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Sahutoglu T, Kazancioglu R, Ozkan MK, Erkasap PÇ, Ates K. Impact of renality-CASE training on knowledge, skills, and practices in peritoneal dialysis catheter placement among nephrologists. Perit Dial Int 2024:8968608241287328. [PMID: 39360475 DOI: 10.1177/08968608241287328] [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: 10/04/2024] Open
Abstract
INTRODUCTION Despite being an effective home-based kidney replacement therapy, peritoneal dialysis (PD) remains underutilized. The aim of the Renality-CASE training program was to assess its impact on nephrologists by expanding their knowledge of PD therapy and enhancing their catheter placement skills to better offer the PD option. METHODS The Renality-CASE program provided two days of training, including theoretical lectures, virtual reality sessions, and hands-on practice of PD catheter placement on live pigs. Eighty-eight participants attended four sessions. An anonymized online questionnaire collected demographic data, self-assessments of knowledge and skills, and feedback. Pre- and post-training comparisons were analyzed using paired samples t-tests and the Wilcoxon signed-rank test, with significance at p < 0.05. RESULTS Fifty-seven out of 88 participants responded to the survey one-year post-training. Post-training, 94.7% felt at least moderately knowledgeable compared to 61.4% pre-training (p < 0.001). Confidence in skills increased to 73.6% post-training from 26% pre-training (p < 0.001). The number of PD catheters placed by participants also rose significantly (p = 0.012). The program received positive feedback and high satisfaction rates. CONCLUSIONS The Renality-CASE program significantly improved nephrologists' PD catheter placement skills through comprehensive training. Despite limitations such as sample size and response bias, the study highlights the need for standardized PD training to enhance clinical practice and increase PD utilization in CKD management.
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Affiliation(s)
- Tuncay Sahutoglu
- Nephrology, Mehmet Akif Inan Education and Research Hospital, University of Health Sciences, Sanliurfa, Türkiye
| | - Rumeyza Kazancioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | | | | | - Kenan Ates
- Department of Nephrology, Ankara University Faculty of Medicine, Ankara, Türkiye
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Pushevski V, Nikolov IG, Karagjozov P, Dzambaz D, Rambabova-Bushljetik I. Percutaneous Onsite Insertion of Catheter for Peritoneal Dialysis - A New Method Introduction in the Country. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:107-112. [PMID: 37453112 DOI: 10.2478/prilozi-2023-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Peritoneal dialysis (PD) is one of the options for renal replacement therapy (RRT) in the end stage renal disease (ESRD) patients. Compared to hemodialysis (HD), patients on PD experience a greater sense of well-being, an improved steady state in terms of extracellular fluid volume shifts and hemodynamics and it is preferred method for patients with problematic vascular access, bleeding tendencies, heart failure and elderly patients. In order to perform PD, a tunneled catheter should be placed through the abdominal wall and into peritoneal space, with positioning of the catheter within the most dependent portion of pelvis. Currently, there are several techniques available for PD catheter placement: open surgery, laparoscopic and percutaneous. We present for the first time in our country a case of 65 year old male patient to whom percutaneous onsite insertion of peritoneal catheter was performed. The idea is to emphasize that sometimes this should be a method of choice for RRT, especially in patients where general anesthesia should be avoid. Compared to other methods, percutaneous insertion is a simple procedure with no need for general anesthesia, and the benefits of quick recovery, earlier ambulation, and less delay in catheter placement.
