Tenckhoff Catheter Research Articles

Hospitalization Causes and Epidemiological Characteristics Among Patients With End-Stage Renal Disease: A Six-Year Retrospective Study.

Chronic kidney disease (CKD) leads to a high rate of complications requiring hospital admission for advanced management. Therefore, this study aims to analyze the main causes of hospitalization following the initiation of renal replacement therapy (RRT). This observational and descriptive study utilized a non-probabilistic quota sampling method, reviewing a total of 423 medical records from General Regional Hospital 1 of the Mexican Social Security Institute in Querétaro. The study evaluated the frequency and causality of hospitalizations during a retrospective period from 2018 to 2023. There were 1,162 hospitalization events involving 423 patients; 71.63% of patients started RRT with peritoneal dialysis, while 26% began with hemodialysis. The leading cause of hospitalization was electrolyte imbalance (397; 34.17%), followed by peritonitis associated with peritoneal dialysis (351; 30.21%), change to hemodialysis (270; 23.24%), Tenckhoff catheter dysfunction (209; 17.99%), and fluid overload (205; 17.64%). The group with the highest number of events was renal-related complications, followed by infectious causes. Hospitalizations in end-stage CKD patients often arise from the complex renal pathophysiology and complications related to acute and decompensated renal function. This condition refers to the kidneys' failure to maintain essential physiological functions despite ongoing treatment, leading to issues such as electrolyte imbalances, fluid overload, and uremic syndrome. To reduce morbidity and mortality, measures such as enhanced training in ambulatory dialysis, improved catheter care, and early infection detection are crucial. A comprehensive approach that addresses both acute issues and preventive strategies is essential for improving clinical outcomes and quality of life for these patients.

#1245 Standard or personalized policy of peritoneal catheter removal at kidney transplantation?

Abstract Background and Aims The presence of peritoneal dialysis (PD) catheter in an immunosuppressed kidney transplant recipient can increment the risk of infectious complications after transplant. For this reason, it is thought that management of PD catheters at the time of transplant can have an impact on patient and graft outcomes. However, there is no agreement when to remove peritoneal dialysis catheter after transplantation. According to European Guidelines, the catheter can be left in situ for 3-4 months despite a functional graft. Our aim was to review the data from our center regarding infectious PD associated complications after kidney transplant. Method We retrospectively reviewed all 132 patients that were previously on PD and were admitted to our center for renal transplantation between January of 2013 and June of 2023, and had information regarding timing of removal of PD access. Simple descriptive and inferential statistics were used to generate results. Categorical data were described using frequency and percentage. Our main outcome was to assess the PD infectious catheter-associated complications. Our secondary outcomes were the timing of removal of PD catheter after renal transplantation, number of episodes of dialysis post transplantation, and kidney replacement therapy (KRT) used. Our follow up included the time from kidney transplantation (KT) until they removed PD catheter. Those who removed PD catheter at the timing of renal transplantation were excluded when evaluating the infectious complications. Results From the 132 kidney transplant recipients eight patients removed PD catheter at the time of the transplant due to ongoing PD associated infection. Sixty-nine patients were men (52.3%), with a median (IQR) age at transplantation of 48.4 years (41-57). Regarding donors’ characteristics, 88 (33.3%) were deceased, 21 of which were expanded criteria donors, and 44 (66.7%) were living donors. A total of 19 (14.4%) patients had history of PD infectious complications in the three months before transplantation. From the 124 patients that remained with the PD catheter after KT the adverse event infection occurred in 19 (15.3%) patients and two of these had previous access related infection in the 3 months interval before transplantation. The adverse events were: exit-site infection (ESI) 10.4% (n = 19), peritonitis 3% (n = 4) and tunnel infection 1.6% (n = 2). Half required hospitalization mainly due to center logistics for catheter removal. No deaths were registered. The identified microorganisms are present in Table 1. The median (IQR) time of removal of the PD catheter was 4 (3-5) months. Sixteen patients (12.9%) required KRT due to delayed graft function: ten patients used the Tenckhoff catheter and the rest performed haemodialysis (four using central venous catheter and two using arteriovenous fistula). Three patients remained dialysis dependent. When analysing the living donor group the rate of KRT was even lower, with three (6.8%) patients requiring dialysis, and only one used the PD catheter. Conclusion Despite the timing of PD catheter removal was according to the European Guidelines, the risk of PD catheter associated infections is not negligible (15.3%), not to mention the burden for the patient to keep an abdominal device demanding routinely care of the exit site. Peritonitis rate was low and comparable to previous studies. Considering the utility of remaining with the catheter, the risk of needing KRT, namely in living donor KT, was low. We postulate whether PD catheter removal at the time of KT should be considered, especially when the risk of late graft function is low, as in living donors, and/or the risk of PD catheter related infections is high. For this reason, we call for an individualized policy regarding catheter removal in the transition to KT.

