Peritoneal Dialysis Catheter Survival Research Articles

Predictive factors for Peritoneal Dialysis Catheter Survival: a ten-year single center study

Introduction and Objectives: Timely insertion and adequate management of peritoneal dialysis catheter (PDC) related complications are crucial for the success of Peritoneal Dialysis. The aim of this study was to review the peritoneal dialysis catheter outcomes at our center, identifying factors that influence catheter survival. Materials and Methods: A retrospective study was conducted on 146 PD patients who received their first PDC between August/ 2012 and July/2022. The mean follow-up was 26.5 ± 22.7 months. Results: Mean age was 55.1 ± 16.6 years, and 58.2% were male. Peritonitis occurred in 75 patients (51.4%), with 26 (34.7%) requiring catheter removal. Mechanical complications were observed in 66 patients (45.2%), with 16 requiring catheter removal. Catheter survival at 12, 24, and 36 months was 80.2%, 72.4%, and 61.6%, respectively. Non-infectious complications (p=0.006) and peritonitis episodes (p=0.017) were associated with higher rate of PDC-associated removal. In the multivariate analysis, non-infectious complications were the only independent variable significantly associated with catheter survival (Hazard ratio 2.53; 95% CI 1.383–4.624). No association was found between PDC survival and age, diabetic status, obesity, prior kidney transplant, previous abdominal surgery, or method of catheter insertion. Conclusions: Despite the significant number of infectious complications, including peritonitis, these did not result in a substantial decrease in catheter survival in the multivariate analysis. These findings emphasize the importance of effectively managing non-infectious complications to ensure successful and long-term use of PDCs. Preventive measures, such as omentectomy simultaneously with PDC implantation, may be considered on a case-by-case basis.

The efficacy of cuff-shaving combined with negative pressure wound therapy in refractory exit-site and tunnel infections: a single center experience

BackgroundRefractory exit-site infections (ESIs) and tunnel infections (TIs) are challenging complications for patients undergoing peritoneal dialysis (PD). This study compared the outcomes of surgical intervention, notably the cuff-shaving (CS) procedure coupled with negative-pressure wound therapy (NPWT), and conservative management strategies for patients with refractory ESI and TI.MethodsWe retrospectively reviewed patients who underwent PD at our center, focusing on the incidence and management of ESI and TI. We evaluated and compared treatment outcomes, including ESI scores, frequency of ESI and/or TI, identification of causative microorganisms, and duration of catheter survival or time until removal.ResultsWe identified 97 episodes of catheter-related ESI and/or TI across 71 patients with an incidence rate of 0.15 episodes per patient-year. Of the 23 patients with refractory ESI and/or TI, surgical intervention was performed in 8, while 15 chose conservative management. In the one-month follow-up, patients who underwent CS combined with NPWT showed no complications such as leakage, and their local symptoms resolved completely. The mean PD catheter survival time was significantly longer in the surgical group (29.38 ± 7.25 months) than in the conservative group (7.86 ± 2.13 months). Surgical intervention demonstrated a significantly higher therapeutic efficacy and extended catheter survival.ConclusionsThe combination of CS and NPWT as a surgical approach is crucial for eradicating infectious foci and significantly improving the longevity of PD catheter function. This integrated surgical strategy offers a promising solution for the management of refractory ESI and TI in patients undergoing PD.

