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Khan SF, Rosner MH. Optimizing peritoneal dialysis catheter placement. FRONTIERS IN NEPHROLOGY 2023; 3:1056574. [PMID: 37675363 PMCID: PMC10479565 DOI: 10.3389/fneph.2023.1056574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/22/2023] [Indexed: 09/08/2023]
Abstract
Long-term success of peritoneal dialysis as a kidney replacement therapy requires a well-functioning peritoneal dialysis catheter. With ongoing reductions in infectious complications, there is an increased emphasis on the impact of catheter-related and mechanical complications. There is currently a marked variation in the utilization of various types of catheters (double cuff vs single cuff, coiled tip vs straight tip), methods of catheter insertion (advanced laparoscopic, open surgical dissection, image guided percutaneous, blind percutaneous), timing of catheter insertion, location of catheter placement (pre-sternal v. abdominal) and peri-operative practices. Specialized approaches to catheter placement in clinical practice include use of extended catheters and embedded catheters. Marked variations in patient lifestyle preferences and comorbidities, specifically in high acuity patient populations (polycystic kidney disease, obesity, cirrhosis) necessitate individualized approaches to catheter placement and care. Current consensus guidelines recommend local procedural expertise, consideration of patient characteristics and appropriate resources to support catheter placement and long-term functioning. This review focuses on an overview of approaches to catheter placement with emphasis on a patient-centered approach.
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Affiliation(s)
- Sana F. Khan
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA, United States
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2
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Cosmatos A, McCormick B, Brown PA. Neobladder creation is still a conduit to peritoneal dialysis - Successful use of peritoneal dialysis after invasive bladder cancer. Perit Dial Int 2021; 42:425-427. [PMID: 34931556 DOI: 10.1177/08968608211065882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Peritoneal dialysis (PD) is as safe and more cost-effective than haemodialysis (HD). It also allows patients to undergo renal replacement therapy (RRT) from home. However, PD remains underutilised in many parts of the world. This is true in part because of many perceived relative contraindications to PD, including a history of prior major abdominal surgery. Prior major abdominal surgery is a concern for standard bedside or surgical catheter placement since these patients are at risk of having adhesions, which can complicate catheter placement. However, with laparoscopic advancements, prior major abdominal surgery is no longer even a relative contraindication to PD for skilled and experienced surgeons. We report the case of a male in his 70s with a history of cystoprostatectomy which was curative for a muscle invasive bladder carcinoma 5 years prior to his RRT. The patient had longstanding chronic kidney disease which worsened gradually. After receiving RRT education, the patient favoured PD. The catheter was placed despite the surgeon noting abdominal adhesions and the patient successfully underwent 12 months of PD which had a positive impact on his quality of life. He transferred to HD after contracting a complex PD-associated peritonitis. Thus, new research should be conducted to better understand the real impact of prior abdominal surgeries as a contraindication to PD, especially in centres where the surgeons have experience with advanced laparoscopy.
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Affiliation(s)
| | - Brendan McCormick
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Pierre Antoine Brown
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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3
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Tan R, Sieunarine K. Peritoneal dialysis catheter intraluminal fibrin cast: A complication after prolonged placement. Case series with a review of literature and the management of this complication. J Vasc Access 2020; 21:1029-1033. [PMID: 32364814 DOI: 10.1177/1129729820917855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Peritoneal dialysis is a renal substitutive therapy used in an increasing number of patients with end-stage renal failure as it allows greater freedom to perform daily activities. Peritoneal dialysis catheter obstruction is a significant non-infectious complication of peritoneal dialysis. We describe three cases of peritoneal dialysis catheter obstruction with complete fibrin casts, its surgical management and a review of the literature in management techniques and have proposed an algorithm to guide clinical practise when a complete intraluminal peritoneal dialysis catheter obstruction is suspected.
