Introduction Surgical peritoneal dialysis (PD) catheter implantation can be performed under various anesthetic strategies, evidence guiding the optimal approach regarding clinical safety and perioperative efficiency remains limited. This study evaluated perioperative outcomes and resource utilization in open surgical PD catheter implantation under general (GA) versus local/regional anesthesia (LA). Methods This retrospective single-center cohort study included all open surgical PD catheter implantations performed between 2010 and 2021. Clinical outcomes and perioperative workflow parameters were analyzed. Patients were stratified by anesthesia type (GA versus LA), comorbidities, and operating room (OR) isolation status related to multidrug-resistant organisms. Results A total of 508 procedures were included (419 GA, 89 LA). Patients undergoing LA were older and more comorbid, with 49.4% classified as ASA ≥ 4 versus 14.6% in the GA group. Surgical procedures were comparable. LA was associated with shorter OR and post-anesthesia care unit times and faster transfer to definitive care units, indicating more efficient perioperative management. Postoperative surgical complication rates were comparable. Prolonged intensive care treatment occurred more frequently in LA patients, likely reflecting higher baseline illness severity. In patients with ASA ≥ 4, LA showed a trend toward reduced intraoperative catecholamine use (47.7% versus 67.2%; p = 0.0697). In multivariable analyses adjusting for age, ASA score, and cardiopulmonary comorbidities, anesthetic strategy was not independently associated with major safety outcomes. Among patients requiring isolation, GA resulted in disproportionate OR occupancy, whereas LA facilitated more efficient workflow regardless of isolation status. Discussion LA is preferentially used in high-risk patients. After adjustment for baseline risk, its surgical safety is comparable to GA, while offering perioperative resource and organizational advantages. Tailoring anesthetic strategies to patient comorbidities and isolation requirements may improve perioperative workflow and resource utilization without compromising outcomes.

The Effect of Obesity on Outcomes of Percutaneous Peritoneal Dialysis Catheter Insertion by Interventional Radiologists.

Outcomes and Risk Factors Following Tunneled Peritoneal Dialysis Catheter Insertion by Interventional Radiologists.

Early and accurate identification of causative microorganisms is essential for improving outcomes in peritoneal dialysis (PD)-associated peritonitis. However, nontuberculous mycobacterial (NTM) peritonitis remains difficult to diagnose and manage, often resulting in delayed treatment and unfavorable clinical outcomes. We conducted a scoping review to summarize the clinical features, microbiological profiles, treatment strategies, and outcomes of PD-associated NTM peritonitis. A total of 107 patients from 81 published reports were identified, including one patient treated at our institution. The mean age was 50.1 years, with a slight male predominance. Diabetes mellitus was the most common underlying cause of end-stage renal disease. Abdominal pain, fever, and cloudy dialysate were the most frequently reported symptoms, and exit-site infection was present in 55% of cases. Rapid-growing NTM species predominated, with Mycobacterium fortuitum being the most frequently identified organism. A substantial delay was observed between symptom onset and initiation of appropriate therapy. The mean duration of antimicrobial treatment was six months. PD catheters were removed in 90% of patients, and 69% were permanently transitioned to hemodialysis. The overall mortality rate during treatment was 18%. These findings suggest that NTM infection should be considered in cases of culture-negative peritonitis unresponsive to standard antibiotics. Early catheter removal combined with prolonged multidrug antimicrobial therapy for at least six months may be beneficial. In pediatric patients, temporary conversion to hemodialysis followed by PD catheter reinsertion or renal transplantation may represent a reasonable management option after successful infection control.