A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRD

Peritoneal dialysis (PD) shows promise for urgent-start dialysis in end-stage renal disease (ESRD), with automated PD (APD) having advantages. However, there is limited multicenter randomized controlled trial (RCT) evidence comparing APD with temporary hemodialysis (HD) for this indication in China. This multicenter RCT enrolled 116 patients with ESRD requiring urgent dialysis from 11 hospitals, randomized to APD or HD. Patients underwent a 2-week treatment with APD or HD via a temporary central venous catheter (CVC), followed by a maintenance PD. Outcomes were assessed over 12 months during 8 visits. The primary outcome was dialysis-related complications. The 1-year incidence of dialysis-related complications was significantly lower in the APD group than in the HD group (25.9% vs. 56.9%, P= 0.001). No significant differences were found between the groups in terms of PD catheter survival rates (P= 0.388), peritonitis-free survival rates (P= 0.335), and patient survival rates (P= 0.329). In terms of health economics, the total direct medical cost of the initial hospitalization for patients with ESRD was significantly lower in the APD group (27,008.39 CNY) than in the HD group (42,597.54 CNY) (P= 0.001), whereas the duration of the first hospital stay showed no significant difference (P= 0.424). For patients with ESRD needing urgent initiation of dialysis, APD was associated with a lower incidence of dialysis-related complications and lower initial hospitalization costs compared with HD, with no significant differences in PD catheter survival rate, peritonitis-free survival rates, or patient survival rates. These findings can guide clinical decision-making for the optimal dialysis modality for patients requiring urgent dialysis initiation.

Advanced Image-Guided Percutaneous Technique Versus Advanced Laparoscopic Surgical Technique for Peritoneal Dialysis Catheter Placement

Timely placement of a functional peritoneal dialysis (PD) catheter is crucial to long-term PD success. Advanced image-guided percutaneous and advanced laparoscopic techniques both represent best practice catheter placement options. Advanced image-guided percutaneous is a minimally invasive procedure that does not require general anesthesia. Retrospective cohort study comparing time from referral to procedure, complication rate, and 1-year catheter survival between placement techniques. Patients who had advanced laparoscopic or advanced image-guided percutaneous PD catheter placement from January 1, 2011 to December 31, 2013 in an integrated Northern California health care delivery system. PD catheter placement using advanced laparoscopic or advanced image-guided percutaneous techniques. One-year PD catheter survival; major, minor, and infectious complications; time from referral to PD catheter placement; and procedure time. Wilcoxon rank sum tests to compare referral and procedure times; χ2/Fisher exact tests to compare complications; and modified least-squares regression to compare adjusted 1-year catheter survival between PD placement techniques. We identified 191 and 238 PD catheters placed through advanced image-guided percutaneous and advanced laparoscopic techniques, respectively. Adjusted 1-year PD catheter survival was 80% (95% CI, 74%-87%) using advanced image-guided percutaneous technique vs 91% (87%-96%) using advanced laparoscopic technique (P=0.01). Major complications were<1% in both groups. Minor and infectious complications were 45.6% and 38.7% in advanced image-guided percutaneous and advanced laparoscopic techniques, respectively (P=0.01). Median days from referral to procedure were 12 and 33 for patients undergoing advanced image-guided percutaneous and advanced laparoscopic techniques, respectively (P<0.001). Median procedure time was 30 and 44.5 minutes for patients undergoing advanced image-guided percutaneous and advanced laparoscopic techniques, respectively (P<0.001). Retrospective study with practice preference influenced by timing, local expertise, and resources. Both advanced image-guided percutaneous and advanced laparoscopic techniques reported rare major complications and demonstrated excellent (advanced laparoscopic) and acceptable (advanced image-guided percutaneous) 1-year PD catheter survival. For patients referred for PD catheter placement at centers where advanced laparoscopic resources or expertise remain limited, the advanced image-guided percutaneous technique can provide a complementary and timely option to support the utilization of PD. Peritoneal dialysis is a preferred dialysis modality for many patients. However, the lack of available skilled surgeons can limit the placement of the peritoneal dialysis catheter in a timely manner. In the past decade, interventional radiology has developed expertise in placing peritoneal dialysis catheters. Using data from an integrated health care system, we compared the outcome of peritoneal dialysis catheters placed using laparoscopic surgery and interventional radiology techniques. Our results showed excellent 1-year patency of peritoneal dialysis catheters placed using laparoscopic surgery, whereas interventional radiology placement of catheters had lower but acceptable1-year patency survival, based on best practice guideline criteria. Hence, interventional radiology placement of peritoneal dialysis catheters may be a viable alternative when laparoscopic surgery is not available or feasible.

