Peritoneal Dialysis Catheter Placement Research Articles

MO701COMBINED PROCEDURE OF PRE- EXISTING ABDOMINAL WALL HERNIA REPAIR AND PERITONEAL CATHETER INSERTION. LONG TERM FOLLOW- UP IN PERITONEAL DIALYSIS TREATMENT

Abstract Background and Aims Successful peritoneal dialysis (PD) program requires a combination of optimal peritoneal access and low incidence of complications. Between pitfalls of this modality are early mechanical complications such as leak, malfunction, and new abdominal wall hernia formation in the long term of PD treatment. Pre-existing abdominal wall hernia is a relative contraindication for PD. Hernias are also a known and not uncommon complication over the course of PD and one of the causes of technique failure. In our center, a physical examination and an ultrasound for hernias detection are routine procedures before the start of PD. If a hernia is discovered, combined hernia repair and catheter implantation are performed. The aim of this study was to assess to long- term results of this approach. Method The current study presents the retrospective analysis of 10 years' experience of our PD program (1.01.2009 – 31.12. 2018) including all incident PD patients who underwent their first peritoneal catheter placement procedure during the study period. The primary endpoints of the study were the rate of hernia formation in the course of PD treatment, type of hernias, identification risk factors for hernia formation and rate of hernia recurrence after previous repair. The secondary endpoint was the rate of procedure-related complications: infectious, leaks and primary catheter malfunction in patients who underwent surgical catheter insertion compared to percutaneous technique. Patients were followed until the end of PD treatment or until 31.10.2019. Results A total of 211 patients were included in the analysis. Of these, 24.5% underwent surgical procedures and 75.5% percutaneous insertion. Mean follow-up was 23.3 ± 25 months (2 to 96 months). About half (53.1%) of the patients were diabetic, aged 64.2±13 years. In 32 patients (15%) a preventive hernia repair with a simultaneous catheter implantation were performed. Patients who underwent a preventive hernia repair were significantly older than other patients (69.4±11.1 years versus 63.2±13.1 years, P=0.013). During the study period, 203 of 211 patients were treated by PD. Thirty three (16.1%) have developed 38 new hernias. Patients suffering from a new hernia during PD were predominantly male, with longer dialysis vintage than patients without new hernia formation (35.3±22.8 months versus 23±22.9, respectively. P=0.001). Five of 33 patients suffered multiple hernias, including recurrent hernias at the same site. Most common types were inguinal and umbilical (44.7% each other), while only few were incisional or ventral. None of our patients suffered from a pericatheter one. The overall rate of new hernias development was 0.09/patient/years. Neither age, comorbidities, obesity nor polycystic kidney disease did not increase the rate of hernia formation during the course of PD treatment. There was no significant association between type of catheter insertion procedure (surgical/percutaneous) and infections, leakages or catheter function. Leak incidence in diabetic patients was significantly higher in comparison with nondiabetic patients (8% versus 1%, P=0.021). Infectious complications were not different between diabetic and not diabetics patients (5.4% among diabetic patients versus 2% nondiabetic, P=0.29). Conclusion Our findings show that male gender and prolonged peritoneal dialysis duration are the main risk factors for the appearance of hernias in the course of PD therapy. Our data also confirm previous observations that the placement of PD catheter using a paramedian incision approach significantly reduces the incidences of exit site and incision hernias. We suggest that early diagnosis of latent asymptomatic hernias and hernia repair prior to starting PD can improve technique survival.

Local Experience: Battling for CAPD in Pakistan: The Shifa Experience

Peritoneal Dialysis (PD) is recognized as a patient centered modality for End Stage Kidney Disease worldwide. Compared to In-Centre Hemodialysis, it gives the patients a better quality of life. Rather than urgent start, 2 weeks rest after placement of PD catheter is preferred to avoid leaks.
 Since I joined Shifa International hospital Islamabad, Pakistan, a gradual increase in CPAD population was seen. We share our experience and discuss the issues faced.