A challenging case of severe bilateral septic arthritis with osteomyelitis of the sternoclavicular joint in a patient with end-stage renal disease.

Septic arthritis of the sternoclavicular joint (SCJ) is a rare condition that comprises <1% of all joint infections. We report a case of severe bilateral septic arthritis of the SCJ in a patient with end-stage renal disease on peritoneal dialysis. A 44-year-old female presented with right SCJ infection 1 month after recovering from a tenckhoff catheter exit-site infection. She completed 6 weeks of antibiotics however this progressed to bilateral SCJ septic arthritis with osteomyelitis necessitating multiple surgical debridement and excision of bilateral clavicular heads. Further imaging showed signs of renal osteodystrophy and degenerative joint changes resembling calcium pyrophosphate deposition. Patients with end-stage renal disease have multiple risk factors including immune system dysfunction, renal osteodystrophy and dialysis access sites that increase susceptibility to bacteraemia and seeding. Therefore in such patients, prompt assessment is necessary to ensure expeditious diagnosis and treatment of this potentially debilitating condition. A multidisciplinary team involving various specialties is crucial for the holistic care for such patients and to reduce the risk of recurrence.

Comparison of clinical outcomes between culture-negative and positive peritonitis in patients undergoing maintenance peritoneal dialysis: a prospective cohort study

BackgroundCulture-negative peritonitis is a serious complication in patients undergoing maintenance peritoneal dialysis (PD) and occurs in up to 40% of all peritonitis episodes. Despite its high incidence, data regarding treatment response and prognosis remain poorly defined. This study compared the clinical outcomes of patients with culture-negative and positive peritonitis.MethodThis prospective cohort study was conducted between 2021 and 2022. Patients treated with maintenance PD who developed PD-associated peritonitis were included and received standard treatment. The primary endpoint was the primary response (resolution of peritonitis 10 days after the initiation of treatment).ResultsOf the 81 patients who developed PD-associated peritonitis during the study, 35 and 46 had culture-negative and culture-positive peritonitis, respectively. Overall, 52 (64.2%) patients achieved the primary response: 24 (68.6%) in the culture-negative group and 28 (60.9%) in the culture-positive group (p = 0.630). There were no significant differences between the two groups in the incidence of complete cure (complete resolution of peritonitis without the need for Tenckhoff catheter removal or salvage antibiotic therapy or peritonitis within 120 days after treatment) (culture-negative vs. culture-positive group, 57.1% vs. 45.7%), refractory peritonitis (28.6% vs. 41.3%), relapse peritonitis (8.6% vs. 2.2%), repeat peritonitis (11.4% vs. 10.9%), salvage antibiotics (40.0% vs. 50.0%), permanent hemodialysis transfer (11.4% vs. 10.9%), Tenckhoff catheter removal (25.7% vs. 41.3%), or mortality (2.9% vs. 2.2%) (all p > 0.05).ConclusionThis study offers valuable insights into the clinical outcomes of culture-negative peritonitis versus culture-positive peritonitis. However, caution must be exercised in interpreting these findings due to the limitations of the small sample size.Clinical trial registrationThe study was retrospectively registered in the Thai Clinical Trials Registry (TCTR20221130006).

Rescue plan for CAPD peritonitis: Using ultrasonography as a guide on when to remove the catheter.

Ultrasound has been found to facilitate early identification of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). A retrospective analysis was carried out to evaluate the effectiveness of ultrasonography-guided removal of the Tenckhoff catheter in reducing complications like a shift to hemodialysis or death in CAPD patients. The "peritonitis rescue plan" supported timely decision-making for the removal of the infected catheter and resulted in a lower peritonitis episode per patient per month ratio (from 1:36 to 1:122) in 2021, a lower death rate (from 19% to 6.6%) and lower incidences of shifts to hemodialysis (from 2%-9% to 0%) as compared to that before the implementation of the plan in 2019. The implementation of the "peritonitis rescue plan" and the removal of the infected catheter within 3 days of peritonitis being detected was successful in improving the standard of care for patients undergoing CAPD.