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Affiliation(s)
- Vladimir Pushevski
- 1University Clinic of Nephrology, Faculty of Medicine, University "SS Cyril and Methodius", Skopje, RN Macedonia
| | - Igor G Nikolov
- 1University Clinic of Nephrology, Faculty of Medicine, University "SS Cyril and Methodius", Skopje, RN Macedonia
| | - Pance Karagjozov
- 2University Clinic of Digestive surgery, Faculty of Medicine, University "SS Cyril and Methodius", Skopje, RN Macedonia
| | - Darko Dzambaz
- 2University Clinic of Digestive surgery, Faculty of Medicine, University "SS Cyril and Methodius", Skopje, RN Macedonia
| | - Irena Rambabova-Bushljetik
- 1University Clinic of Nephrology, Faculty of Medicine, University "SS Cyril and Methodius", Skopje, RN Macedonia
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Jha V, Abrahams AC, Al-Hwiesh A, Brown EA, Cullis B, Dor FJMF, Mendu M, Ponce D, Divino-Filho JC. Peritoneal catheter insertion: combating barriers through policy change. Clin Kidney J 2022; 15:2177-2185. [PMID: 36381371 PMCID: PMC9384046 DOI: 10.1093/ckj/sfac136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 12/02/2022] Open
Abstract
Barriers to accessing home dialysis became a matter of life and death for many patients with kidney failure during the coronavirus disease 2019 (COVID-19) pandemic. Peritoneal dialysis (PD) is the more commonly used home therapy option. This article provides a comprehensive analysis of PD catheter insertion procedures as performed around the world today, barriers impacting timely access to the procedure, the impact of COVID-19 and a roadmap of potential policy solutions. To substantiate the analysis, the article includes a survey of institutions across the world, with questions designed to get a sense of the regulatory frameworks, barriers to conducting the procedure and impacts of the pandemic on capability and outcomes. Based on our research, we found that improving patient selection processes, determining and implementing correct insertion techniques, creating multidisciplinary teams, providing appropriate training and sharing decision making among stakeholders will improve access to PD catheter insertion and facilitate greater uptake of home dialysis. Additionally, on a policy level, we recommend efforts to improve the awareness and feasibility of PD among patients and the healthcare workforce, enhance and promulgate training for clinicians—both surgical and medical—to insert PD catheters and fund personnel, pathways and physical facilities for PD catheter insertion.
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Affiliation(s)
- Vivekanand Jha
- George Institute for Global Health India, New Delhi, India; School of Public Health, Imperial College, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Alferso C Abrahams
- Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Abdullah Al-Hwiesh
- Department of Internal Medicine, Nephrology Division, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Brett Cullis
- Renal and Intensive Care Unit, Hilton Life Hospital, South Africa
- Department of Child Health, University of Cape Town, South Africa
| | - Frank J M F Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Mallika Mendu
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - José Carolino Divino-Filho
- Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Latin America Chapter- Diálisis Domiciliaria (LAC-DD)
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Liu AYL, Nikam M. Nephrologists-led intervention increases utilisation of peritoneal dialysis in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:919-921. [PMID: 34985105 DOI: 10.47102/annals-acadmedsg.2021360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Athmalingam VKR, Wong KW. Combined fluoroscopic- and sonographic-assisted Tenckhoff catheter insertion for patients with previous intraperitoneal surgery. Semin Dial 2021; 35:245-250. [PMID: 34390274 DOI: 10.1111/sdi.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Tenckhoff catheter (TC) insertion for patients with previous intraperitoneal surgery (IPS) is challenging. METHODS This is a case series of 11 patients with history of previous IPS who underwent TC insertion under combined fluoroscopic and sonographic (CFS) guidance with preperitoneal tunneling at our center. RESULTS This is an interim result of our study. The mean age of the patients was 49.1 (±12.7). Seven were females, and four were males. Only two patients underwent more than one IPS prior to this procedure. The mean body mass index (BMI) of patients was 29.2 kg/m2 (±6.2). All patients underwent the procedure successfully. One patient developed post-procedure exit site bleeding which resolved spontaneously. One patient had urgent-start peritoneal dialysis (PD) (less than 72 h), and two patients had early-start PD (less than 2 weeks). Median catheter survival is 8 months at the time of writing. CONCLUSION CFS-assisted TC insertion with preperitoneal tunneling for patients with previous IPS is a safe and effective technique.
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Affiliation(s)
| | - Koh Wei Wong
- Department of Nephrology, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
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A Simple Tenckhoff Catheter Placement Technique for Continuous Ambulatory Peritoneal Dialysis (CAPD) Using the Bandung Method. Int J Nephrol 2020; 2020:4547036. [PMID: 32566295 PMCID: PMC7284935 DOI: 10.1155/2020/4547036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/21/2020] [Accepted: 05/12/2020] [Indexed: 11/18/2022] Open
Abstract
Insertion of Tenckhoff catheters for continuous ambulatory peritoneal dialysis by nephrologists remains uncommon in most developing countries, including Indonesia. The aim of this study is to describe our experience on a simple technique of Tenckhoff catheter insertion by a nephrologist called the Bandung method. We conducted a retrospective observational study from May 2012 until December 2018 in 230 patients with end-stage renal disease using the Bandung method, a blind percutaneous insertion approach modified from the Seldinger technique. Early complications after insertion were assessed. The mean age of patients was 47.28 years (range 14–84 years). Within 1 month after insertion, complications occurred in 34 patients: 13 (5.7%) malposition, 8 (3.5%) omental trapping, 6 (2.6%) outlow failure, 3 (1.3%) peritonitis, 1 (0.4%) catheter infections, 1 (0.4%) bleeding, 1 (0.4%) kinking, and 1 (0.4%) hernia. None of these complications led to catheter removal. One patient experienced a late (>1 month) post-insertion complication of malposition that could not be repositioned and led to catheter removal. The Bandung method is a simple, cost effective, and minimally invasive technique for Tenckhoff catheter insertion that is associated with the same rate of complications compared to other techniques. This technique may useful for application in developing countries.
