral leg amputations. The patient experienced persistent diarrhea due to diabetic neuropathy, significantly impairing his daily functioning. Despite transitioning from hemodialysis to peritoneal dialysis, the diarrhea persisted. A colostomy was subsequently performed, which, although it did not completely resolve the diarrhea, allowed for better control, improving the patient's self-care and independence. Notably, the catheter exit site was maintained on the opposite side of the abdomen. Despite initial concerns about the feasibility of peritoneal dialysis (PD) in patients with stomas, including the challenges of creating a stoma in patients with an existing PD catheter, this case demonstrates the successful continuation of PD following a colostomy. Traditionally, intestinal stomas have been viewed as a relative contraindication to PD due to risks such as leakage and infection. However, current guidelines recommend using extended catheters with a presternal exit site to minimize these risks. The patient's quality of life improved significantly after the colostomy, with no major complications observed during follow-up. This report underscores the importance of tailoring treatment to individual patient needs, balancing risks with potential well-being benefits, and highlights the necessity of interdisciplinary collaboration and adherence to best practices. Given the limited literature on PD in patients with intestinal stomas, this case contributes valuable clinical insights for future management.