Management of peritoneal dialysis in an adolescent with septic shock, AKI, multi-organ failure and COVID-19: a case report

The kidneys is the most commonly injured organs in sepsis, which might manifest as acute kidney injury (AKI). Peritoneal dialysis (PD) is the preferred modality of renal replacement therapy (RRT), especially in the developing countries. Furthermore, the COVID-19 pandemic has made hemodialysis (HD) unavailable due to infection concerns. We present a critically-ill 16-year-old male with morbid obesity (BMI 43.3 kg/m2), diabetic ketoacidosis, acute pancreatitis, acute kidney injury, and COVID-19 pneumonia. The patient looked somnolent on admission with very high random blood glucose and hypernatremia. Blood gas analysis showed metabolic acidosis. The patient was treated with 1 g/day Meropenem, 0.5 µg/kg/min norepinephrine, 0.04 unit/kg/h vasopressin, and correction of electrolyte imbalance and metabolic acidosis. After 48 h, the diuresis and the creatinine levels worsened. We placed a Tenckhoff catheter and started PD. The patient showed improvement after 72 h of peritoneal dialysis.&#x0D; This case report highlighted the use of PD as a modality of RRT in sepsis-induced AKI, multi-organ failure, and COVID-19. Although it remains controversial, we observed an improvement in diuresis and creatinine levels following PD. PD is more cost-effective and provides a similar outcome compared to other modalities.&#x0D; Abbreviations: AKI - Acute Kidney Injury; BMI- Body Mass Index; CRRT- Continous Renal Replacement Therapu; GCS- Glasgow Coma Scale; HD- Hemodialysis; ICU- Intensive Care Unit; PD- Peritoenal Dialysis; RRT- Renal Replacement Therapy; S-AKI- Sepsis-Associated Acute Kidney Injury; SIRS- Systemic Inflammatory Response Syndrome&#x0D; Key words: Septic shock; Acute kidney injury; Peritoneal dialysis&#x0D; Citation: Andiantoro DS, Sedono R, Jennefer J. Management of peritoneal dialysis in an adolescent with septic shock, AKI, multi-organ failure and COVID-19: a case report. Anaesth. pain intensive care 2023;27(4):600−603.&#x0D; DOI: 10.35975/apic.v27i4.2163&#x0D; Received: February 14, 2023; Reviewed: April 17, 2023; Accepted: April 22, 2023

#3122 30-DAY COMPLICATIONS IN PERITONEAL DIALYSIS CATHETERS INSERTED PERCUTANEOUSLY VERSUS SURGICALLY IN A SECOND LEVEL HOSPITAL IN MERIDA, YUCATAN, MEXICO

Abstract Background and Aims Peritoneal dialysis (PD) catheter insertion technique has an impact on the health outcomes and technical success in PD. The percutaneous technique allows for a bedside, minimally invasive and faster insertion without the need of using an operating room and general anesthesia. In 2021, Agarwal et. al reported that percutaneous insertion was associated with a 64% relative risk reduction (RRR) of early exit site infection and a 48% RRR of early peritonitis with no difference in terms of mechanical complications compared to the surgical technique [1]. The aim of our study was to describe the frequency of mechanical and infectious complications within the first 30 days of PD catheter insertion between the percutaneous and surgical technique. Method We conducted a descriptive and prospective study in our Hospital from January 1st to December 31st, 2022. Patients who were candidates for renal replacement therapy with PD and who had no previous history of abdominal surgery or only minor abdominal surgery, underwent percutaneous insertion of PD catheter by a nephrologist with a bedside blind technique, whereas patients with previous abdominal surgery underwent surgical insertion with a mini laparotomy. Informed consent and preoperative blood tests were obtained before the procedure in both techniques. Patient preparation for the percutaneous insertion included fasting the night before, colonic enema and the placement of a urinary catheter, patients received antimicrobial prophylaxis as well as analgesia and light sedation. Mechanical and infectious complications within the first 30 days after insertion of double cuff Tenckhoff catheters were registered. Results During the study period, 155 PD catheter insertions took place in our hospital, the majority of insertions were surgical (53.5% versus 46.4%) and happened in women (60.6%). The mean age of the population was 51.5 years and 70.3% of the participants were diabetic. Exit-site infection was significantly more frequent in the surgically placed PD catheters (10% versus 1%, p = 0.02), there was a tendency for more mechanical dysfunction in the surgical technique versus the percutaneous technique (14.4% versus 5.5%, p = 0.07) and transfer to hemodialysis was more frequent in the surgical insertion group (10.8% versus 1.3%, p = 0.01). There was no difference between peritonitis in both groups and the frequency of uncomplicated PD catheters (catheter survival without any complication) was similar in both techniques. Conclusion Bedside PD catheter insertion by the nephrologist using a percutaneous technique can be an easy, timely, safe and adequate procedure with comparable success to the surgical insertion. It may have the advantage of more efficient control of infectious and mechanical complications and what is more, this approach could reduce the cost of kidney failure treatment as it allows for the use of minimal material and human resources.