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Xie D, Zhou J, Cao X, Zhang Q, Sun Y, Tang L, Huang J, Zheng J, Lin L, Li Z, Cai G, Chen X. Percutaneous insertion of peritoneal dialysis catheter is a safe and effective technique irrespective of BMI. BMC Nephrol 2020; 21:199. [PMID: 32450790 PMCID: PMC7249625 DOI: 10.1186/s12882-020-01850-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 05/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND A large body mass index (BMI) has been considered as a relative contraindication for percutaneous catheter insertion, although this technique has many advantages. Up to now, there are few studies on peritoneal catheter placement and obesity. The aim of this study was to determine whether patients with large BMI can also choose the percutaneous technique for peritoneal dialysis catheter insertion. METHODS One hundred eighty seven consecutive patients underwent peritoneal catheter insertions in the Chinese PLA General Hospital between January 1, 2015 and December 31, 2016, with 178 eligible cases being included in the analysis. Two groups were created based on the catheter insertion techniques, the percutaneous group (group P) and the surgical group (group S). Subgroups were created according to BMI > 28 or ≤ 28. The outcomes included catheter related complications and catheter survival. RESULTS Total infectious complication rates were significantly lower in group P than in group S. There were no significant differences in peritonitis rate between group P and group S (1.20% vs. 3.16% with P = 0.71 in early stage, and 4.82% vs. 11.58% with P = 0.11 in late stage). All other measured complications were similar between the two groups. Though the one-year infection-free catheter survival in group P was 7.5% higher than group S, the difference was not significant. The one-year dysfunction-free catheter survival, one-year dysfunction-and-infection-free catheter survival, and overall catheter survival were similar between the two groups. Subgroup analyses showed a superior one-year infection-free catheter survival of percutaneous technique in patients with BMI > 28, which was confirmed by Kaplan-Meier analysis. CONCLUSIONS Despite the challenges that may be encountered with patients who have a large BMI, the percutaneous technique seems to be a safe and effective approach to placing a peritoneal dialysis catheter.
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Affiliation(s)
| | - Jianhui Zhou
- Department of Nephrology, the First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Fuxing Road 28, Beijing, 100853, People's Republic of China.
| | - Xueying Cao
- Department of Nephrology, the First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Qingtao Zhang
- Department of Nephrology, the First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Yanli Sun
- Department of Nephrology, the First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Li Tang
- Department of Nephrology, the First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Jing Huang
- Department of Nephrology, the First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Juanli Zheng
- Department of Nephrology, the First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Li Lin
- Department of Nephrology, the First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Zhenzhen Li
- Department of Nephrology, the First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Guangyan Cai
- Department of Nephrology, the First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Fuxing Road 28, Beijing, 100853, People's Republic of China
| | - Xiangmei Chen
- Department of Nephrology, the First Medical Centre, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Fuxing Road 28, Beijing, 100853, People's Republic of China.