Association between different peritoneal dialysis catheter placement methods and short\u2010term postoperative complications

BackgroundConsidering that current peritoneal dialysis has its own shortcomings, In this study, the Seldinger technique was modified to explore the relationship between different catheter placement methods of peritoneal dialysis and short-term postoperative complications.MethodsWe retrospectively analyzed the data of 157 patients who received peritoneal dialysis in the Department of Nephrology of our hospital from January 2017 to December 2019. According to different catheter placement methods, the patients were divided into three groups: 111 cases of open surgery technique, 23 cases of Seldinger technique, and 23 cases of modified Seldinger technique (ultrasound-guided Veress needle puncture). The general data, laboratory indexes, and abdominal infection and catheter-related complications within one month postoperatively were collected.ResultsThere were 48 (31.0 %) cases of complications in 157 patients within one month postoperatively, which were mainly catheter-related complications (45 cases, 29.0 %). The incidence of catheter tip peritoneal drift (catheter migration) in the three groups was 27.3 %, 39.1 %, and 9.1 %, respectively, with no significant difference between groups (P = 0.069). Univariate logistic regression analysis showed that the systolic blood pressure, history of abdominal and pelvic surgery, creatinine, and modified Seldinger technique were possible impact factors of catheter migration (P < 0.10). After fully adjusting for confounding factors, Compared with the open surgery group, the modified Seldinger method group significantly reduced the risk of catheter migration with an OR of 0.161 (95 % confidence interval: 0.027–0.961, P = 0.045); However, the difference between the Seldinger method group and the open surgery group was not significant, with an OR of 1.061 (95 % confidence interval: 0.308–3.649, P = 0.926). Curve fitting showed that the average incidence of catheter migration in the three groups was 27.3 % (95% CI: 15.9-42.7 %), 28.5 % (95% CI: 10.7-56.9 %), and 5.7 % (95% CI: 1.0-27.0 %); the modified Seldinger method has the lowest average incidence of catheter migration.ConclusionsModified Seldinger technique can significantly reduce catheter-related short-term complications after peritoneal dialysis, and it is especially effective in reducing the incidence of catheter migration. Modified Seldinger technique is a safe and feasible method for the placement of a peritoneal dialysis catheter.

POS-668 BARRIERS AND OPPORTUNITIES TO INCREASE PD INCIDENCE AND PREVALENCE: LESSONS FROM A EUROPEAN SURVEY

Peritoneal Dialysis (PD) remains underutilized despite the fact that outcomes have been demonstrated to be equal to hemodialysis (HD). Several barriers for PD growth have been identified, such as late referral, economic incentives, lack of training facilities or PD catheter placement issues. However, the potential interaction between all these mediators has not been explored, and they might be intertwined. The EuroPD™Future Leadership group* therefore performed a pan-European survey to identify potential barriers to growth of PD programs by exploring PD and home HD related practices and organizational aspects at centre level. In this abstract, we focus on the association between PD catheter placement policy, urgent (unplanned) start and education policy*EuroPD™FutureLeadership includes also Bechade C France; de Laforcade L France; Eden G Germany; Martin H,Germany; Steubl D,Germany; Wojtaszek E,Poland; Altabas K,Slovenia; Pajek J,Slovenia; Ros S,Spain; Vega A,Spain; Burkhalter F,Suisse; Allen J,UK; Corbett Richard,UK; Lambie M,UK An electronic survey was send to the contacts of EuroPD™ and to the members of regional societies of the members of the EuroPD Future Leadership initiative. In the survey, a virtual case vignette of a 48 year old woman not previously known to your unit who arrives at the emergency department with established end stage kidney disease was presented (late referral/unplanned start). We used chi-square tests and (ordinal) logistic regression to assess associations between modality choices for this case vignette and PD related practices, and also with % incident and prevalent patients on PD. We received 628 responses (317 academic, 243 non academic non private, 68 private; 67 with less than 50, 125 with 50-100, 243 with 100-220 and 193 with more than 200 patients). For the unplanned start case vignette, 32.6, 32.2 and 35.2% indicated they would start urgent PD, urgent HD or urgent HD with the plan to educate patient on PD at a later time respectively. Only 2 out of 3 respondents indicated that it was (very) likely this patient would receive education on PD in the unplanned setting. Urgent placement of a PD catheter (<48hours) was only possible in 32.4% of centres. In univariate analysis, choice for urgent start PD was associated with presence of a dedicated PD team, presence of a structured PD education program, the likelihood of an unplanned patient to receive education on PD, and having good relations with the PD access placement team, but not with centre size, %PD incidence or prevalence, financial issues, or the possibility to have a PD catheter placed within 48 hours. In a general linear mixed model, inclination to start PD in the case-vignette on unplanned start was only associated with presence of a dedicated PD team and the likelihood that the patient will receive education on homebased therapies. Percentage PD incidence and prevalence were only associated with presence of good education for both planned as for unplanned patients, and with a good relationship with the PD access team. Absence of a dedicated PD team seems to be the common denominator of already identified barriers to PD growth such as unplanned start and PD access placement issues. If we intend to grow PD programs, we will need to establish enthusiastic PD teams with good collaborations with dedicated PD catheter placement teams.