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Affiliation(s)
- Rebekah Tan
- Hollywood Private Hospital, Nedlands, WA, Australia
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4
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Oliver MJ, Perl J, McQuillan R, Blake PG, Jain AK, McCormick B, Yang R, Pirkle JL, Fissell RB, Golper TA, Shen JI, Hu SL, Pellegrino B, Liebman SE, Krishna VN, Ravani P, Clarke A, Quinn RR. Quantifying the risk of insertion-related peritoneal dialysis catheter complications following laparoscopic placement: Results from the North American PD Catheter Registry. Perit Dial Int 2020; 40:185-192. [PMID: 32063191 DOI: 10.1177/0896860819893813] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is a more cost-effective therapy to treat kidney failure than in-center hemodialysis, but successful therapy requires a functioning PD catheter that causes minimal complications. In 2015, the North American Chapter of the International Society for Peritoneal Dialysis established the North American PD Catheter Registry to improve practices and patient outcomes following PD catheter insertion. AIMS The objective of this study is to propose a methodology for defining insertion-related complications that lead to significant adverse events and report the risk of these complications among patients undergoing laparoscopic PD catheter insertion. METHODS Patients undergoing laparoscopic PD catheter insertion were enrolled at 14 participating centers in Canada and the United States and followed using a Web-based registry. Insertion-related complications were defined as flow restriction, exit-site leak, or abdominal pain at any point during follow-up. We also included infections or bleeding within 30 days of insertion, and any immediate postoperative complications. Adverse events were categorized as PD never starting or termination of PD therapy, delay in the start of PD therapy or interruption of PD therapy, an emergency department visit or hospitalization, or need for invasive procedures. Cause-specific cumulative incidence functions were used to estimate risk. RESULTS Five hundred patients underwent laparoscopic PD catheter insertion between 10 November 2015 and 24 July 2018. The cumulative risk of insertion-related complications 6 months from the date of insertion that led to an adverse event was 24%. The risk of flow restriction, exit-site leak, and pain at 6 months was 10.2%, 5.7%, and 5.3%, respectively. PD was never started or terminated in 6.4% of patients due to an insertion-related complication. Leaks and flow restrictions were most likely to delay or interrupt PD therapy. Flow restrictions were the primary cause of invasive procedures. Fifty percent of the complications occurred before the start of PD therapy. CONCLUSIONS Insertion-related complications leading to significant adverse events following laparoscopic placement of PD catheters are common. Many complications occur before the start of PD. Insertion-related complications are an important area of focus for future research and quality improvement efforts.
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Affiliation(s)
- Matthew J Oliver
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeff Perl
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rory McQuillan
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter G Blake
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Arsh K Jain
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Brendan McCormick
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Yang
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - James L Pirkle
- Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rachel B Fissell
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas A Golper
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jenny I Shen
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Susie L Hu
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Scott E Liebman
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Vinay N Krishna
- Division of Nephrology, Department of Medicine, the University of Alabama at Birmingham, AL, USA
| | - Pietro Ravani
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alix Clarke
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert R Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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5
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Successful Initiation of Dialysis with a 20-Year-Old Buried Peritoneal Dialysis Catheter: Case Report and Literature Review. Case Rep Nephrol 2019; 2019:5678026. [PMID: 30911423 PMCID: PMC6398044 DOI: 10.1155/2019/5678026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/06/2019] [Indexed: 11/17/2022] Open
Abstract
Buried peritoneal dialysis (PD) catheters are typically inserted several weeks or months before the anticipated need for dialysis. Occasionally, renal function unexpectedly stabilizes after the surgery, and a patient may go years before the catheter is needed. We report a case of successful initiation of PD with a twenty-year-old buried catheter. We outline the steps needed to optimize the catheter function and review the benefits of the buried PD catheter.