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Ahmad M, Wallace EL, Jain G. Setting Up and Expanding a Home Dialysis Program: Is There a Recipe for Success? ACTA ACUST UNITED AC 2020; 1:569-579. [DOI: 10.34067/kid.0000662019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Home dialysis modalities remain significantly underused in the United States despite similar overall survival in the modalities, and recent incentives to expand these modalities. Although the absolute number of patients using home modalities has grown, the proportion compared to in-center hemodialysis (ICHD) continues to remain quite low. Well known barriers to home dialysis utilization exist, and an organized and team-based approach is required to overcome these barriers. Herein, we describe our efforts at growing our home dialysis program at a large academic medical center, with the proportion of home dialysis patients growing from 12% to 21% over the past 9 years. We prioritized individualized education for patients and better training for physicians, with the help of existing resources, aimed at better utilization of home modalities; an example includes dedicated dialysis education classes taught twice monthly by an experienced nurse practitioner, as well as the utilization of the dialysis educator from a dialysis provider for inpatient education of patients with CKD. The nephrology fellowship curriculum was restructured with emphasis on home modalities, and participation in annual home dialysis conferences has been encouraged. For timely placement and troubleshooting of access for dialysis, we followed a complementary team approach using surgeons and interventional radiologists and nephrologists, driven by a standardized protocol developed at UAB, and comanaged by our access coordinators. A team-based approach, with emphasis on staff engagement and leadership opportunities for dialysis nurses as well as collaborative efforts from a team of clinical nephrologists and the dialysis provider helped maintain efficiency, kindle growth, and provide consistently high-quality clinical care in the home program. Lastly, efforts at reducing burden of disease such as decreased number of monthly visits as well as using innovative strategies, such as telenephrology and assisted PD and HHD, were instrumental in reducing attrition.
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Li Z, Ding H, Liu X, Zhang J. Ultrasound-guided percutaneous peritoneal dialysis catheter insertion using multifunctional bladder paracentesis trocar: A modified percutaneous PD catheter placement technique. Semin Dial 2020; 33:133-139. [PMID: 32160357 PMCID: PMC7187385 DOI: 10.1111/sdi.12862] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background To evaluate the efficacy and safety of ultrasound‐guided percutaneous peritoneal dialysis catheter insertion using multifunctional bladder paracentesis trocar. Methods A retrospective review of 103 ESRD patients receiving percutaneous PD catheter insertion using a multifunctional bladder paracentesis trocar under ultrasound guidance at a single center between May 2016 and May 2018. Mechanical complications and catheter survival were evaluated over a 12‐month follow‐up. Result Catheterization using this technique required only 10‐30 minutes from the beginning of local anesthesia to the end of skin suture at the puncture site (mean 18 ± 7 minutes) and an incision length of 2‐4 cm. Moreover, only four of 103 cases required catheter removal due to poor drainage within one month after surgery, with a success rate of 96.19%. Among failures, omentum wrapping was cause in two cases, catheter displacement in one case, and protein clot blockage in one case, while there were no instances of organ injury, severe hemorrhage, peritubular leakage, hernia, peritonitis, or exit infection within one month of PD catheter insertion. Catheter survival at 1 year was 92.2%. Conclusion Percutaneous PD catheter insertion using a multifunctional bladder paracentesis trocar and ultrasound guidance is a feasible technique for ESRD patients.
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Affiliation(s)
- Zhen Li
- Department of nephrology, YongChuan Hospital, ChongQing, China
| | - Hongyun Ding
- Department of nephrology, YongChuan Hospital, ChongQing, China
| | - Xue Liu
- Department of Medical Ultrasonics, YongChuan Hospital, ChongQing Medical University, ChongQing, China
| | - Jianbin Zhang
- Department of nephrology, YongChuan Hospital, ChongQing, China
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Chow KM, Szeto CC, Leung CB, Kwan BCH, Pang WF, Li PKT. Tenckhoff Catheter Insertion by Nephrologists: Open Dissection Technique. Perit Dial Int 2020; 30:524-7. [PMID: 20378842 DOI: 10.3747/pdi.2009.00145] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BackgroundThe practice of Tenckhoff catheter insertion by nephrologists remains uncommon in most countries.MethodsWe report our single-center experience of Tenckhoff catheter insertion by nephrologists using the open dissection surgical technique in a dedicated ward-based procedure room.ResultsBetween November 2005 and September 2008, 250 peritoneal catheters were inserted by 6 nephrologists with varying levels of experience. Surgical dissection followed by exposure of the peritoneum under direct vision was performed under local anesthesia. Primary catheter failure, as defined by catheters that failed to function within 1 month after insertion, occurred in 2.8% of cases. Within 1 month of catheter insertion, 20 patients developed infectious complications: 9 (3.6%) peritonitis, and 11 (4.4%) exit-site infections; none of these complications led to catheter removal. Mean technique survival for the catheters was 41.2 months (95% confidence interval: 39.5 months to 42.9 months). Catheter survival rates at 1 and 2 years were 92.7% and 87.2% respectively.ConclusionsWe reported an encouraging outcome for Tenckhoff catheters inserted by nephrologists in an open surgical manner, with a 2-year catheter survival of 87.2% and a good safety profile.