POS-640 FUNGAL PERITONITIS IN AUTOMATED PERITONEAL DIALYSIS : AN 18-YEAR SINGLE CENTRE EVALUATION

Infectious peritonitis is the most serious complication of peritoneal dialysis (PD). Its origin is often bacterial. Fungal peritonitis (FP) is rare but always devastating, accounting for high rates of technique failure, morbidity and mortality. It is therefore important to know its microbiological and clinical profile and its evolution in order to establish preventive and therapeutic strategies. The aim of our study is to determine the FP frequency and to describe its clinical, microbiological and therapeutic aspects in patients treated with automated peritoneal dialysis (APD), APD being the most frequent PD modality in our centre. This was a single-centre retrospective study carried out in the PD unit of Charles Nicolle Hospital in Tunis from January 01, 2000 to December 31, 2018, on patients treated with APD and having presented at least one fungal peritonitis. Clinical, biochemical characteristics and detailed data on peritonitis episodes were recorded. Six cases of FP were identified, ie 3% of all infectious peritonitis that occurred during the study period. The patients' sex ratio was 2. Their mean Charlson score at onset of APD was 3 [Extremes: 2-6]. Only one patient was diabetic. Their mean age at the time of peritonitis was 40 +/- 16 years. Candida albicans was the most frequently (50%) detected yeast followed by candida non albicans (2 patients). Aspergillus has been isolated in one patient. This group experienced an average of 2 bacterial peritonitis before FP. All FP were preceded by bacterial peritonitis: In five patients, they were diagnosed following refractory peritonitis mainly due to Enterobacteria (4 patients). In one case, the patient had a history of three episodes of bacterial peritonitis, FP presented as a new episode of infectious peritonitis occurring 5 months after the third peritonitis. All Candida peritonitis were treated with intravenous fluconazole for an average of 13 days. Aspergillary peritonitis was treated with amphotericin B for 15 days. The PD catheter was removed in all cases. Four patients were transferred to hemodialysis. APD was retried in the other two patients. They were switched to hemodialysis after 1 and 7 months, respectively, of placement of the second PD catheter for loss of ultrafiltration and catheter dysfunction. FP are certainly rare, but they are an ineluctable cause of PD failure.

Pediatric Peritoneal Dialysis Catheter Placement: An Anonymous Survey of APSA Members

BackgroundAlthough literature is sparse, there are guidelines regarding optimal placement technique for peritoneal dialysis (PD) catheters in the pediatric population. Through this study, we sought to identify commonly used techniques among pediatric surgeons and identify areas for future work. Materials and methodsA 16-question anonymous survey was emailed to American Pediatric Surgery Association members in September 2018 regarding routine practices for PD catheter placement. Descriptive statistics and Fisher's exact test were used for analysis. ResultsIn all, there were 221 respondents, 6.8% of whom did not place PD catheters in their practice. Of the remaining 206, the majority have been in practice >15 y. PD catheter placement during fellowship training varied widely, with 6.5% reporting no fellowship experience to 6% reporting >25 placed during fellowship. Almost half (48%) reported placing catheters via laparoscopic approach (versus open or combined approach). Most (62%) respondents reported an annual practice volume of 1-5 catheters, with only 11% placing >10 per year. Exit-site sutures were placed “always” by 33% of participants and “never” by 49% of participants. There was no association between years in practice or fellowship experience and exit-site suture placement. However, there was a trend for “never” placement (72%) with more recent graduates. Omentectomy was performed by 91% of respondents, whereas 8.3% reported never performing omentectomy/omentopexy. Similarly, there was no association between practice and fellowship experience and omentectomy. In the setting of abdominal stoma, 96% reported placing the exit site on the opposite side of the abdomen. Fibrin glue was used along the tunnel by 21% of participants, ranging from “always” to “sometimes”, whereas 79% “never” used it. ConclusionsFellowship, posttraining experience, and techniques in PD catheter placement vary widely among American Pediatric Surgery Association member respondents. Despite guidelines, practices differ among providers without an association between the number of cases performed in fellowship and postfellowship volume.

ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 Update (paediatrics).