It is a priority for Aboriginal and/or Torres Strait Islander Australians living with kidney failure to receive best practice care. Commencing dialysis with pre-formed access (arteriovenous fistula, arteriovenous graft, or peritoneal dialysis catheter) is considered best practice, however rates remain low. Data for Aboriginal and Torres Strait Islander people are limited. This study aims to establish the differences in rates of pre-formed dialysis access between Aboriginal and/or Torres Strait Islander people and non-Indigenous Australians. Using the Australia and New Zealand Dialysis and Transplantation Registry we considered all Australian adult patients commencing chronic dialysis (1/1/2004 - 31/12/2020), comparing rates of pre-formed dialysis access between Aboriginal and/or Torres Strait Islander and non-Indigenous people, and evaluated the association with geographical remoteness and late referral. Of 43273 people commencing dialysis, 56.7% had pre-formed dialysis access. Aboriginal and/or Torres Strait Islander people were less likely to commence dialysis with pre-formed access (adjusted odds ratio (aOR) 0.75 CI 0.68-0.83). For Aboriginal and/or Torres Strait Islander people living remotely, the disparity was greater (aOR 0.45 CI 0.32-0.65). Of the 20% of the cohort referred late, rates of pre-formed dialysis access were lowest (24.5%), but the association with ethnicity was no longer apparent (aOR 0.87 CI 0.69-1.08). Aboriginal and/or Torres Strait Islander people, especially those living remotely, are less likely to receive best-practice care when commencing dialysis. Co-created, culturally safe models to improve dialysis preparation for Aboriginal and Torres Strait Islander people are essential to close the gap in health outcomes.

Abstract Background Peritoneal dialysis (PD) is an increasingly emphasized modality in nephrology care, due to patient autonomy, reduced healthcare cost, and alignment with value-based care initiatives. A critical factor influencing successful PD uptake is the timely placement of peritoneal dialysis catheters (PDCs). Traditional advanced laparoscopic surgical (ALS) methods are effective but constrained by the need for general anesthesia and operating room access. The image-guided percutaneous (IGP) approach has emerged as a potentially safer and more accessible alternative. Methods We conducted a retrospective study of adult patients who underwent PDC placement within Kaiser Permanente Northern California (KPNC) from January 1, 2018, to December 31, 2022. Patient characteristics, procedural variables, post-procedure length of stay, 90- and 180-day catheter intervention rates, 30-day readmission, and mortality rates were compared between IGP and ALS techniques. Results Among 3 062 patients, 835 (27%) received PDCs via IGP and 2 227 (73%) via ALS. While there were differences in patient characteristics due to selection biases, with the IGP group having higher prevalence of heart failure and lower BMI, eGFR, hemoglobin, and albumin levels, IGP was associated with significantly shorter post-procedure length of stay among admitted outpatients (1.8 vs. 3.1 days, P = 0.01) and lower catheter intervention rates at 90 days (1% vs. 2.5%, P = 0.006) and 180 days (1.3% vs. 4%, P < 0.0001). After adjustment for patient gender, race, BMI, and polycystic kidney disease status, the ALS technique remained significantly associated with higher odds of catheter re-intervention compared to IGP at both 90 days (adjusted OR 2.76, 95% CI 1.30–5.85, P = 0.008) and 180 days (adjusted OR 3.16, 95% CI 1.67–5.96, P < 0.0004). Overweight BMI was independently associated with increased intervention risk. Conclusions Despite being applied to a potentially sicker patient cohort, IGP was associated with favorable short- and intermediate-term outcomes compared to ALS, including reduced catheter interventions without compromising safety outcomes.