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6
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Sinha S, Fok M, Davenport A, Banga N, Lindsey B, Fernando B, Forman CJ. Use of the embedded peritoneal dialysis catheter. Ann R Coll Surg Engl 2018; 100:534-544. [PMID: 29692189 DOI: 10.1308/rcsann.2018.0088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction The use of embedded peritoneal dialysis (PD) catheters is purported to offer numerous benefits over standard placement. However, the optimum period of embedment and the effect of prolonged embedment on subsequent catheter function remain unclear. Methods This retrospective observational study looked at adult patients undergoing embedded PD catheter insertion in a large tertiary referral centre in the UK. Possible predictors for catheter non-function at externalisation were investigated. These included patient factors (age, sex, diabetic status, body mass index, ethnicity, smoking status, previous surgery, estimated glomerular filtration rate), procedural factors (modality of surgery, concurrent surgical procedure), duration of catheter embedment and catheter damage at externalisation. Outcomes examined were proportion of catheters functioning after externalisation, futile placement rate, surgical reintervention rate, infectious complication rate and proportion of externalised catheters lost owing to malfunction. Results Sixty-six catheters were embedded and two-thirds (n=47, 63.6%) were externalised after a median embedment period of 39.4 weeks. Of these, 25 (53.2%) functioned on externalisation. Fourteen (63.6%) of the 22 non-functioning catheters were salvaged. The overall utilisation of PD was 34/47 (72.3%) and the futile placement rate was 12.1%. Over half of the externalised catheters (n=27, 57.4%) were lost directly as a result of catheter related complications, with a median survival time of 39.4 weeks. In adjusted analysis, increasing embedment duration was significantly predictive of catheter non-function at externalisation (adjusted odds ratio: 0.957, 95% confidence interval [CI]: 0.929-0.985, p=0.003) while subsequent catheter loss was highly dependent on catheter function at externalisation (hazard ratio: 0.258, 95% CI: 0.112-0.594, p=0.001). Conclusions Prolonged embedment of PD catheters is associated with a significantly higher likelihood of catheter dysfunction following externalisation, which is in turn associated with subsequent catheter loss. We have discontinued the use of this technique in our unit.
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Affiliation(s)
- S Sinha
- Royal Free London NHS Foundation Trust , UK.,Basildon and Thurrock University Hospitals NHS Foundation Trust , UK
| | - M Fok
- Basildon and Thurrock University Hospitals NHS Foundation Trust , UK
| | | | - N Banga
- Royal Free London NHS Foundation Trust , UK
| | - B Lindsey
- Royal Free London NHS Foundation Trust , UK
| | - B Fernando
- Royal Free London NHS Foundation Trust , UK
| | - C J Forman
- Royal Free London NHS Foundation Trust , UK
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7
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Abstract
Peritonitis complicating peritoneal dialysis represents a major cause of technique failure, hospitalization, and increased mortality. Peritonitis tends to be recurrent and clustered within particular patients at risk. The aim of this review is to evaluate the potential predictive factors for development of peritoneal dialysis-associated peritonitis based on currently available evidence. Risk factors were divided into medical and non-medical ones, and characterized by a schema of fixed versus modifiable factors. A new direction in the landscape change of the risk factors of peritonitis appears to focus on psychosocial aspects and patient training. Identification of these factors have important clinical implications because of the hitherto lack of well-established strategies to prevent peritonitis complicating peritoneal dialysis. It is hoped that better understanding of the risk factors will allow us to take tangible steps toward minimizing the infectious burden from the Achilles' heel of peritoneal dialysis.
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Affiliation(s)
- K. M. Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong - China
| | - P. K.-T. Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong - China
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8
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Affiliation(s)
- Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong; Shatin Hong Kong, China
| | - Todd S. Ing
- Stritch School of Medicine; Loyola University Chicago; Maywood IL USA
| | - Philip Kam-Tao Li
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong; Shatin Hong Kong, China
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9
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Moist LM, Lok CE. Incident Dialysis Access in Patients With End-Stage Kidney Disease: What Needs to Be Improved. Semin Nephrol 2017; 37:151-158. [DOI: 10.1016/j.semnephrol.2016.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Oliver MJ, Quinn RR. Selecting Peritoneal Dialysis in the Older Dialysis Population. Perit Dial Int 2016; 35:618-21. [PMID: 26702000 DOI: 10.3747/pdi.2014.00346] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Selecting peritoneal dialysis (PD) in older individuals is a complex, multi-step process. At each step, older individuals may not have the opportunity to receive PD unless care is optimized. Older individuals are less likely to complete a PD assessment, because of unstable medical conditions, consideration of palliative care, or reluctance to approach frail patients once they are established on hemodialysis (HD). Older individuals are also more likely to have medical or social conditions that contraindicate PD or to have barriers to self-care PD that may not be overcome with support. Older individuals who are eligible for PD may be reluctant to choose it, leaving HD as the default modality. Finally, receipt of PD may be compromised by urgent HD or PD catheter-related complications at the time of insertion. Despite all these challenges, older patients can do very well on PD, so each step should be well understood and optimized in renal programs to maximize PD use in older patients.