#4850 20 YEARS' EXPERIENCE OF PERITONEAL DIALYSIS IN SARAWAK, MALAYSIA

Abstract Background and Aims Peritoneal dialysis is a modality of renal replacement therapy first introduced in the 1960s. In the event of the recent COVID 19 pandemic, peritoneal dialysis is gaining popularity due to the increased preference of home dialysis. Sarawak is the largest state in Malaysia with a population of more than 2 million. Unfortunately, 13% of households in the state are living in poverty. We present our experience with continuous ambulatory peritoneal dialysis (CAPD) for the past years in a geographically and socioeconomically challenging region. Method Sarawak General Hospital is the centre of referral for Tenckhoff catheter insertion from other districts in Sarawak. This is a retrospective record review of all CAPD patients who were under our clinic follow up from 2001 to 2022. Data examined included patient's demographic data, incidence of peritoneal dialysis related peritonitis and their outcome. Results All of the patients on CAPD were recorded by December of each year since we started our service in 2001 which shows a rising trend of patients on CAPD, with the highest in December 2022 at 399 patients. The number of patients with dialysis related peritonitis was also collected. Despite having more patients on CAPD, the number of peritonitis episodes per patient-year were in a decreasing trend. This was the result of the implementation of empirical first line intra-peritoneal antibiotics as part of the CAPD Peritonitis Management Protocol in 2015 and Decontamination Protocol in 2016. Conclusion Despite the headwinds of geographic and socioeconomic challenges, the number of patients on CAPD is on the rise. Over the years, peritonitis rate declined approaching to 0.2 episodes per patient-year. This was made possible with the introduction of local decontamination protocol and CAPD peritonitis management protocol, which helped improve the life expectancy and health of renal patients in the region.

#5521 TENCKHOFF CATHETER EXIT-SITE INFECTION BY ACTINOMYCES ODONTOLYTICUS: A RARE CASE

Abstract Background and Aims Actinomyces odontolyticus is an anaerobic Gram-positive bacteria, which can be found among the commensal flora of the mouth and oropharynx. Diagnosis of infections due to this microorganism can be difficult because of its rarity, indolent course and lack of specific symptoms. Only one case of exit-site infection (ESI) due to Actinomyces odontolyticus in a patient on continuous ambulatory peritoneal dialysis (CAPD) has been reported. This work aims to report a case of ESI due to this rare agent. Method We present a case of Tenckhoff catheter ESI due to Actinomyces odontolyticus in a patient on CAPD. Results Case report: We report the case of a 26-year-old woman with a personal history of dyslipidemia, arterial hypertension and end-stage chronic kidney disease caused by Alport Syndrome in a CAPD program since April 2016. In June 2020, the patient presented an episode of refractory ESI due to methicillin-sensitive Staphylococcus aureus and was submitted to a shaving of the external cuff of the Tenckhoff catheter, with good subsequent evolution. The patient had no complications related to the catheter until April 2021, when she presented purulent drainage through the exit-site associated with erythema of the surrounding area. The consecutive exit-site swabs were negative. She underwent antibiotic therapy with cotrimoxazole for 2 weeks with apparent resolution. However, in May 2021, the patient presents again erythema and purulent drainage and, at that time, a rare agent was isolated in the swab: Actinomyces odontolyticus with resistance to penicillin, amoxicillin, ceftriaxone and cotrimoxazole. Given this isolation, the patient was treated with doxycycline 100mg every 12 hours for 4 weeks. The evolution was favorable with resolution of the infection and absence of recurrence for a 6-month follow-up. At the end of this follow-up time, the patient was transplanted. Conclusion Actinomyces odontolyticus is a bacteria of the commensal flora of the oral cavity and upper gastrointestinal tract, which can acquire pathogenicity in situations of impaired mucosal integrity and in immunosuppressed patients. Infections caused by this agent are rare and represent a diagnostic challenge due to its growth in an anaerobic environment and prolonged isolation time (5 days to 4 weeks). The immunosuppression conferred by chronic kidney disease and the history of external cuff shaving may have propitiated the infection by this rare opportunistic agent in our patient. The ESI presented for the patient in the previous month, which did not have an identified agent, was possibly caused by Actinomyces odontolyticus, but it was not isolated probably due to culture difficulties. The treatment of Actinomyces infections is generally conservative with 2 to 4 weeks of high-dose of intravenous penicillin, followed by 2 to 6 months of oral antibiotic therapy. In case of allergy, regimens with ceftriaxone, doxycycline, clindamycin or carbapenems are recommended. There is no consensus on the duration of treatment, with some authors recommending a minimum of 2 to 6 weeks. The mentioned patient was treated with 4 weeks of doxycycline according to the sensitivity test and the result was favorable, without the need to remove the catheter.