#4062 PERITONEAL DIALYSIS CATHETER SURVIVAL: A TEN-YEAR SINGLE CENTER STUDY

Abstract Background and aims Timely insertion and adequate management of peritoneal dialysis catheter (PDC) related complications are crucial for the success of Peritoneal Dialysis (PD). The aim of the present study was to review the peritoneal dialysis catheter outcomes at our center and evaluate variables influencing catheter survival. Methods We conducted a retrospective study including 146 patients who had their first PD catheter implanted between 1st of August 2012 and 31st of July 2022 in our institution. The primary endpoint was PD catheter failure, defined as removal of the PD catheter due to catheter-related complications. Kaplan-Meier curves were used to estimate catheter survival. Cox regression model was used to identify factors that were independently associated with catheter survival. All demographic and clinical characteristics of the patients and PD complications were included as covariates. A p value of less than 0.05 was considered statistically significant. Results The study population included 85 men and 61 women, aged 55.1 $ \pm {\rm{\ }}$ 16.7 years. Mean follow-up was 26.5 +/- 22.7 months. Diabetes was the most common etiology of the stage 5 chronic kidney disease (n = 41, 28%), followed by chronic glomerulonephritis (n = 30, 20.5%). Ninety patients (61.2%) had one or more comorbidities and seventeen (11,6%) had previous abdominal surgery. In 98 patients (60.1%), the PDC was inserted using a mini-laparotomy approach, whereas the laparoscopic method was used in 54 patients (33.1%). Only 8 patients (4.9%) had their catheter placed percutaneously using the Seldinger technique. The total number of patients with one or more PD-related infectious complications during follow-up was 99 (67%): 51 patients (31%) had a single episode and 29 (17.8%) had multiple episodes of peritonitis; 34 patients (20.9%) had a single episode of PD catheter related exit site or tunnel infection, while 47 (28.8%) had more than 1 event. Sixty-six patients (45%) had PD-related mechanical complications, mostly due to outflow failure (19 patients with catheter migration, 11 with omental wrapping). The remaining non-infectious complications were hernia (n = 20, 13.7%), hemoperitoneum (n = 8, 5,5%), leakage (n = 4, 2.7%) and pleuroperitoneal shunt (n = 4, 2.7%). Fourteen patients required intervention due to mechanical complications, namely repositioning of the catheter with fluoroscopic technique in 8 patients and surgical repositioning in 6. Removal of the catheter was required in 49 patients (33.6%). The leading cause of catheter removal was infection (n = 29, 59%): peritonitis in 28 patients and refractory tunnel infection in 1. Mechanical complications were also a significant factor, accounting for 40.8% of the removals (n = 20). Overall PD catheter survival rates over 12, 24 and 36 months were 80.2%, 72.4% and 61.6%, respectively. PD catheter-related non-infectious complications was the only independent variable significantly associated with catheter survival (Hazard ratio 2.573; 95% CI 1.426–4.645). No significant association was observed between the PD catheter survival and other risk factors including age, diabetic status, comorbidities, previous abdominal surgeries, method of catheter insertion or infectious complications. Conclusions PDC non-infectious complications were the only independent factor significantly associated with catheter survival. Despite the significant number of infectious complications, including peritonitis, it was found that these complications did not result in a significant decrease in catheter survival. These findings highlight the crucial role of proper management of peritoneal dialysis catheter-related non-infectious complications for successful and long-term usage of PDC.

Long-term impact of early non-infectious complications at the initiation of peritoneal dialysis.