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Affiliation(s)
- Matthew J Oliver
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert R Quinn
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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11
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Crabtree JH, Burchette RJ, Siddiqi RA. Embedded Catheters: Minimizing Excessive Embedment Time and Futile Placement while Maintaining Procedure Benefits. Perit Dial Int 2015; 35:545-51. [PMID: 25292403 PMCID: PMC4597987 DOI: 10.3747/pdi.2013.00301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/22/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Embedding peritoneal catheters far in advance of anticipated need may successfully commit patients to their modality choice and reduce central venous catheter use but can be complicated by excessive embedment periods and futile catheter placement. OBJECTIVE Embedded catheter outcomes were studied to identify factors that minimize inordinate embedment time and futile placement while maintaining procedure benefits. METHODS Clinical and laboratory data were examined in 107 patients with embedded catheters that were either externalized, remained embedded, or were futilely placed. RESULTS Externalization of 84 catheters was performed after a median embedment period of 9.4 months. Flow dysfunction occurred in 14.3% of externalized catheters. Overall function rate was 98.8% after laparoscopic revision. One patient changed their mind about modality choice. Except for 1 patient hospitalized acutely in a facility unfamiliar with embedded catheters, none remaining on a peritoneal dialysis pathway initiated dialysis with a central venous catheter. Including catheters with extremely long embedment periods, the incidence of futile placement was 13.1%. Multiple regression analysis identified estimated glomerular filtration rate (eGFR) and serum albumin as the 2 variables best associated with catheter embedment duration (r(2) = 0.44, p < 0.0001). Diabetic nephropathy was statistically more likely to be associated with lower serum albumin values (p < 0.0001); however, no association was noted between diabetic status and embedment duration (p = 0.62). CONCLUSIONS Timing of the embedment procedure should include appraisal of both eGFR and serum albumin. Appropriate consideration of these values together may help minimize excessive embedment periods and decrease futile placements while preserving procedure benefits.
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Affiliation(s)
- John H Crabtree
- Research and Evaluation Department, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena, California Visiting Clinical Faculty, Division of Nephrology and Hypertension, Harbor-University of California Los Angeles Medical Center, Torrance, California
| | - Raoul J Burchette
- Research and Evaluation Department, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena, California
| | - Rukhsana A Siddiqi
- Division of Nephrology, Department of Medicine, Kaiser Permanente Downey Medical Center, Downey, California
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12
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Dahlan R, Bargman JM, Biyani M, Lavoie S, McCormick BB. Asymptomatic Peritoneal Leukocytosis after Exteriorization of Buried Peritoneal Dialysis Catheters: A Case Series. Perit Dial Int 2015; 35:103-5. [DOI: 10.3747/pdi.2013.00196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Randah Dahlan
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Ottawa, ON, Canada
| | - Joanne M. Bargman
- Division of Nephrology, Department of Medicine, University of Toronto and the University Health Network Toronto, ON, Canada
| | - Mohan Biyani
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Ottawa, ON, Canada
| | - Susan Lavoie
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Ottawa, ON, Canada
| | - Brendan B. McCormick
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Ottawa, ON, Canada
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13
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Peritoneal dialysis catheter embedment: surgical considerations, expectations, and complications. Am J Surg 2013; 206:464-71. [DOI: 10.1016/j.amjsurg.2013.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/07/2013] [Accepted: 03/21/2013] [Indexed: 01/11/2023]
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Ghaffari A, Kalantar-Zadeh K, Lee J, Maddux F, Moran J, Nissenson A. PD First: peritoneal dialysis as the default transition to dialysis therapy. Semin Dial 2013; 26:706-13. [PMID: 24102745 DOI: 10.1111/sdi.12125] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Peritoneal dialysis (PD) and in-center hemodialysis (HD) are accepted as clinically equivalent dialysis modalities, yet in-center HD is the predominant renal replacement therapy (RRT) modality offered to new end-stage renal disease (ESRD) patients in the United States and most other industrialized nations. This predominance has little to do with clinical outcomes, patient choice, cost, or quality of life. It has been driven by ease of HD initiation, physician experience and training, inadequate pre-ESRD patient education, ample in-center HD capacity, and lack of adequate infrastructure for PD-related care. As compared with in-center HD, PD is a widely applicable, yet underutilized modality of RRT that provides comparable clinical outcomes, superior quality of life measures, significant cost savings, and many other unmeasured advantages. A "PD First" approach not only has advantages for patients but also physicians, healthcare systems, and society. In this review, we will summarize evidence demonstrating that PD should be the default modality when new ESRD patients are transitioning to dialysis therapy when preemptive transplantation is not an option and highlight the essential infrastructural requirements to allow for a "PD First" model.