Risk factors for early dialysate leakage around the exit site after catheter placement in pediatric peritoneal dialysis: a single-center experience.

Dialysate leakage, a major complication in peritoneal dialysis (PD), causes difficulty in continuing PD. However, literature evaluating risk factors for leakage in detail and the appropriate break-in period to avoid leakage in pediatric patients is scarce. We conducted a retrospective study on children aged < 20years who underwent Tenckhoff catheter placement between April 1, 2002, and December 31, 2021, at our institution. We compared clinical factors between patients with and without leakage within 30days of catheter insertion. Dialysate leakage occurred in 8 of 102 (7.8%) PD catheters placed in 78 patients. All leaks occurred in children with a break-in period of < 14days. Leaks were significantly more frequent in patients with low body weight at the catheter insertion, single-cuffed catheter insertion, a break-in period ≤ 7days, and a long PD treatment time per day. Only one patient who had leakage with a break-in period > 7days was neonate. PD was suspended in four of the eight patients with leakage and continued in the others. Two of the latter had secondary peritonitis, one of whom required catheter removal, and leakage improved in the remaining patients. Three infants had serious complications from bridge hemodialysis. A break-in period of > 7days and if possible 14days is recommended to avoid leakage in pediatric patients. Whereas infants with low body weight are at high risk of leakage, their difficulty in inserting double-cuffed catheter, hemodialysis complications, and possible leakage even under long break-in period make prevention of leakage challenging.

Two plus one port laparoscopic assisted continuous ambulatory peritoneal dialysis insertion modified technique: a case series.

A retrospective case series from the medical records at Semarang Tertiary Hospital was identified between 2017 and 2021. Demographic, clinical, intraoperative, and postoperative complication data were collected with a 1-year follow-up after the CAPD procedure. This study included 49 patients with a mean age of 43.2±13.6 years, and diabetes was the main cause (51.02%). This modified technique showed no complications intraoperatively. The postoperative complications were found to include one case of hematoma (2.04%), eight cases of omental adhesion (16.3%), seven cases of exit-site infection (14.28%), and two cases of peritonitis (4.08%). Malposition of the Tenckhoff catheter was not found 1-year after the procedure. The two plus one port modified laparoscopic assisted CAPD technique could prevent malposition of the Teckhoff catheter because it is already fixated in the pelvic. A long-term follow-up of 5 years is necessary to know the long-term survival of the Tenckhoff catheter in the next study.

Systematic use of magnetic double J stent in pediatric kidney transplantation: A single-center experience.

The intraoperative insertion of a double J stent (DJS) is known to reduce urological complications and is broadly accepted in kidney transplant (KTx) patients. The magnetic ureteral DJS (mDJS) represents a valid alternative device as it can be removed without cystoscopy, using a transurethral magnet. This is of particular importance in the pediatrics, allowing us to avoid cystoscopy requiring general anesthesia (GA) in this population. To date, few data are available on the systematic use of mDJS in pediatric patients undergoing KTx. We report a retrospective analysis of 32 consecutive pediatric KTx at our center from July 2020 to December 2021. Ureteral stents remained in place for a median of 35 days (range: 12-76). Non-surgical magnetic removal of the mDJS was attempted in all cases without complications. In most cases (69%), the removal procedure was performed in an outpatient clinic. In 10 cases, the mDJS was removed in the operating room under sedation before removal of the abdominal Tenckhoff catheter. All patients were clinically followed (range: 3-15 months). We confirm the safety and feasibility of systematic use of mDJS in the setting of pediatric KTx. The systematic use of this device contributes to reduce the need for GA and the rate of hospital admission.