BackgroundGranulomas at the exit sites of peritoneal dialysis (PD) catheters are common among patients undergoing PD and cause pain, discomfort, and infections. Few studies have explored non-pharmacological interventions that can be performed at home. This study examined the effectiveness of common salt in improving these granulomas in such patients.MethodsThis prospective study examined patients undergoing PD who had exit-site granulomas and no acute infections. The 55 eligible patients were allocated to a common salt group (n = 31) or a salt-and-vinegar mixture group (n = 24) based on their preference. The outcome indicators were the Exit-Site Scoring System (ESSS) score, time until granuloma resolution, and adverse reactions.ResultsThere was a significant difference in the number of participants with complete resolution of granulomas between the two groups on day 7 post-intervention (T3). The resolution rate in the common salt group was significantly higher than that in the salt-and-vinegar mixture group (adjusted odds ratio = 0.04; 95% confidence interval: 0.00-0.44, p = 0.008). Generalized estimating equation analysis indicated that on day 3 post-intervention (T2), the ESSS score in the common salt group was significantly better than that in the salt-and-vinegar mixture group (β = -1.148, p = 0.002). No adverse reactions were observed in either group throughout the entire study period.ConclusionCommon salt appears to be an effective non-pharmacological home intervention for the removal of granulomas at the exit sites of PD catheters without adverse reactions, although it should be implemented after evaluation by a healthcare professional and in the absence of acute infection.

Percutaneous peritoneal dialysis access procedures (PPAP) are commonly employed for peritoneal dialysis (PD) catheter placement in patients with end-stage renal disease (ESRD). However, traditional techniques such as the blind Seldinger method can lead to complications, particularly bowel perforation and catheter malposition. We report a safe and effective technique for PD catheter placement utilized in a 73-year-old male with ESRD. This novel approach involves lifting the abdominal wall and directly visualizing the puncture site with ultrasound, thereby minimizing the risk of bowel injury. Additionally, the combined use of transversus abdominis plane (TAP) and rectus sheath (RS) block provides effective postoperative analgesia. This technique is particularly beneficial in resource-limited settings, offering a safer, adaptable, and analgesia-optimized alternative for PD catheter placement.

BackgroundStrengthening peritoneal dialysis (PD) utilization in Germany is crucial to ensure dialysis care for patients with kidney failure in an aging population with a predicted decline in the number of health care professionals. PD catheter implantations are a key indicator for the utilization of PD. We performed the first comprehensive study on PD catheter implantation rates and inpatient outcomes in Germany.MethodsFor this retrospective study we queried the diagnosis related group statistics of the Federal Statistical Office of Germany for the years 2011 to 2021, which includes demographics and information on the medical course from all German inpatient cases.ResultsDuring the observation period, 14,158 PD catheters were implanted, with an average of 1272 ± 127 (mean ± standard deviation) per year. Nationally, annual implantation rates were stable, without notable changes over time. Notably, there were significant regional differences in implantation rates within Germany. The average patient age at the time of PD catheter implantation was 59.7 years, with a male-to-female ratio of 1.7:1. During the hospital stay for PD catheter implantation, 517 patients (3.7%) died. Centers with higher implantation rates had more favorable outcomes. Age, number of comorbidities and certain comorbidities (e.g., cancer and heart failure) were associated with higher mortality. The length of stay in the hospital for PD catheter implantation was 19.5 (±22.3) days.ConclusionOur analysis reveals that relatively few PD catheters are implanted in Germany each year. Over the observation period, there was no substantial increase, indicating a continued underutilization of PD in Germany.

ABSTRACTIn patients in peritoneal dialysis (PD) who develop exit site and/or catheter tunnel infections, expeditious identification of the causative organism and early implementation of treatment are important to ensure good outcomes. Among the many causative organisms, the diagnosis of Mycobacterium fortuitum is particularly challenging, with its treatment often requiring a combination of approaches, including the removal of the peritoneal catheter and the administration of multiple antibiotics. Here, we present the case of a 25‐month‐old pediatric patient on PD who developed PD‐associated tunnel infection due to M. fortuitum; the patient was successfully treated with multimodal antibiotics, with no sequela, following the rapid identification of the causative agent, the use of multimodal antibiotics, and PD catheter removal. In our case, the timely initiation of treatment, combined with ultrasound evaluation, was crucial for achieving a favorable outcome.