1.1 Peritoneal dialysis is a suitable renal replacement therapy modality for treatment of acute kidney injury in children. (1C)2. Access and fluid delivery for acute PD in children.2.1 We recommend a Tenckhoff catheter inserted by a surgeon in the operating theatre as the optimal choice for PD access. (1B) (optimal)2.2 Insertion of a PD catheter with an insertion kit and using Seldinger technique is an acceptable alternative. (1C) (optimal)2.3 Interventional radiological placement of PD catheters combining ultrasound and fluoroscopy is an acceptable alternative. (1D) (optimal)2.4 Rigid catheters placed using a stylet should only be used when soft Seldinger catheters are not available, with the duration of use limited to <3 days to minimize the risk of complications. (1C) (minimum standard)2.5 Improvised PD catheters should only be used when no standard PD access is available. (practice point) (minimum standard)2.6 We recommend the use of prophylactic antibiotics prior to PD catheter insertion. (1B) (optimal)2.7 A closed delivery system with a Y connection should be used. (1A) (optimal) A system utilizing buretrols to measure fill and drainage volumes should be used when performing manual PD in small children. (practice point) (optimal)2.8 In resource limited settings, an open system with spiking of bags may be used; however, this should be designed to limit the number of potential sites for contamination and ensure precise measurement of fill and drainage volumes. (practice point) (minimum standard)2.9 Automated peritoneal dialysis is suitable for the management of paediatric AKI, except in neonates for whom fill volumes are too small for currently available machines. (1D)3. Peritoneal dialysis solutions for acute PD in children3.1 The composition of the acute peritoneal dialysis solution should include dextrose in a concentration designed to achieve the target ultrafiltration. (practice point)3.2 Once potassium levels in the serum fall below 4 mmol/l, potassium should be added to dialysate using sterile technique. (practice point) (optimal) If no facilities exist to measure the serum potassium, consideration should be given for the empiric addition of potassium to the dialysis solution after 12 h of continuous PD to achieve a dialysate concentration of 3-4 mmol/l. (practice point) (minimum standard)3.3 Serum concentrations of electrolytes should be measured 12 hourly for the first 24 h and daily once stable. (practice point) (optimal) In resource poor settings, sodium and potassium should be measured daily, if practical. (practice point) (minimum standard)3.4 In the setting of hepatic dysfunction, hemodynamic instability and persistent/worsening metabolic acidosis, it is preferable to use bicarbonate containing solutions. (1D) (optimal) Where these solutions are not available, the use of lactate containing solutions is an alternative. (2D) (minimum standard)3.5 Commercially prepared dialysis solutions should be used. (1C) (optimal) However, where resources do not permit this, locally prepared fluids may be used with careful observation of sterile preparation procedures and patient outcomes (e.g. rate of peritonitis). (1C) (minimum standard)4. Prescription of acute PD in paediatric patients4.1 The initial fill volume should be limited to 10-20 ml/kg to minimize the risk of dialysate leakage; a gradual increase in the volume to approximately 30-40 ml/kg (800-1100 ml/m2) may occur as tolerated by the patient. (practice point)4.2 The initial exchange duration, including inflow, dwell and drain times, should generally be every 60-90 min; gradual prolongation of the dwell time can occur as fluid and solute removal targets are achieved. In neonates and small infants, the cycle duration may need to be reduced to achieve adequate ultrafiltration. (practice point)4.3 Close monitoring of total fluid intake and output is mandatory with a goal to achieve and maintain normotension and euvolemia. (1B)4.4 Acute PD should be continuous throughout the full 24-h period for the initial 1-3 days of therapy. (1C)4.5 Close monitoring of drug dosages and levels, where available, should be conducted when providing acute PD. (practice point)5. Continuous flow peritoneal dialysis (CFPD)5.1 Continuous flow peritoneal dialysis can be considered as a PD treatment option when an increase in solute clearance and ultrafiltration is desired but cannot be achieved with standard acute PD. Therapy with this technique should be considered experimental since experience with the therapy is limited. (practice point) 5.2 Continuous flow peritoneal dialysis can be considered for dialysis therapy in children with AKI when the use of only very small fill volumes is preferred (e.g. children with high ventilator pressures). (practice point).

From "feeling" to "seeing": modification of the percutaneous peritoneal dialysis catheter insertion with an optical puncture system.