Urgent vs. planned peritoneal dialysis initiation: complications and outcomes in the first year of therapy.

Urgent-start peritoneal dialysis (US-PD) has been proposed as a safe modality of renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients with an indication for emergency dialysis initiation. We aimed to compare the characteristics, 30-day complications, and clinical outcomes of US-PD and planned peritoneal dialysis (Plan-PD) patients over the first year of therapy. This was a single-center retrospective study that included incident adult patients followed for up to one year. US-PD was considered when incident patients started therapy within 7 days after Tenckhoff catheter implantation. Plan-PD group consisted of patients who started therapy after the breaking period (15 days). Mechanical and infectious complications were compared 30 days from PD initiation. Hospitalization and technique failure during the first 12 months on PD were assessed by Kaplan-Meier curves and the determinants were calculated by Cox regression models. All patients starting PD between October/2016 and November/2019 who fulfilled the inclusion criteria were analyzed. We evaluated 137 patients (70 in the US-PD x 67 Plan-PD). The main complications in the first 30 days were catheter tip migration (7.5% Plan-PD x 4.3% US-PD - p= 0.49) and leakage (4.5% Plan-PD x 5.7% US-PD - p=0.74). Most catheters were placed using the Seldinger technique. The main cause of dropout was death in US-PD patients (15.7%) and transfer to HD in Plan-PD patients (13.4%). The occurrence of complications in the first 30 days was the only risk factor for dropout (OR = 2.9; 95% CI 1.1-7.5, p = 0.03). Hospitalization rates and technique survival were similar in both groups. The lack of significant differences in patients' outcomes between groups reinforces that PD is a safe and applicable dialysis method in patients who need immediate dialysis.

Marty Roberts; The Man Who Brought Sorbent Dialysis to Life.

Marty Roberts; The Man Who Brought Sorbent Dialysis to Life.

Antibiotic Prophylaxis for Tenckhoff Catheter Insertion: A Prospective Randomized Controlled Trial

Antibiotic Prophylaxis for Tenckhoff Catheter Insertion: A Prospective Randomized Controlled Trial

Applicability of the drainage effectiveness of Blake drains and Tenckhoff catheters in the peritoneal dialysis of healthy rabbits ( Oryctolagus cuniculus )

To compare the efficacy of dialysate drainage between Tenckhoff (TC) catheter and Blake (BL) in peritoneal dialysis (PD) in healthy rabbits. Prospective experimental study. University Teaching Hospital and University research laboratory. Twenty healthy, male, New Zealand rabbits. PD via the TC catheter and the BL abdominal drain was compared during 3 consecutive days of dialysis delivery. One session of PD was performed per day for 3 consecutive days (S1: first session, S2: second session, S3: third session) and each session included 4 cycles of infusion, dwell of dialysate in the abdomen, and drainage. Data collection included daily urea, creatinine, alanine aminotransferase, albumin, and potassium, in addition to hematological parameters (eg, RBC, HCT, hemoglobin, WBC, and platelet count). Statistical analysis using a mixed linear model with multiple comparisons was performed. The BL drain resulted in an increase in volume drained (ml/kg) when compared to TC catheter on S2 (third and fourth cycles) and S3 (first and second cycles). The BL drain proved to be superior to the TC catheter, being capable of draining a larger volume of dialysate during the drainage processes in the peritoneal PD of healthy rabbits. The TC catheter had major complications with regard to fluid retention in the abdomen, representing reduced drainage efficiency, while the BL drain showed a greater tendency for the peritoneal fluid to leak.

Ultrasound-Guided Modified Seldinger Placement of Tenckhoff Catheters in Pediatric Patients Undergoing Peritoneal Dialysis: Single Center Experience.