Early non-infectious complications at initiation of peritoneal dialysis (PD) are a major burden with unknown long-term impacts on individuals. Prospective multicentre cohort study using univariable and multivariable Cox regression to identity mortality risk and PD discontinuation risk in those with and without non-infectious complications. All individuals commencing PD between 1 January 2014 and 31 December 2018, registered in the New Zealand Peritoneal Dialysis Registry (NZPDR) were followed up to 31 December 2020. Early non-infectious complications defined as functional, catheter-related, exit-site dialysate leak or anatomical leak complications occurring within 30 days of initiation of PD. Primary outcomes were patient survival and time on PD therapy. Secondary outcomes were peritonitis free survival, first PD catheter survival and catheter tunnel infection free survival. Of 1596 individuals included in the study, 102 experienced an early non-infectious complication. Multivariable analysis demonstrated these complications were associated with higher risk of overall mortality (hazard ratio (HR) 1.71; 95% confidence interval (CI) 1.21-2.44), PD discontinuation (HR 1.84; 95% CI 1.41-2.41) and first catheter failure (HR 2.89; 95% CI 2.28-3.66). No difference was found for risk of development of first peritonitis episode or catheter tunnel infection. Mortality risk was associated with functional and exit-site dialysate leak complications and continued beyond 180 days. Risk of PD discontinuation and first catheter loss were associated with catheter and functional complications in the first 180 days. Early non-infectious complications are associated with long-term mortality risk. Further research in risk factors and causes of early non-infectious complications are required.

Catheter Diversion Procedure With Exit-Site Renewal Promotes Peritoneal Dialysis Catheter Survival

IntroductionCatheter-related infections such as exit site infection (ESI) and tunnel infection (TI) are major causes of peritoneal dialysis (PD) discontinuation. For ESI/TI treatment, catheter diversion procedure (CDP) with exit-site renewal for catheter salvage presents an alternative to catheter removal. Nevertheless, CDP capability of improving PD catheter survival remains unclear.MethodsWe retrospectively reviewed our hospital patients who started PD during 2001–2019 (n=148): 33 treated for ESI/TI by CDP (CDP group) and 115 treated for ESI/TI using conservative therapy or none (non-CDP group). A “virtual discontinuation group” was designated for patients in the CDP group who had received PD catheter removal instead of CDP and who had stopped PD. Kaplan-Meier analysis and log-rank test PD were used for intergroup catheter survival comparison. Associations between clinical factors and PD discontinuation or death were examined using Cox proportional hazards regression analyses.ResultsFor patients (76% male, mean age of 61.7±13.0 years), 40 CDP were performed for 33 CDP group patients. Infection-free rates at 30 and 90 days after CDP were, respectively, 90% and 67%. The CDP group PD catheter survival rate was significantly higher than that of virtual discontinuation group (P < .01) and higher than that of the non-CDP group (P = .03). Multivariate analysis revealed independent association of serum albumin concentration (hazard ratio 0.33, 95% confidence interval 0.17–0.67), PD+HD combination therapy (hazard ratio 0.29, 95% confidence interval 0.17–0.49), and CDP (hazard ratio 0.44, 95% confidence interval 0.24–0.80) with PD discontinuation or death.ConclusionResults show that CDP may improve PD catheter survival as an effective and less-invasive surgical treatment for ESI/TI to avoid withdrawal of PD.

P1220COMPARISON OF PERITONEAL DIALYSIS CATHETER INSERTION TECHNIQUES BY NEPHROLOGISTS: SURGICAL METHOD VS BLIND METHOD USING A TROCAR