Blind insertion limits the application of percutaneous peritoneal dialysis (PD) catheter placement. In this study, we first described the use of an optical puncture system in the PD catheter insertion, and investigated the feasibility and advantages of this modified technique. This retrospective study included 65 patients with chronic kidney disease stage 5 (CKD5) who received ultrasound-guided percutaneous PD catheter insertion with or without optical puncture system assistance between June 2018 and July 2019. The patients' characteristics as well as the surgical outcomes and complications were compared between the modified group and the routine percutaneous insertion group. Twenty-five patients underwent optical puncture system assistant insertion, whereas 40 patients received routine percutaneous insertion. More patients had previous abdominal surgical histories in the modified group than those in the routine group (24.0% vs. 5.0%, p = 0.047). The time of accessing to the abdominal cavity was significantly shorter in the modified group (median [IQR]; 1.1min [0.8-1.3] vs. 5.0min [4.0-6.0]; p < 0.001). Meanwhile, the time of the whole procedure was also significantly shorter in the modified group (median [IQR]; 26.0min [25.0-29.0] vs. 33.0min [29.0-35.0]; p < 0.001). None of the patient in the modified group, while two patients (5.0%) in the routine group converted to open procedure. There were no significant differences in the short and long postoperative complications between the two groups. The operation of ultrasound-guided PD catheter placement with the optical puncture system is easy, safe, fast and accurate, whereby the PD catheter can be implanted percutaneously and visually under local anesthesia with minimal procedure-related complications. The visible puncture of the optical puncture system may facilitate ultrasound-guided percutaneous PD catheter insertion in patients with obesity and previous abdominal surgeries.

Canadian Association of Paediatric Nephrologists COVID-19 Rapid Response: Home and In-Center Dialysis Guidance.

Purpose of the program:This article provides guidance on optimizing the management of pediatric patients with end-stage kidney disease (ESKD) who will be or are being treated with any form of home or in-center dialysis during the COVID-19 pandemic. The goals are to provide the best possible care for pediatric patients with ESKD during the pandemic and ensure the health care team’s safety.Sources of information:The core of these rapid guidelines is derived from the Canadian Society of Nephrology (CSN) consensus recommendations for adult patients recently published in the Canadian Journal of Kidney Health and Disease (CJKHD). We also consulted specific documents from other national and international agencies focused on pediatric kidney health. Additional information was obtained by formal review of the published academic literature relevant to pediatric home or in-center hemodialysis.Methods:The Leadership of the Canadian Association of Paediatric Nephrologists (CAPN), which is affiliated with the CSN, solicited a team of clinicians and researchers with expertise in pediatric home and in-center dialysis. The goal was to adapt the guidelines recently adopted for Canadian adult dialysis patients for pediatric-specific settings. These included specific COVID-19-related themes that apply to dialysis in a Canadian environment, as determined by a group of senior renal leaders. Expert clinicians and nurses with deep expertise in pediatric home and in-center dialysis reviewed the revised pediatric guidelines.Key findings:We identified 7 broad areas of home dialysis practice management that may be affected by the COVID-19 pandemic: (1) peritoneal dialysis catheter placement, (2) home dialysis training, (3) home dialysis management, (4) personal protective equipment, (5) product delivery, (6) minimizing direct health care providers and patient contact, and (7) caregivers support in the community. In addition, we identified 8 broad areas of in-center dialysis practice management that may be affected by the COVID-19 pandemic: (1) identification of patients with COVID-19, (2) hemodialysis of patients with confirmed COVID-19, (3) hemodialysis of patients not yet known to have COVID-19, (4) management of visitors to the dialysis unit, (5) handling COVID-19 testing of patients and staff, (6) safe practices during resuscitation procedures in a pandemic, (7) routine hemodialysis care, and (8) hemodialysis care under fixed dialysis resources. We make specific suggestions and recommendations for each of these areas.Limitations:At the time when we started this work, we knew that evidence on the topic of pediatric dialysis and COVID-19 would be severely limited, and our resources were also limited. We did not, therefore, do formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. Thus, this article’s advice and recommendations are primarily expert opinions and subject to the biases associated with this level of evidence. To expedite the publication of this work, we created a parallel review process that may not be as robust as standard arms’ length peer-review processes.Implications:We intend these recommendations to help provide the best care possible for pediatric patients prescribed in-center or home dialysis during the COVID-19 pandemic, a time of altered priorities and reduced resources.