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Affiliation(s)
- Arshia Ghaffari
- Division of Nephrology, Keck School of Medicine, University of Southern California, Los Angeles, California
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15
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Ren W, Chen W, Pan HX, Lan L, Wang P, Huang YH, Kong M, Wang Y. Clinical application of right low-position modified peritoneal dialysis catheterization. Exp Ther Med 2013; 5:457-460. [PMID: 23404635 PMCID: PMC3570151 DOI: 10.3892/etm.2012.808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 10/09/2012] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate peritoneal dialysis catheter malposition following low-position modified peritoneal dialysis catheterization and its clinical application value. A total of 48 patients receiving traditional peritoneal dialysis catheterization (the traditional group) and 95 patients receiving right low-position modified peritoneal dialysis catheterization (the modified group) from 2006 to 2011 were selected. The inflow time, outflow time, ultrafiltration volume of peritoneal dialysis solution and rate of peritoneal dialysis catheter malposition in the two groups of patients following surgery were compared and analyzed. There were no significant differences of inflow time, outflow time and ultrafiltration volume of the peritoneal dialysis solution between the two groups. In the modified group, no post-operative peritoneal dialysis catheter malposition occurred, therefore the incidence rate was 0. However, 9 patients in the traditional group presented peritoneal dialysis catheter malposition, an incidence rate of 18.75% (9/48). Among them, 6 patients required a second surgery. There was a statistically significant difference in the incidence rate of catheter malposition between the two groups (P<0.01). Right low-position modified peritoneal dialysis catheterization significantly reduced the incidence rate of peritoneal dialysis catheter malposition following peritoneal dialysis, and was shown to be significantly more effective than the traditional peritoneal dialysis catheterization and is therefore worth promoting for clinical use.
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Affiliation(s)
- Wei Ren
- Renal Division, Anhui Provincial Hospital, Hefei, Anhui 230001, P.R. China
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16
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Wu YL, Chen LC, Sheu MH, Chen TH, Wu SC, Wu CL, Li SY, Yang WC, Ng YY. Peritoneal-uterine communication: a complication of prolonged embedding of a peritoneal catheter. ARCH ESP UROL 2012; 32:481-3. [PMID: 22859846 DOI: 10.3747/pdi.2011.00016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Saggi SJ, Allon M, Bernardini J, Kalantar-Zadeh K, Shaffer R, Mehrotra R. Considerations in the optimal preparation of patients for dialysis. Nat Rev Nephrol 2012; 8:381-9. [DOI: 10.1038/nrneph.2012.66] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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18
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Miller M, McCormick B, Lavoie S, Biyani M, Zimmerman D. Fluoroscopic manipulation of peritoneal dialysis catheters: outcomes and factors associated with successful manipulation. Clin J Am Soc Nephrol 2012; 7:795-800. [PMID: 22362064 DOI: 10.2215/cjn.09850911] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Mechanical failure of the peritoneal dialysis (PD) catheter is an important cause of technique failure. Fluoroscopic guidewire manipulation may be undertaken in an attempt to correct the failure. The purpose of this study was to determine the efficacy of fluoroscopic manipulation of previously embedded PD catheters, the factors associated with successful manipulation, and the complication rate associated with manipulation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A single-center, retrospective review of 70 consecutive PD patients undergoing fluoroscopic manipulation for mechanical failure of their PD catheter from June 2006 to February 2011 was undertaken. Logistic regression models were developed to determine the variables associated with successful manipulation. RESULTS Of the 70 manipulations, 44 were successful (62.9%). In univariate analysis, catheters located in the pelvis compared with those in the upper abdomen (73.5% versus 42.9%, P=0.01) and catheters that were previously functional compared with those that failed at exteriorization (75.0% versus 46.7%, P=0.04) were more likely to be successfully manipulated. Time embedded, previous hemodialysis, and number of intra-abdominal surgeries were not correlated with likelihood of successful manipulation. In multivariate analysis, catheters located in the pelvis (P=0.01) and those with secondary failure (P=0.01) were more likely to successfully manipulated. Two of the patients developed peritonitis (2.9%), neither requiring cessation of PD. CONCLUSIONS Fluoroscopic manipulation is an effective and safe therapy for failed PD catheters that are unresponsive to conservative treatment. Properly positioned catheters and those that were previously functional are more likely to be successfully manipulated.