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Affiliation(s)
- Kai Ming Chow
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Cheuk Chun Szeto
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Chi Bon Leung
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Bonnie Ching Ha Kwan
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Wing Fai Pang
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Philip Kam-tao Li
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, PR China
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Chow KM, Szeto CC. Open Surgical Insertion of Tenckhoff Catheters for Peritoneal Dialysis. Perit Dial Int 2020; 30:502-3. [PMID: 20829548 DOI: 10.3747/pdi.2009.00247] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kai Ming Chow
- Division of Nephrology Department of Medicine and Therapeutics Prince of Wales Hospital Chinese University of Hong Kong Hong Kong, China
| | - Cheuk-Chun Szeto
- Division of Nephrology Department of Medicine and Therapeutics Prince of Wales Hospital Chinese University of Hong Kong Hong Kong, China
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Shanmugalingam R, Makris A, Hassan HC, Li Y, DeGuzman I, Nandakoban H, Aravindan A, Narayanan G, Wong JK. The Utility of Sonographic Assessment in Selecting Patients for Percutaneous Insertion of Peritoneal Dialysis Catheter. Perit Dial Int 2020; 37:434-442. [DOI: 10.3747/pdi.2017.00006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/19/2017] [Indexed: 12/27/2022] Open
Abstract
BackgroundPercutaneous insertion of peritoneal dialysis (PD) catheters by nephrologists is a safe and effective alternative to open surgical techniques. These patients are usually carefully selected due to anatomical considerations and medical comorbidities, with the current literature suggesting exclusion of patients with prior abdominal surgery.MethodWe conducted a retrospective cohort study of pre-dialysis patients who attended a preprocedural clinic in a tertiary center over 6 years. Procedural complications and catheter survival were assessed. Chi-squared test and Kaplan-Meier survival analysis were undertaken. Inpatient assessments were excluded.ResultsA total of 217 patients were assessed, of whom 171 (78.8%) were accepted for percutaneous PD catheter insertion by a nephrologist. The key exclusion criteria were: ( 1 ) the clinical presence of abdominal hernia ( p < 0.001), ( 2 ) ultrasound findings of skin to peritoneum depth of > 5.5 cm ( p < 0.001) and ( 3 ) ultrasound findings of impaired visceral slide test ( p < 0.001). Prior abdominal surgery was not a default exclusion criterion ( p = 0.1), as 63 patients (37%) with prior abdominal surgery, average of 1.3 prior surgeries per patient, were assessed as appropriate for the percutaneous procedure. There was no difference in the procedural complication rate and catheter survival between patients with and without prior abdominal surgery.ConclusionA comprehensive preprocedural assessment utilizing ultrasound permits an objective selection of patients for percutaneous insertion of PD catheters by nephrologists. This allowed for successful and safe percutaneous insertion of PD catheters in patients who may have otherwise been excluded, e.g., prior abdominal surgery, patients with large bilateral poly-cystic kidneys, and central obesity.
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Affiliation(s)
- Renuka Shanmugalingam
- Department of Renal Medicine, Sydney, Australia
- Liverpool Hospital, Sydney, NSW, Australia; Western Sydney University, Sydney, Australia
| | - Angela Makris
- Department of Renal Medicine, Sydney, Australia
- Liverpool Hospital, Sydney, NSW, Australia; Western Sydney University, Sydney, Australia
- Sydney, Australia; and University of New South Wales, Sydney, Australia
| | - Hicham C. Hassan
- Department of Renal Medicine, Sydney, Australia
- Sydney, Australia; and University of New South Wales, Sydney, Australia
| | - Yan Li
- Department of Renal Medicine, Sydney, Australia
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Abstract
Peritoneal dialysis (PD) may be a feasible, safe, and complementary alternative to hemodialysis not only in the chronic setting, but also in the acute setting. It previously was widely accepted for acute kidney injury (AKI) treatment, but its practice decreased in favor of other types of extracorporeal therapies. The interest in PD to manage AKI patients has been reignited and PD now frequently is used in developing countries because of its lower cost and minimal infrastructural requirements. Studies from these countries have shown that, with careful thought and planning, critically ill patients can be treated successfully using PD. Some of the classic limitations of PD use in AKI, such as a high chance of infectious and mechanical complications and poor metabolic control, have been overcome with the use of cyclers, flexible catheters, and a high volume of dialysis fluid. However, in developing countries the infrastructure for quality research often is lacking and the result has been limited evidence on standardized treatment regimens such as indications, dosing, and technical failure and mortality. The recent publication of the International Society for Peritoneal Dialysis guidelines for PD in AKI have tried to address these issues and provide an evidence-based standard by which to initiate therapy. In this article, advances in technical aspects and the advantages and limitations of PD are discussed, and recent literature on clinical experience with PD for the treatment of AKI patients is reviewed.