Abstract Background and Aims Successful PD requires timely peritoneal dialysis catheter (PDC) insertion and management of PDC related complications. Some societies have recently made an effort to increase PD and PDC insertion by nephrologists is an important issue. The aim of the present study was to evaluate comparative analysis of PDC insertion between blind and surgical methods by nephrologists. Method We reviewed medical records at a tertiary medical center in Korea and identified 249 adults who underwent first-time PDC insertion. All PDC insertions were performed using the blind or surgical methods. In our hospital during study period, two of three nephrologists performed the blind method routinely in all of eligible patients (blind group, n = 144). One of three nephrologists performed the surgical method in all of eligible patients (surgical group, n = 105). During follow-up, we collected data regarding peritoneal dialysis peritonitis (PDP), exit site and/or tunnel infection (ESI/TI). Catheter survivor was defined as maintaining of PD at July 2019 or PDC removal by PDC unrelated problems such as patient death due to PDC unrelated factors, kidney transplantation, patient demand, inadequate PD, improved renal function, poor oral intake due to abdominal distension, and colon cancer. Catheter non-survivor and/or PDC associated removal was defined as PDC removal by PDC related problems such as PDP, ESI/TI or PDC malfunction. Intervention-free non-survivor was defined as PDC revision, removal, or exchange by PDC related problems. Results Mean age at the PDC insertion in blind and surgical groups were 57.5 ± 13.7 and 56.3 ± 12.9 years, respectively (P = 0.640). There were no significant differences in age, sex, body mass index, underlying disease of ESRD, and Davies comorbidity index between the 2 groups. Mean follow-up durations were 37.0 ± 26.3 and 32.6 ± 23.4 months in the blind and surgical groups, respectively (P = 0.172). Total numbers of patients with one or more PDP events during follow-up period were 72 (50.0%) and 42 (40.0%) in blind and surgical groups (P = 0.118). Total numbers of PDP episodes were 157 and 100, respectively. Total numbers of patients with one or more ESI/TI events during follow-up period were 14 (9.7%) and 7 (6.7%) in blind and surgical groups (P = 0.392). Total numbers of ESI/TI episodes were 27 and 8, respectively. The 5-year PDC survival rates were 87.0% and 91.1% in the blind and surgical groups, respectively (P = 0.995, Figure 1). The 5-year intervention-free survival rates were 79.6% and 77.0% in the blind and surgical groups, respectively (P = 0.723). The leading cause of PDC removal was patient death. There was no significant difference in the distributions of cause of PDC removal in the 2 groups (P = 0.335). PDC associated removal rates in blind and surgical groups were 14 (18.4%) and 9 (16.4%), respectively (P = 0.760). Conclusion Our study shows that catheter outcomes including infectious and mechanical complications and catheter survival are similar between blind and surgical insertion techniques by nephrologists.

Peritoneal dialysis catheter placement, outcomes and complications.

Peritoneal dialysis (PD) is a commonly used method for renal support in pediatric patients and can be associated with the risk of post-surgical complications. We evaluated method of placement of PD catheters with regard to post-surgical complications. PD catheters placed at two institutions between 2005 and 2017 were reviewed. Complication rates were evaluated based on method of placement, delayed usage, omentectomy, and patient age using Fisher's exact test, two-sided, with significance set at 0.05. Factors influencing complication were evaluated with multivariate logistic regression and Kaplan-Meier survival analysis. There were 130 patients with 157 catheters placed, ranging in age from 1day to 23years. There was no significant difference in complication rate by method of placement or delayed usage. Infants were significantly more likely to experience leakage (21% vs 8%, p 0.036) and hernias (15% vs 5%, p 0.030). Patients that underwent an omentectomy were less likely to require a catheter replacement (7% vs 27%, p 0.004), and the catheters had a significantly higher survival rate (p 0.009). We found that laparoscopic intervention resulted in catheter salvage. Lateral exit sites may be a risk factor for catheter migration in some patients. Omentectomy is associated with longer PD catheter survival. Laparoscopic salvage of dysfunctional catheters may be a valuable adjunct in management.

Peritoneal dialysis catheter function and survival are not adversely affected by obesity regardless of the operative technique used.