Surgical Outcomes of Pediatric Peritoneal Dialysis Catheter Function in a Referral Center

Peritoneal dialysis (PD) is used in children with end-stage renal disease (ESRD) for renal replacement therapy. However, it can be associated with the risk of post-surgical complications. The objectives of this study were to report our experience with the placement of PD catheters for 14 years and to assess the incidence of PD malfunction and other PD-related complications, including the effect of adopting minimally invasive techniques for catheter placement. The objectives of this study were to report our experience with placement of PD catheters for 14-year period and to assess the incidence of PD-related complications and the effect of adopting minimally invasive techniques for catheter placement. It is a retrospective cohort study at the department of pediatric surgery and pediatric nephrology, dialysis, and transplant in Jeddah, Saudi Arabia. We reviewed the records of all children who had PD catheter placements between 2005 and 2019. The data included demographics, the surgical technique, the performance of omentectomy, duration of PD catheter, and complication rates. Sixty-five patients had PD catheter insertion during the study period; 16 (24.6%) of them were placed in other institutions then referred to us. Thirty-five patients had no complications. Omentectomy during the first procedure was performed in 53 patients (81.54%). Early dialysate leaking occurred in six patients (9.3%); none were treated with surgical revisions. Four leaks resolved spontaneously, and hemodialysis (HD) was needed in two patients. The median PD catheter duration was 29 months (25th-75th percentiles: 21-41). Sixteen patients required revision (24.62%), and mortality occurred in five patients (7.69%). PD is a safe option in children with ESRD. Open placement with omentectomy in a specialized center could reduce leakage,help to start dialysis early, and decrease the conversion to HD.

Peritoneal transport status and first episode of peritonitis: a large cohort study

Background Peritonitis is one of the most serious complications of peritoneal dialysis (PD). This study aimed to explore the relationship between peritoneal transport status and the first episode of peritonitis, as well as the prognosis of patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Method A retrospective cohort study was conducted, analyzing data of CAPD patients from 1st January 2009, to 31st December 2017. Baseline data within 3 months after PD catheter placement was recorded. Cox multivariate regression analysis was performed to determine the risk factors for the first episode of peritonitis, technique failure and overall mortality. Results A total of 591 patients were included in our analysis, with a mean follow-up visit of 49 months (range: 27–75months). There were 174 (29.4%) patients who had experienced at least one episode of peritonitis. Multivariate Cox regression analysis revealed that a higher peritoneal transport status (high and high-average) (HR 1.872, 95%CI 1.349–2.599, p = 0.006) and hypoalbuminemia (HR 0.932,95% CI 0.896, 0.969, p = 0.004) were independent risk factors for the occurrence of the first episode of peritonitis. In addition, factors including gender (male) (HR 1.409, 95%CI 1.103, 1.800, p = 0.010), low serum albumin (HR 0.965, 95%CI 0.938, 0.993, p = 0.015) and the place of residence (rural) (HR 1.324, 95%CI 1.037, 1.691, p = 0.024) were independent predictors of technique failure. Furthermore, low serum albumin levels (HR 0.938, 95%CI 0.895, 0.984, p = 0.008) and age (>65years) (HR 1.059, 95%CI 1.042, 1.076, p < 0.001) were significantly associated with the risk of overall mortality of PD patients. Conclusions Baseline hypoalbuminemia and a higher peritoneal transport status are risk factors for the first episode of peritonitis. Factors including male gender, hypoalbuminemia, and residing in rural areas are associated with technique failure, while hypoalbuminemia and age (>65years) are predictors of the overall mortality in PD patients. Nevertheless, the peritoneal transport status does not predict technique failure or overall mortality of PD patients.

Peritoneal Dialysis Catheter Insertion by Nephrologist Using Minilaparotomy: Do Survival and Complications Vary in Obese?

Introduction:Peritoneal dialysis catheter (PDC) placement for chronic kidney disease (CKD) amongst overweight and obese patients is difficult owing to deeper operating field. Literature being discordant on survival and complications in this patient subset, we attempted to analyse this research question in Indian population.Materials and Methods:We retrospectively analysed PDC inserted by nephrologist using surgical minilaparotomy for survivals and complications amongst 'overweight and obese' cohort ('O') at two tertiary care government hospitals in India, and compared results with normo-weight cohort ('N'), with 12−36 months follow-up.Results:245 PDCs were inserted by surgical minilaparotomy and 'N' to 'O' ratio was 169:76. 'O' group were more rural residing (P = 0.003) and post-abdominal surgery (P = 0.008) patients. The 1, 2, and 3-year death censored catheter survival rate was 98.6%, 95.8%, and 88.2% respectively in 'O' group, and 97.6%, 94.5% and 91.8% in 'N' group respectively (P = 0.52). Patient survival (P = 0.63), mechanical complications (P = 0.09) and infective complications (P = 0.93) were comparable despite technically challenging surgery in 'O' group. Refractory peritonitis related PDC removal was comparable (P = 0.54). Prior haemodialysis or catheter related blood stream infections or diabetes were non-contributory to results.Conclusions:Catheter survival and patient survival amongst obese and overweight CAPD patients was non-inferior to normal weight patients. Mechanical, and infective complications were comparable despite technically challenging abdominal terrain in 'O' group. The overall CAPD performance was good amongst obese and overweight.