Minimally invasive peritoneal dialysis (PD) catheterization is increasingly common, and percutaneous PD catheters may be placed using a trocar or the Seldinger technique. There are few reports of pediatric percutaneous PD catheter insertion. We retrospectively compared the outcomes from percutaneous placement of Tenckhoff catheters using a modified Seldinger technique with catheter placement by open surgery. This single-center retrospective study compared 14 pediatric patients who received percutaneous PD catheter insertion using an ultrasound-guided modified Seldinger technique (August 2018–February 2021) with 10 patients who received open-surgical PD catheter insertion (2015–2018). Complications and catheter survival were evaluated. The overall technical success rate was 100%, but the Seldinger technique required less time (30 vs. 45 min) and smaller incisions (1.1 vs. 4.4 cm). The early complications in the Seldinger and control groups were bleeding (1 vs. 0), catheter dysfunction (1 vs. 1), abdominal pain (3 vs. 7), and exit leakage (0 vs. 1). In the Seldinger group, the median time from insertion to first use was 3 days, and the minimum follow-up was 6 months. Catheter survival at 6 months was 93% (Seldinger group) and 90% (open surgery group). The adoption of this technique at our institution led to a significant increase in the percentage of new pediatric dialysis patients commencing PD rather than hemodialysis. Collectively, the modified Seldinger technique described here was safe and feasible in pediatric patients. This approach is simpler and more rapid than open surgery, and reduces early complications and increases PD uptake.

MO718: Urgent, Early and Planned Start Peritoneal Dialysis—Does the Initiation Modality Matter to Patient's Outcomes?

Abstract BACKGROUND AND AIMS Peritoneal dialysis (PD) has been used as a renal replacement therapy for end-stage kidney disease patients in different initiation patterns: urgent, early and planned start PD. The indication of PD initiation is mainly based on the presence or not of signs and symptoms that would indicate dialysis urgent initiation and in the possibility of patients receive pre-dialysis when they would plan RRT initiation when necessary. Our aim was to evaluate if the PD initiation modality interfere in patients’ 30- and 180-day outcomes and in the technique survival. METHOD This is a single-center retrospective study that included incident adult patients starting PD between October 2016 and March 2021. Exclusion criteria were: (i) have done previously PD, (ii) patients younger &amp;lt; 18 years old and (iii) missing data related to main outcomes analysed. US-PD group was considered those incident patients starting therapy with some urgent indication and within 3 days after Tenckhoff catheter implantation, ES-PD group was those patients who had previously received urgent hemodialysis (HD) and started PD between 3 and 14 days and, Plan-PD group consisted of patients who started therapy after the breaking period (15 days). Complications and hospitalization due to all cause were compared 30 and 180 days from PD initiation. Technique survival during the first 180 days on PD were assessed by Kaplan–Meier curves. RESULTS During the period mentioned earlier 280 patients started PD. In these analyses 201 patients were included. Mean age was 58.4 ± 15.2 years old, most part of patients were female (51.7%) and considered themselves as white race (92%). The most common etiology for kidney disease was diabetes (32%). Most part of patients had arterial hypertension and diabetes as main comorbidities (88.6% and 48.3%). Considering the PD initiation, 62 (30.8%) patients started PD urgently, 84 (41.8%) patients had an earlier start and 55 (27.4%) started PD planned. Patients have similar characteristics regarding demographics, comorbidities, and cause of renal disease. Patients in the ES-PD group had higher prevalence of heart failure and coronary arterial disease compared to the others (P = 0.03 and 0.08, respectively). Regarding complications in the first 30 days on PD, the most common complication was mechanical ones such as leakage and catheter tip migration and the incidence of these did not differ from PD initiation modalities. The US and ES-PD groups presented a greater incidence of hospitalization events in the first 30 days compared with the Plan-PD group [8 (13.6%) events US-PD, 16 (19.3%) ES-PD and 1 (0.5%) Plan-PD—P = 0.04], most part of them not related to PD. Complication and hospitalization events were similar in all groups in 180 days on therapy. Patients on the ES-PD group had a higher percentage of transfer to HD during the first 180 days. Technique survival was similar between groups (US-PD 85.2%, ES-PD 77.1% and Plan-PD 88.7%—log-rank P = 0.18) in 180 days follow-up (Fig. 1). Death and transfer to HD were the most common causes for dropout, mainly in the ES-PD group [9 (10.7% deaths and 12 (14.3%) transfer to HD]. CONCLUSION The study demonstrates similar complications after 30 days PD initiation regardless of type of PD initiation, greater hospitalization events in the ES-PD group after 30 days, which can be related to the patients’ characteristics. Similar complications, hospitalizations, and technique survival after 180 days on PD we found for both groups.