Obesity has been considered a relative contraindication to peritoneal dialysis (PD). Surprisingly, PD catheter dysfunction rates and longevity have not been studied in the growing obese ESRD population. The aim of this study was to determine the effect of patient weight on PD catheter survival in the three insertion technique categories of advanced laparoscopy (AL), basic laparoscopy (BL), and open. We examine retrospectively collected data on 231 consecutive PD catheter insertions at the NorthShore University HealthSystem between 2004 and 2014. Three cohorts were created based on the catheter insertion technique: open, BL using selective adhesiolysis, and AL using rectus sheath tunnel, selective omentopexy, and adhesiolysis. Primary outcomes included catheter dysfunction and catheter dysfunction-free survival for each cohort by BMI: normal weight (18.5-24.9), overweight (25-29.9), obese (≥30). Nominal variables were compared using Chi-square test, continuous variables using ANOVA or Kruskal-Wallis tests, and catheter survival was assessed using the Kaplan-Meier method with log-rank test. Statistical significance was established at 0.05. For the three BMI categories, there were no statistically significant differences in patient demographics. There were no statistically significant differences in catheter dysfunction or peri-operative complications by BMI category among all patients. This was also true in the AL cohort. Among all patients, similar 2-year dysfunction-free catheter survival was noted for normal weight, overweight, and obese patients (log-rank p=0.79). This was also true across all insertion techniques: open (log-rank p=0.87), BL (log-rank p=0.41), AL (log-rank p=0.43). In the obese cohort, the 2-year dysfunction-free catheter survival was 91.1% in AL, 83.5% in BL, and 65.7% in open (log-rank p=0.58). Obesity does not increase complications or shorten dysfunction-free PD catheter survival regardless of the operative technique used. Obesity should not be considered as a relative contraindication to PD catheter placement as it confers similar technique success to normal- and overweight individuals.

Synchronous laparoscopic-assisted percutaneous endoscopic gastrostomy and peritoneal dialysis catheter placement is a valid alternative to open surgery

ObjectiveGastrostomy feeding is frequently necessary in children receiving chronic peritoneal dialysis (PD). Synchronous laparoscopic-assisted placement of percutaneous endoscopic gastrostomy (PEG) and PD catheter has many potential advantages. This study investigates whether this technique is comparable to open placement. MethodsThe notes of all patients over a 16-year time period were reviewed retrospectively. Peritonitis was defined as the presence of a white blood cell count > 100/mm3 with at least 50% being polymorphonuclear leukocytes, and infection was defined as the presence of positive peritoneal cultures with peritonitis. ResultsTen patients received primary laparoscopic-assisted PEG and PD catheter insertion (LAP) and 23 patients open gastrostomy and PD catheter (OPEN). PD catheter survival was median 12 months in the LAP group and 17 months in the OPEN group. Peritonitis and infection rates per catheter-year were 0.89 and 0.7 LAP and 0.59 and 0.5 OPEN. The risk of peritonitis and infection was not related to method of placement. ConclusionsThere were no statistically significant differences in outcomes between the two groups. We conclude that laparoscopic-assisted synchronous PD and PEG catheter insertion is safe and effective.

Growing a peritoneal dialysis program: A single‐center experience

Growing a peritoneal dialysis program: A single‐center experience

Risk Factors Associated with Peritoneal Dialysis Catheter Survival: A 9-Year Single-Center Study in 315 Patients