Outcomes of Laparoscopic Peritoneal Dialysis Catheter Placement Using an Optimal Placement Technique.

Background:Peritoneal dialysis (PD) is a widely employed renal replacement modality. A prospective study was conducted to determine the short-term and midterm outcomes and complication rates associated with a standardized optimal laparoscopic peritoneal dialysis catheter placement technique.Methods:All patients undergoing laparoscopic PD catheter placement by one surgeon using our standardized method over a 5-year period were entered into a prospective database. Patients were evaluated preoperatively and postoperatively through office visits. Development of complications was assessed using follow up telephone or mail surveys.Results:A total of 100 patients with a mean age of 56 years underwent laparoscopic PD catheter placement over the 5-year study period. In total, 103 laparoscopic PD catheter placement attempts were made in 100 patients. Placement was successful in 98 (95.1%) attempts and no placement required conversion to an open operation. Omentopexy was performed in 82 (83.7%) patients. There was no mortality reported within 30 days of the index operation. For patients who successfully underwent laparoscopic PD placement, early complications developed in 9 (9.2%) patients, of which 6 (6.1%) complications were directly related to the PD catheter. Midterm complications developed in 25 (25.5%) patients. Complication-related catheter repositioning was required for 12 (12.2%) catheters and catheter-related complication removal was required for 18 (18.4%) catheters.Conclusion:Laparoscopic placement of PD catheters can be successfully performed using a combination of described standardized laparoscopic maneuvers for optimal placement resulting in acceptable perioperative and short and midterm complication rates with negligible mortality rates.

Intestinal Perforation Secondary to Peritoneal Dialysis Catheter; An Uncommon Complication

One of the rare complications of peritoneal dialysis catheter placement is intestinal perforation, often with a late presentation.

Video-Assisted Peritoneal Dialysis Placement in COVID-19 Patients

Video-Assisted Peritoneal Dialysis Placement in COVID-19 Patients

Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis.

No consensus currently exists regarding the optimal approach for peritoneal dialysis catheter placement. We aimed to compare the outcomes of percutaneous and surgical peritoneal dialysis catheterplacement. A systematic review of the literature was performed using the MEDLINE, Cochrane Library, and Scopus databases (end-of-search date: August 29th, 2020). We included studies comparing percutaneous (blind, under fluoroscopic/ultrasound guidance, and "half-perc") and surgicalperitoneal dialysis catheter placement (open and laparoscopic) in terms of their infectious complications (peritonitis, tunnel/exit-site infections), mechanical complications (leakage, inflow/outflow obstruction, migration, hemorrhage, hernia, bowel perforation) and long-term outcomes (malfunction, removal, replacement, surgery required, and mortality). Thirty-four studies were identified, including thirty-two observational studies (twenty-six retrospective and six prospective) and two randomized controlled trials. Percutaneous placement was associated with significantly lower rates of tunnel/exit-site infection [relative risk (RR) 0.72, 95% confidence interval (CI) 0.56-0.91], catheter migration (RR 0.68, 95% CI 0.49, 0.95), and catheter removal (RR 0.73, 95% CI 0.60-0.88). The 2-week and 4-week rates of early tunnel/exit-site infection were also lower in the percutaneous group (RR 0.45, 95% CI 0.22-0.93 and RR 0.41, 95% CI 0.27-0.63, respectively). No statistically significant difference was observed regarding other outcomes, including catheter survival and mechanical complications. Overall, the quality of published literature on the field of peritoneal dialysis catheterplacement is poor, with a small percentage of studies being randomized clinical trials. Percutaneous peritoneal dialysis catheterplacement is a safe procedure and may result in fewer complications, such as tunnel/exit-site infections, and catheter migration, compared to surgical placement. PROSPERO CRD42020154951.