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Affiliation(s)
- Matthew Miller
- Division of Nephrology, McMaster University, Hamilton, Canada
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19
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Shahbazi N, McCormick BB. Peritoneal Dialysis Catheter Insertion Strategies and Maintenance Of Catheter Function. Semin Nephrol 2011; 31:138-51. [DOI: 10.1016/j.semnephrol.2011.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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20
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Bilodeau J, Lavoie S, Brown P, McCormick B. No Change in Small Molecule Transport with Prolonged Embedding of Peritoneal Dialysis Catheters. Perit Dial Int 2011; 31:104; author reply 105. [DOI: 10.3747/pdi.2010.00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J.F. Bilodeau
- Department of Medicine University of Sherbrooke Sherbrooke, Quebec
| | - S.D. Lavoie
- Department of Medicine University of Ottawa Ottawa, Ontario, Canada
| | - P.A. Brown
- Department of Medicine University of Ottawa Ottawa, Ontario, Canada
| | - B.B. McCormick
- Department of Medicine University of Ottawa Ottawa, Ontario, Canada
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21
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Brunier G, Hiller JA, Drayton S, Pugash RA, Tobe SW. A change to radiological peritoneal dialysis catheter insertion: three-month outcomes. Perit Dial Int 2010; 30:528-33. [PMID: 20421428 DOI: 10.3747/pdi.2009.00114] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Best practices for peritoneal dialysis (PD) catheter insertion call for timely placement of catheters to reduce complications and increase the likelihood of a successful initiation of PD. The purpose of our study was to assess if a change in approach to PD catheter insertion, including a switch to radiological insertion of PD catheters and introduction of a dialysis access nurse to coordinate all patient care, was associated with more outpatient procedures and achievement of guideline-based outcomes, including timelier PD starts. ♢ METHODS We conducted a single-center retrospective chart review of all patients that had their first PD catheter inserted at our center over a 7-year period ending in 2007. ♢ RESULTS PD catheters were placed in 88 patients by interventional radiology and in 125 patients by surgical insertion during an earlier period. Insertion of PD catheters by interventional radiology was significantly associated with a higher rate of outpatient procedures (70% vs 32%, p < 0.0001) than surgical placement. At PD start, 82% of patients that underwent radiological insertions had an estimated glomerular filtration rate of over 8 mL/minute/1.73 m(2) and their mean serum albumin level was 38.2 g/L. ♢ CONCLUSIONS The new procedure of radiological insertion of PD catheters, coordinated by a dedicated dialysis access nurse, was associated with more outpatient procedures than the earlier surgical method and allowed patients to receive a PD catheter with timing consistent with clinical practice recommendations.