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Affiliation(s)
- Daniela Ponce
- Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil
| | - Andre Balbi
- Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil
| | - Brett Cullis
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa.
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Abstract
The success of peritoneal dialysis as renal-replacement therapy depends on a well-functioning peritoneal catheter. Knowledge of best practices in catheter insertion can minimize the risk of catheter complications that lead to peritoneal dialysis failure. The catheter placement procedure begins with preoperative assessment of the patient to determine the most appropriate catheter type, insertion site, and exit site location. Preoperative preparation of the patient is an instrumental step in facilitating the performance of the procedure, avoiding untoward events, and promoting the desired outcome. Catheter insertion methods include percutaneous needle-guidewire with or without image guidance, open surgical dissection, peritoneoscopic procedure, and surgical laparoscopy. The insertion technique used often depends on the geographic availability of material resources and local provider expertise in placing catheters. Independent of the catheter implantation approach, adherence to a number of universal details is required to ensure the best opportunity for creating a successful long-term peritoneal access. Finally, appropriate postoperative care and catheter break-in enables a smooth transition to dialysis therapy.
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Affiliation(s)
- John H Crabtree
- Division of Nephrology and Hypertension, Harbor-University of California Los Angeles Medical Center, Torrance, CA.
| | - Kai-Ming Chow
- Division of Nephrology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
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Annigeri RA, Ostermann M, Tolwani A, Vazquez-Rangel A, Ponce D, Bagga A, Chakravarthi R, Mehta RL. Renal Support for Acute Kidney Injury in the Developing World. Kidney Int Rep 2017. [PMCID: PMC5678608 DOI: 10.1016/j.ekir.2017.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Rajeev A. Annigeri
- Department of Nephrology, Apollo Hospitals, Chennai, India
- Correspondence: Dr. Rajeev A. Annigeri, Apollo Hospitals, Department of Nephrology, 21, Greams Lane, Off Greams Road, Chennai, Tamil Nadu 600006, India.Apollo Hospitals, Department of Nephrology21, Greams Lane, Off Greams RoadChennaiTamil Nadu 600006India
| | - Marlies Ostermann
- Department of Nephrology & Critical Care, Guy’s & St Thomas’ Hospital, London, UK
| | - Ashita Tolwani
- Division of Nephrology, University of Alabama, Birmingham, Alabama, USA
| | | | - Daniela Ponce
- Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ravindra L. Mehta
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California, USA
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Ponce D, Balbi A. Acute kidney injury: risk factors and management challenges in developing countries. Int J Nephrol Renovasc Dis 2016; 9:193-200. [PMID: 27578995 PMCID: PMC5001661 DOI: 10.2147/ijnrd.s104209] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Acute kidney injury (AKI) is a major global health problem in both developed and developing nations, negatively affecting patient morbidity and responsible for an estimated 1.4 million deaths per year. Although the International Society of Nephrology set a goal of eliminating preventable deaths from AKI by 2025, implementation of this program in developing countries presents major challenges not only because of the lack of resources but also because of the scarce data addressing the epidemiology and causes of AKI in developing countries, the limited health care resources to diagnose and treat AKI, and the poor awareness of the impact of AKI on patient outcomes.