Laparoscopic two-port pre-tied peritoneal dialysis catheter insertion in children: a simple modification

BackgroundDifferent laparoscopic approaches for insertion of a peritoneal dialysis catheter (PDC) have been adopted. Most of these techniques require 2–3 ports. One port laparoscopic technique for PDC placement was introduced by some authors to minimize potential complications. The main drawback of these techniques was the inadequate position of catheter tip and hence affecting its efficacy.The purpose of this study is to evaluate a simple modified laparoscopic technique during insertion of PDC.ResultsThe mean age of these patients was 6 ± 4.1 years. There were 11 females. The mean body weight was 13 ± 3.3 kg. The mean operative time was 35.5 min. No operative complications occurred. Two cases had catheter obstruction. Wound infection developed in three cases. Mean follow-up period was 11 ± 5.3 monthsConclusionsLaparoscopic insertion of PDC in children suffering end-stage renal disease using a pre-tied catheter tip with V-loc/STRATAFIX ® size 3/0 suture and two-port-only technique was associated with shorter operative time and longer life of catheter without migration or catheter malfunction.

How To Build a Successful Urgent-Start Peritoneal Dialysis Program.

In-center hemodialysis (HD) remains the predominant dialysis therapy in patients with ESKD. Many patients with ESKD present in late stage, requiring urgent dialysis initiation, and the majority start HD with central venous catheters (CVCs), which are associated with poor outcomes and high cost of care. Peritoneal dialysis (PD) catheters can be safely placed in such patients with late-presenting ESKD, obviating the need for CVCs. PD can begin almost immediately in the recumbent position, using low fill volumes. Such PD initiations, commencing within 2 weeks of the catheter placement, are termed urgent-start PD (USPD). Most patients with an intact peritoneal cavity and stable home situation are eligible for USPD. Although there is a small risk of PD catheter-related mechanical complications, most can be managed conservatively. Moreover, overall outcomes of USPD are comparable to those with planned PD initiations, in contrast to the high rate of catheter-related infections and bacteremia associated with urgent-start HD. The ongoing coronavirus disease 2019 pandemic has further exposed the vulnerability of patients with ESKD getting in-center HD. PD can mitigate the risk of infection by reducing environmental exposure to the virus. Thus, USPD is a safe and cost-effective option for unplanned dialysis initiation in patients with late-presenting ESKD. To develop a successful USPD program, a strong infrastructure with clear pathways is essential. Coordination of care between nephrologists, surgeons or interventionalists, and hospital and PD center staff is imperative so that patient education, home visits, PD catheter placements, and urgent PD initiations are accomplished expeditiously. Implementation of urgent-start PD will help to increase PD use, reduce cost, and improve patient outcomes, and will be a step forward in fostering the goal set by the Advancing American Kidney Health initiative.

Urgent Peritoneal Dialysis Catheter Placement at a New York City Hospital During the COVID-19 Pandemic

Urgent Peritoneal Dialysis Catheter Placement at a New York City Hospital During the COVID-19 Pandemic

Interventional Radiology Placement and Management of Tunneled Peritoneal Dialysis Catheters: A Pictorial Review.

Interventional radiology (IR) is an underutilized resource for the placement and management of tunneled peritoneal dialysis (PD) catheters, as only about 5% of PD catheters are placed by using IR. PD is a cost-effective and physiologically beneficial alternative to hemodialysis (HD) with an increased survival benefit and lower complication rate than HD. As a home dialysis therapy, patients who undergo PD experience many advantages over patients who undergo HD, including a greater sense of well-being and quality of life. The author explains the history, need, rationale, benefits, complications, patient selection, preprocedure patient evaluation and preparation, catheter selection, procedural directives, and management strategies of IR involvement in tunneled PD catheter placement. Surgical and non-image-guided placement techniques and pitfalls are also discussed, and their benefits and limitations are compared with the cost-effective percutaneous image-guided IR technique. Specific attention to image-documented placement of the PD catheter coil into the retrovesical or retrouterine space is emphasized for optimal PD catheter function, as the retrovesical or retrouterine space is the most dependent portion of the peritoneal space and is void of omentum and small bowel. These features increase the functional ability of the PD catheter to effectively exchange the dialysate fluid and avoid complications such as omental wrap. IR, as an image-based specialty, is well positioned to evaluate for other complications of tunneled PD catheters such as migration, catheter kink and obstruction, and catheter leak. The demand for PD is predicted to increase in the future, and IR is strategically situated to become a leader in tunneled PD catheter placement and management. Published under a CC BY 4.0 license.