New method of internal fixation in laparoscopic Tenckhoff catheter placement.

Despite obvious advantages of peritoneal dialysis (PD), mechanical complications are responsible for the failure of PD at early stage. Suture fixation in laparoscopic PD catheter method could reduce mechanical complications. In our study, a simple method to fix PD catheter was developed. Tenckhoff catheter placement was performed in 49 consecutive patients. In the technique, only two trocars were used. With the help of syringe needle and forceps, a loop of silk was prepared at the abdominal wall. The PD catheter was thread through the loop. The silk ligature was tied subcutaneously keeping the catheter suspended from the abdominal wall. Primary outcomes were catheter-related complications. Secondary outcomes were 6-month catheter survival rates and death within 30 days. Data were analyzed retrospectively. The average operation time was 49.7 ± 15.8min. Minimum follow-up time was 6months. No catheter displacement or hernia was detected. One patient had omental wrapping after silk suture rupture, 2 patients had outflow obstruction, and 3 patients had leakage. No one died within 30 days postoperatively. Catheter survival was 95.8% at 6months. The method we described greatly reduced the risk of catheter displacement and omental wrap. Also, the required instrument and laparoscopic skill were simple.

POS-678 OUTCOMES OF TENCKHOFF CATHETER INSERTION: A TWO-YEAR RETROSPECTIVE STUDY OF 380 PATIENTS

Timely and effective insertion of Tenckhoff Catheters (TC) for Peritoneal Dialysis (PD) is the Achilles’ heel of a successful PD programme. Complications are varied and not uncommon during insertion. Retrospective descriptive study of all TC insertions in Nephrology Unit, Hospital Raja Permaisuri Bainun, Malaysia performed in 2019-2020. We describe the 1-month complications and 3-month outcomes in this cohort. We also compared the complication rates and outcomes of TCs inserted using the Seldinger vs peritoneoscope technique – both performed by nephrologists. A total of 413 TCs were inserted in year 2019-2020. Case notes were unable to be retrieved in 33 patients. The remaining 380 were included in analysis. Patients were predominantly males (57.9%), Malay in ethnicity (69%) with mean age of 53.9 (SD 14.59) and mean BMI of 26.03 (SD 5.23). Majority had hypertension (90.5%) and diabetes mellitus (66.8%). The most common disease leading to CKD were diabetes mellitus (65.5%) and hypertension (12.6%). One fifth of patients were converted from regular haemodialysis to PD – main reason was vascular access difficulty (86.8%). Prior history of TC insertions was reported in 17.1% of patients. The most frequent method of TC insertion was peritoneoscope (63.7%), followed by Seldinger (31.3%) and laparoscopic (4.7%). Catheter break-in at less than 2 weeks post insertion was 22.6%. Catheter survival was 89.2% at 1-month and 81.3% at 3-month post insertion. Patient survival was 97.1% at 3-month post insertion. One death occurred as a result of complication during TC insertion. Complications occurred in 36.3% of TC insertions at one month (Table 1). Multivariate analysis showed that when compared to patients age 40 and below, patients aged 41-59 and aged ≥60 had 49% and 58% less odds of developing complications respectively (p=0.026, 95%CI 0.29-0.9; p=0.005, 95% CI 0.23-0.77) . Patients with serum cholesterol ≥4.5mmol/L are 60% less likely to develop complications compared to those with <4.5mmol/L(p<0.0001, 95%CI 0.24, 0.65). Subgroup analysis comparing outcomes of Seldinger (n=119) and peritoneoscope (n=242) insertion revealed more catheter obstruction in the Seldinger subgroup (p=0.042). Kaplan-Meier survival analysis revealed no significant difference in overall catheter survival at 90 days between both techniques (p=0.085). Survival rate at 90 days were 76.5% for Seldinger technique and 83.9% for peritoneoscope technique. TC insertion is safe. Serious complications are rare. Most complications can be managed with good outcomes. Patients with lower serum cholesterol are more likely to develop complications, probably due to poorer nutritional status/inflammatory state. With proper patient selection, both Seldinger and peritoneoscope insertion techniques provide comparable outcomes.