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Affiliation(s)
- Gillian Brunier
- Division of Nephrology and Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Kopriva–Altfahrt G, König P, Mündle M, Prischl F, Roob JM, Wiesholzer M, Vychytil A, Arneitz K, Karner A, Artes R, Wolf E, Auinger M, Pawlak A, Hietzing K, Fraberger J, Hofbauer S, Waldviertel L, Galvan G, Salmhofer H, Pichler B, Wazel M, Landeskliniken S, Gruber M, Thonhofer A, Hager A, Malajner S, Heiss S, Braunsteiner T, Zweifler M, König P, Rudnicki M, Nephrologie KAF, Kogler R, Kohlhauser D, Wiesinger T, Kopriva–Altfahrt G, Moser E, Kotanko P, Loibner H, Nitz H, Miska HJ, Wenzel R, Wölfler M, Mündle M, Breuss H, Hölzl B, Oberortner W, Prischl F, der Kreuzschwestern K, Schmekal B, Riener EM, Krankenhaus A, Roob JM, Wonisch W, Vikydal R, Vychytil A, Frank B, Wieser C, Wiesholzer M, Pokorny K. Exit-Site Care in Austrian Peritoneal Dialysis Centers — a Nationwide Survey. Perit Dial Int 2009. [DOI: 10.1177/089686080902900319] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Catheter-associated infections markedly contribute to treatment failure in peritoneal dialysis (PD) patients. There is much controversy surrounding prophylactic strategies to prevent these infections. Methods In this nationwide multicenter study we analyzed strategies to prevent catheter-associated infections as performed in Austrian PD centers in 2006. A questionnaire was sent to all 23 PD centers in Austria. Results Ten different catheter models were used in the 332 patients being treated in the 23 Austrian PD centers. Systemic antibiotics prior to catheter placement were given by 17 of the 23 PD centers (glycopeptides, n = 7; cephalosporins, n = 10). Nasal swabs were taken preoperatively by 17 PD centers; nasal Staphylococcus aureus carriers were treated prophylactically with mupirocin cream in 15 of these centers. Dressing change was routinely performed in 318 of 332 chronic PD patients (nonocclusive film dressing, n = 58; gauze dressing, n = 260). Disinfectants for chronic exit-site care included povidone iodine ( n = 155), sodium hypochlorite ( n = 31), povidone iodine + sodium hypochlorite together ( n = 102), and octenidine dihydrochloride/phenoxyethanol ( n = 17). Water+non-disinfectant soap or 0.9% sodium chloride was administered as a cleansing agent to the exit site by 27 patients. Routine S. aureus screening (nasal and/or exit-site swabs) in chronic PD patients was performed in 12 PD centers; carriers were treated with mupirocin cream in 11 of these centers. Dialysis staff members were screened for S. aureus in 8 PD centers and spouses were screened for S. aureus in 5 PD centers. The overall exit-site infection rate was 1 episode/43.9 patient-months, tunnel infection rate was 1 episode/88.9 patient-months, and peritonitis rate was 1 episode/51.0 patient-months. Patients of centers that have installed a prophylaxis protocol for treating S. aureus carriers had lower mean infection rates compared with those not using such a protocol. Conclusion Various individual prophylactic strategies are used to prevent catheter-associated infections in Austrian PD centers. Infection rates are within the range reported in the literature. There is still scope for improvement in some centers ( e.g., by establishing a prophylaxis protocol).
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Affiliation(s)
| | - Paul König
- Nephrology and Hypertensiology, University Hospital of Medicine IV, Medical University of Innsbruck, Austria
| | - Michael Mündle
- Division of Nephrology and Dialysis, Department of Medicine, Landeskrankenhaus Feldkirch, Austria
| | - Friedrich Prischl
- Division of Nephrology and Dialysis, Third Department of Medicine, Krankenhaus der Barmherzigen Schwestern vom Hl. Kreuz, Wels, Austria
| | - Johannes M. Roob
- Clinical Division of Nephrology and Dialysis, Medical University of Graz, Austria
| | - Martin Wiesholzer
- Division of Nephrology and Dialysis, First Department of Medicine, A.ö. Krankenhaus St. Pölten
| | - Andreas Vychytil
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Austria
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Oreopoulos DG, Tzamaloukas AH. Our war against bacteria in peritoneal dialysis, the last 40 years! Int Urol Nephrol 2009; 40:709-14. [PMID: 18443912 DOI: 10.1007/s11255-008-9392-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Prischl F, Knoll F, Kramar R. Another Peritoneal Dialysis Catheter Encapsulated in Peritoneal Tissue. Perit Dial Int 2009. [DOI: 10.1177/089686080902900119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- F.C. Prischl
- Nephrology 3rd Department of Medicine Klinikum Wels-Grieskirchen Wels, Austria
| | - F. Knoll
- Nephrology 3rd Department of Medicine Klinikum Wels-Grieskirchen Wels, Austria
| | - R. Kramar
- Nephrology 3rd Department of Medicine Klinikum Wels-Grieskirchen Wels, Austria
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Quand débuter la dialyse ? Nephrol Ther 2007. [DOI: 10.1016/s1769-7255(07)78753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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