Peritoneal dialysis-associated peritonitis (PD peritonitis) is a serious complication of PD, with fungal cases carrying high morbidity and mortality. We report a 65-year-old female with PD peritonitis caused by Ulocladium, a filamentous fungus not previously implicated in the literature. She was asymptomatic at presentation but noticed black spots in her PD catheter lumen; effluent analysis confirmed peritonitis. Initial cultures grew nonspecific mold, prompting treatment initiation with intravenous liposomal amphotericin B and PD catheter removal. Final cultures identified Ulocladium spp., sensitive to amphotericin B, and treatment continued for four weeks. The patient successfully resumed PD after treatment. This case highlights the need for clinicians to maintain a high index of suspicion for fungal PD peritonitis in patients undergoing PD, and the importance of early initiation of systemic antifungals and prompt catheter removal to improve outcomes.

Peritoneal dialysis (PD) associated peritonitis is a common complication and main cause of PD failure among end-stage chronic kidney disease (CKD) patients, presenting with abdominal pain, diarrhea and cloudy dialysate. On the other side, these patients may have an increased risk for Clostridioides difficile infection (CDI), with a clinical presentation indistinguishable from PD associated peritonitis. We present the case of a female patient who presented with multiple episodes of watery diarrhea days after PD catheter insertion, treated initially as a suspected PD associated peritonitis but later identifying C. difficile toxin assay in stool and responding with triple therapy including oral vancomycin, metronidazole and tigecycline. Considering the scarce evidence, we conducted a literature search and identified 10 case reports involving 11 patients describing CDI associated peritonitis in patients with PD. Most cases initiated empiric intraperitoneal treatment for PD associated peritonitis but after lack of clinical improvement or increase in PD fluid cell count, and a positive C. difficile toxin assay in stool, treatment for CDI was started. Half of these patients had received prior antibiotic therapy or had a prior hospital admission. In conclusion, patients with PD associated peritonitis unresponsive to initial empiric intraperitoneal treatment should be tested for C. difficile in stool, especially those with previous antibiotic exposure or hospital admission.

IntroductionPaget’s bone disease is typically seen in elderly patients, and bisphosphonate (BP) therapy is the first-line treatment for achieving remission. However, in patients with end-stage renal disease (ESRD), it may be overlooked due to its radiologic and biochemical resemblance to secondary hyperparathyroidism-related bone lesions. This case underscores the diagnostic and therapeutic difficulties that may arise when Paget’s disease coexists with ESRD.Clinical CaseA 61-year-old male shuttle driver from Türkiye, with a medical history of ESRD attributed to hypertensive nephropathy since 2017, was referred to the endocrinology clinic in October 2024. A referral was initiated for incidentally identified expansile lesion in the right femoral head, observed on imaging during follow-up for prostate adenocarcinoma, first diagnosed in 2021.The patient has had peritoneal dialysis since 2018 and has been diagnosed with secondary hyperparathyroidism, treated with cinacalcet due to rising parathormone levels during follow-up. He had no familial history of bone disease. He experienced no discomfort, morning stiffness, or trouble walking, localized bone pain, hearing loss, or history of fractures for three years.The physical examination was unremarkable, with the exception of a peritoneal dialysis catheter. Blood Pressure:140/90 mmHg, height:168 cm, weight:80 kg BMI:28,3 kg/m2 Table-1 showed laboratory results at the time of presentation.In 2021, a surveillance MRI for prostate cancer identified heterogeneous intramedullary bone marrow in the trochanteric and subtrochanteric regions, accompanied by irregular cortical thickening. The patient did not undergo a biopsy and was treated conservatively with radiotherapy and hormonal therapy for prostate cancer.In 2023, the patient resumed follow-up, and further evaluation of the bone lesion was conducted using a PET-CT scan due to his prostate malignancy. The scan revealed FDG uptake in the femoral neck and trochanteric region, indicating an active bone lesion. Bone scintigraphy conducted in August 2024 demonstrated significant uptake localized to the proximal right femur, consistent with Paget’s disease. (Figure-1)The assessment of bone mineral density showed:L1–L4: 1.423 g/cm², T-score: +1.5; left femoral neck: 1.361 g/cm², T-score: +2.2The differential diagnosis comprised Paget’s disease, secondary hyperparathyroidism with bone lesions, and metastatic bone disease. The imaging findings, absence of systemic symptoms, and presence of a monostotic lesion corroborated the diagnosis of Paget’s disease. Table -2 showed time course of laboratory findings.BP therapy was avoided due to the elevated risk of vascular and soft tissue calcification. A multidisciplinary discussion with nephrology was held to optimize management.ConclusionThis case highlights the infrequency of Paget’s disease among dialysis patients and the diagnostic difficulties arising from its similarities to Brown tumors of hyperparathyroidismFigure 1:Radiography & Scintigraphy of Paget’s disease at right femur, shown at the arrow point Table 1:Laboratory results at the time of presentation Table 2:Time course of laboratory findings