To review the peritoneal dialysis (PD) catheter outcomes at our center and assess factors affecting catheter survival. We carried out a retrospective study on 315 patients who had their first PD catheter placed between January 2001 and September 2009 at the UT Southwestern/DaVita Peritoneal Dialysis Clinic at Dallas, Texas. Medical records were reviewed for demographic and clinical information of the patients. The primary end point of the study was PD catheter failure, defined as removal of a dysfunctional PD catheter due to catheter-related complications. Catheter survival was estimated using the Kaplan-Meier method. Cox proportional hazard regression model was used to identify factors that are independently associated with catheter survival. The mean age of the patients was 49.7 ± 29 yrs. The study population included 54.6% females, 42.5% African American, 27.9% Caucasian and 22.9% Hispanic patients. Diabetes was the primary etiology of end-stage renal disease in 43.2% of patients. More than 90% of patients had one or more co-morbidities, and 57.5% had previous abdominal surgery. The mean BMI for the group was 28.6 ± 13.8 kg/m2. Less than a quarter of the patients (24.1%) had non-infectious/mechanical catheter problems. Overall PD catheter survival rates over 12, 24 and 36 months were 92.9%, 91.9% and 91.1%, respectively. PD catheter-related non-infectious problem was the only independent variable that was significantly associated with catheter survival (hazard ratio 22.467; 95% CI 6.665-75.732). No significant association was observed between the PD catheter survival and other risk factors including age, body mass index (BMI), diabetic status, co-morbidities, previous abdominal surgeries or infections. Our study shows an excellent 3-yr PD catheter survival (91.1%). Only PD catheter-related non-infectious problems are significantly associated with catheter failure. Other factors such as age, gender, race, BMI, diabetic status, co-morbidities, previous abdominal surgeries, peritoneal infections or exit site/tunnel infections were not found to affect the PD catheter survival and should not be considered barriers to PD initiation.

Long‐Term Complication Rates and Survival of Peritoneal Dialysis Catheters: The Role of Percutaneous Versus Surgical Placement

Considerable controversy currently exists in the literature concerning the mode of catheter placement and its impact on the technical success of peritoneal dialysis (PD). We decided to compare the impact of the surgical versus the percutaneous insertion technique on peritoneal dialysis catheter (PDCs) complications and survival. Our study population comprised 152 patients in whom 170 PDCs were inserted between January 1990 and December 2007 at the main PD unit on the island of Crete. Eighty four catheters were surgically placed (S group) and 86 were placed percutaneously by nephrologists (N group). The total experience accumulated was 4997 patient-months. The overall complications did not differ between the two groups. Only early leakage was more frequent in N group than S group (10.3 versus 1.9 episodes per 1000 patient-months; p < 0.001). However, it was easily treated and did not constitute a cause of early catheter removal. Catheter survival was 91.1%, 80.7%, and 73.2%, in the S group versus 89.5%, 83.7%, and 83.7% for the N group at 1, 2, and 3 years, respectively (p = 0.2). Catheter survival has significantly increased over the last decade. Factors positively affecting PDC survival appeared to be the use of mupirocin for exit site care and the utilization of the coiled type of catheter, practices implemented mainly after 1999. Peritonitis-free survival and patient survival were not associated with the mode of placement, while in Cox regression analysis, were longer in patients treated with automated PD. The placement mode did not affect PD outcomes. Percutaneous implantation proved a safe, simple, low cost, immediately available method for PDC placement and helped to expand our PD program.

Fluoroscopically Guided Peritoneal Dialysis Catheter Placement: Long-Term Results from a Single Center

Despite percutaneous fluoroscopy ensuring appropriate placement of peritoneal dialysis (PD) catheters, the efficacy of this method is not well known. Therefore, we evaluated our long-term experience with fluoroscopy-assisted placement of PD catheters. We retrospectively reviewed 134 PD catheters in 114 PD patients that were treated in the PD center of a university-based hospital. We evaluated complications related to PD catheters, causes for catheter removal, and catheter survival. We used the multivariate Cox proportional hazard model to identify independent factors related to PD catheter survival. Early complications related to insertion included 1 case of pericatheter bleeding; there were no placement failures. Early complications occurred in 8.5% of patients. Most late complications were migration and leakage, which occurred in 10.4% and 9.7% of patients respectively. The most common cause for catheter removal was intractable and recurrent peritonitis. The 12- and 24-month survival rates of the catheters were 80.0% and 74.9%. The most significant prognostic factor of percutaneous fluoroscopy-assisted PD catheter survival was late leakage (p < 0.01). In addition to the advantages of simplicity, minimal invasiveness, and relative safety, the survival rate of PD catheters placed using the percutaneous fluoroscopy-assisted method was comparable to that of more invasive methods. Percutaneous fluoroscopy-assisted placement of PD catheters should be considered when available, and may be preferred to other placement methods.