Rationale:Pregnancy in patients undergoing maintenance peritoneal dialysis (PD) is a rare and high-risk clinical scenario with limited documented successful outcomes, necessitating detailed reporting of management strategies.Patient concerns:A 26-year-old woman with end-stage renal disease on maintenance PD for over 5 years presented with an incidentally discovered viable singleton pregnancy at 26⁺ weeks of gestation.Diagnoses:Chronic kidney disease (CKD), Stage 5D (on PD). Pregnancy, singleton, at 26⁺ weeks of gestation. Severe anemia, associated with CKD. Secondary hyperparathyroidism, severe. Hypertension, in the context of CKD.Interventions:An individualized PD regimen (reduced the amount of dialysis per session, increased exchange frequency) was implemented. Comprehensive management included correction of anemia (transfusions, erythropoiesis-stimulating agents, iron supplements), antihypertensive therapy, and control of hyperparathyroidism. Close multidisciplinary surveillance was maintained. Emergency cesarean section was performed at 30⁺ weeks due to fetal distress, preceded by a single hemodialysis session.Outcomes:A live infant (1100 g) was delivered, requiring neonatal intensive care but demonstrating favorable long-term growth and neurodevelopment. The maternal postoperative course was complicated by an intra-abdominal infection associated with the PD catheter, which resolved following its removal.Lessons:Successful pregnancy in PD patients requires meticulous dialysis prescription tailoring, aggressive management of comorbidities, and sustained multidisciplinary collaboration. Postpartum PD catheter removal should be considered to mitigate infectious risk. Favorable maternal and neonatal outcomes are achievable with dedicated, individualized care.

Background:Peritoneal dialysis is an effective therapy for end-stage kidney disease patients. Fungal peritonitis is a rare complication in patients on peritoneal dialysis. Data on peritoneal dialysis-associated fungal peritonitis from Oman are lacking.Objective:To report the epidemiology, management practices, and outcomes in cases of peritoneal dialysis-associated fungal peritonitis from a tertiary hospital in Oman.Patients and Methods:This retrospective study included all patients aged ≥13 years who developed fungal peritonitis after peritoneal dialysis treatment at Nizwa Hospital, Nizwa City, Oman, between March 01, 2005, and March 31, 2023.Results:A total of 311 patients were followed-up for peritoneal dialysis during the study period, of which 10 patients developed peritoneal dialysis-related fungal peritonitis (3.2%) (males: 80%; mean age: 54.5 ± 19.9 years). Candida spp. accounted for 80% of the cases, with a predominance of non-Candida albicans spp., while Aspergillus accounted for the remaining 20%. Previous bacterial peritonitis was noted in seven patients (70%) treated with multiple antibiotics, while six patients (60%) had received antibiotics within the past 1 month. Therapeutic approach was immediate systemic antifungal and peritoneal dialysis catheter removal with transfer to hemodialysis. The mortality rate was 20%.Conclusions:About 3% of the patients on peritoneal dialysis at Nizwa Hospital, Oman, developed fungal peritonitis. Prior antibiotic use was a major risk factor, and thus antifungal prophylaxis is recommended. Candida spp. was the most common pathogen.

Introduction: Continuous Ambulatory Peritoneal dialysis (CAPD) is one of the effective treatments for end-stage renal disease patients (ESRD) as it ensures a better quality of life. A peritoneal dialysis catheter (PDC) is usually inserted by the general surgeon or interventional radiologist for CAPD initiation. The study was aimed to evaluate the safety, reliability, and outcomes of percutaneous continuous ambulatory peritoneal dialysis (CAPD) catheter insertion performed by nephrologists and to assess the ability of nephrologists to independently perform the procedure and provide comprehensive peri-procedural and postprocedure patient management. Methods: A retrospective cross-sectional study was conducted at Shahid Dharmabhakta national transplant center (SDNTC). The blind percutaneous Seldinger technique using a double-cuffed Tenckhoff catheter with straight tips was performed. The data of 150 patients undergoing CAPD catheter insertion by nephrologists from January 2012 to December 2021 was extracted. Results: Out of 150 participants, 56.7% were male and 43.3% were female. The mean age was 49.78±10.3 years. Seropositivity (13.3%) and low ejection fraction (9.3%) were the major indications for PDC insertion. The major renal cause of ESRD was hypertension with an unknown cause (53.3%). Hemorrhage (12%) and exit site infection (11.3%) were the most common early complications. The technical success rate was 98.7%. The mean break-in period was 11.07±2.46 days. The catheter survival rate was 98.7 after 90 days of the procedure. Conclusions: Percutaneous insertion of PDC by a nephrologist is a simple, safe, reliable, and cost-effective method.

Percutaneous peritoneal dialysis catheterization with visualization of rectovesical/rectouterine pouch under ultrasound guidance: a retrospective study of 507 patients

Background: Renal failure (RF) is global health problem, which strikes millions of people worldwide, and causing either a lifetime severs disability or death. Renal failure is treated in several ways, one of which is peritoneal dialysis, but this method is accompanied by many complications that affect the patient's life. Objective: A study focuses on the common complications associated with peritoneal dialysis and to find out relationship between the patient peritoneal dialysis catheter complications and their demographic characteristics. Methods: A descriptive cross-sectional study was carried out through the present study in order to achieve the early stated objectives. The study is conducted in Al-Najaf City/Al-Najaf Al-Ashraf Health Directorate/ Al-Furat Al-Awsat Center for Peritoneal Dialysis and Al-Najaf Teaching Hospital. The study was begun from October, 9th, 2024 to March, 1st, 2025. Data collected by use constructed questionnaire, which consisted of 3 parts, the first part was concerning with socio-demographic characteristics which includes (6) items and the second part was concerning with Clinical data that have (3) items, finally the last part of questionnaire which include catheter site complication. Result: This cross-section study includes 80 patients under peritoneal dialysis, 41 males and 39 females. 45% of patients had bleeding as an early complication of peritoneal dialysis and 51.3% of patients had peritonitis as a late complication of peritoneal dialysis. Conclusion: The results of this study conclude that patients subject to peritoneal dialysis are exposed to many complications, but most common complication is bleeding and peritonitis. Also, study conclude that a hypertension is the most common disease among peritoneal dialysis patients.

BackgroundPeritoneal dialysis catheter (PDC) dysfunction significantly impacts patient survival. While individual risk factors are known, a practical tool that integrates multi-dimensional predictors—including surgical, anatomical, and postoperative parameters—for early risk stratification is lacking. This study evaluates open versus laparoscopic catheterization techniques and aims to develop such a predictive model.MethodsA retrospective cohort study analyzed 462 end-stage renal disease patients undergoing first PDC implantation (2022–2024). Data included clinical characteristics, surgical method (open/laparoscopic), and dysfunction events. Multivariate COX regression identified independent risk factors, and a nomogram was developed. Model performance was assessed via ROC and calibration curves, with Bootstrap validation.ResultsAmong 462 patients (324 modeling, 138 validation) with a median follow-up of 30.7 months, laparoscopic catheterization was associated with a significantly lower risk of dysfunction compared to the open approach (18% vs. 27%; hazard ratio [HR] 2.188, 95% CI 1.263–3.791, p = 0.005). Multivariate analysis identified five independent predictors of catheter dysfunction: history of abdominal surgery (HR 6.924, p < 0.001), open catheterization (HR 2.188, p = 0.005), diabetes (HR 2.373, p = 0.016), albumin < 30 g/L (HR 0.865, p < 0.001), and blood potassium < 4 mmol/L (HR 1.479, p = 0.015). The developed nomogram integrating these predictors showed outstanding discriminative performance, with C-indices of 0.953 (95% CI 0.940–0.967) in the modeling cohort and 0.951 (95% CI 0.929–0.972) in the validation cohort. Time-dependent ROC analysis further confirmed its predictive accuracy, with 1- and 2-year AUCs of 0.957/0.979 and 0.921/0.988 in the modeling and validation sets, respectively. Calibration curves showed close alignment between predicted and observed outcomes across both cohorts. The nomogram provides a clinically useful tool for individualized risk assessment and postoperative management.ConclusionsLaparoscopic catheterization reduces dysfunction risk. The presented nomogram is unique in its integration of readily available surgical, comorbidity, and nutritional metrics into a single, visual tool. It facilitates early identification of high-risk patients, thereby aiding individualized surgical planning and targeted postoperative monitoring to improve PDC longevity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00423-025-03945-9.

BackgroundPeritoneal dialysis (PD) offers greater flexibility than hemodialysis, especially in patients with limited mobility or demanding schedules; however, PD-related infection is a major complication and a cause of withdrawal from peritoneal dialysis. The Antibiotic effect of Silver continuous ambulatory peritoneal dialysis (CAPD) Catheter on Peritoneal Dialysis-related infections (ASCA-PD) study will evaluate the effectiveness of a novel silver CAPD catheter, incorporating silver-based antimicrobial technology, for preventing these infections and improving PD adherence.Methods/designThis randomized, open-label, parallel-group, multicenter trial will evaluate the efficacy and safety of a silver CAPD catheter compared with those of a conventional catheter at 14 Japanese facilities. A total of 250 adult patients with newly initiated PD will be enrolled and randomized 1:1 to receive either catheter type. The key exclusion criteria are prior PD, emergency PD initiation, non-abdominal exit-site placement, metal allergy, life expectancy <1 year, severe liver disease, certain dermatologic conditions, and immunosuppression. After providing informed consent, patients will undergo nasal swab screening for methicillin-resistant Staphylococcus aureus. Randomization will be stratified by facility and diabetes status. The primary outcome is the composite endpoint of all exit-site and tunnel infections within 12 months of PD initiation. Secondary outcomes include individual infection events, catheter removal, peritonitis, catheter patency, allergic reactions, technique failure (transition to hemodialysis for ≥30 days or death), and transition to hybrid dialysis. A Poisson regression model will be used to analyze the primary outcome, adjusting for observation time, treatment group, and stratification factors. Time-to-event secondary outcomes will be analyzed by competing risk regression. Subgroup analyses will be carried out to explore the impacts of age, sex, diabetes, insertion method, and body mass index.DiscussionUnlike previous designs, our silver CAPD catheter incorporates AgNPs into silicone, enabling sustained antimicrobial effects both externally and internally, potentially overcoming limitations seen in prior human studies. This study will demonstrate the efficacy of silver CAPD catheters for preventing PD-related infections, especially during the initiation phase of PD, with the aim of providing a new therapeutic option.Trial registrationJapan Registry of Clinical Trials, jRCTs052250003. Registered on April 4, 2025.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09250-6.