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Affiliation(s)
- Daniela Ponce
- Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil
| | - Andre Balbi
- Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil
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Tullavardhana T, Akranurakkul P, Ungkitphaiboon W, Songtish D. Surgical versus percutaneous techniques for peritoneal dialysis catheter placement: A meta-analysis of the outcomes. Ann Med Surg (Lond) 2016; 10:11-8. [PMID: 27489619 PMCID: PMC4961679 DOI: 10.1016/j.amsu.2016.07.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 11/18/2022] Open
Abstract
Background Peritoneal dialysis (PD) is an effective method of renal replacement therapy for end-stage renal disease patients. The PD catheter could be inserted by surgical (open surgery/laparoscopic-assisted) or percutaneous techniques. However, the efficacy of the techniques, including catheter survival and catheter related complications, is still controversial. Method The dataset was defined by searching PubMed, EMBASE, Google Scholar and the Cochrane database that had been published until July 2014. The meta-analysis was performed using Review Manager Software version 5.2.6. Result The final analysis was conducted on 10 studies (2 randomized controlled studies (RCTs) and 8 retrospective studies), including 1626 patients. The pooled data demonstrate no significant difference in 1-year catheter survival (OR = 1.04, 95% CI = 0.52–2.10, P = 0.90) between surgical and percutaneous groups. However, the sensitivity analysis of the RCTs demonstrated that the incidence of overall infectious (OR = 0.26, 95% CI = 0.11–0.64, P = 0.003) and overall mechanical complications (OR = 0.32, 95% CI = 0.15–0.68, P = 0.003) were significantly lower in the percutaneous groups than the surgical groups. Furthermore, the subgroup analyses revealed no significant difference in the rates of peritonitis, tunnel and exit site infection, leakage, inflow-outflow obstruction, bleeding and hernia by comparing the methods. Conclusion The results showed that the placement modality did not affect 1-year catheter survival. Percutaneous catheter placement is as safe and effective as surgical technique. Peritoneal dialysis (PD) is an effective and less costly method of renal replacement therapy for end-stage renal disease patients (ESRD). Peritoneal dialysis is more effective in preserves renal function while awaiting renal transplantation, faster restoration of diuresis and better quality of life as a home treatment than hemodialysis. Currently, there is no consensus for preferring type of catheter and the catheter placement method because of each modality has its pros, cons, and post-operative complication. Thus, the authors performed a meta-analysis an attempt to clarify the comparison of the outcomes of both techniques (such as a 1-year catheter survival, infectious complication, and mechanical complication).
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Affiliation(s)
- Thawatchai Tullavardhana
- Corresponding author. Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhon Nayok 26120, Thailand.
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Sun TYT, Voss D, Beechey D, Lam-Po-Tang M. Comparison of peritoneal dialysis catheter insertion techniques: Peritoneoscopic, radiological and laparoscopic : A single-centre study. Nephrology (Carlton) 2016; 21:416-22. [DOI: 10.1111/nep.12621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/02/2015] [Accepted: 08/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Tina Y-T Sun
- Department of Renal Medicine; Counties Manukau DHB; Auckland New Zealand
| | - David Voss
- Department of Renal Medicine; Counties Manukau DHB; Auckland New Zealand
| | - Denise Beechey
- Department of Renal Medicine; Counties Manukau DHB; Auckland New Zealand
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Ros-Ruiz S, Alonso-Esteve Á, Gutiérrez-Vílchez E, Rudas-Bermúdez E, Hernández D. The impact of interventional nephrologists on the growth of a peritoneal dialysis program: Long-term, single-center experience. Nefrologia 2016; 36:19-23. [DOI: 10.1016/j.nefro.2015.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/13/2015] [Indexed: 11/16/2022] Open
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Overcoming the Underutilisation of Peritoneal Dialysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:431092. [PMID: 26640787 PMCID: PMC4658397 DOI: 10.1155/2015/431092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/20/2015] [Indexed: 11/23/2022]
Abstract
Peritoneal dialysis is troubled with declining utilisation as a form of renal replacement therapy in developed countries. We review key aspects of therapy evidenced to have a potential to increase its utilisation. The best evidence to repopulate PD programmes is provided for the positive impact of timely referral and systematic and motivational predialysis education: average odds ratio for instituting peritoneal dialysis versus haemodialysis was 2.6 across several retrospective studies on the impact of predialysis education. Utilisation of PD for unplanned acute dialysis starts facilitated by implantation of peritoneal catheters by interventional nephrologists may diminish the vast predominance of haemodialysis done by central venous catheters for unplanned dialysis start. Assisted peritoneal dialysis can improve accessibility of home based dialysis to elderly, frail, and dependant patients, whose quality of life on replacement therapy may benefit most from dialysis performed at home. Peritoneal dialysis providers should perform close monitoring, preventing measures, and timely prophylactic therapy in patients judged to be prone to EPS development. Each peritoneal dialysis programme should regularly monitor, report, and act on key quality indicators to manifest its ability of constant quality improvement and elevate the confidence of interested patients and financing bodies in the programme.
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Revision Techniques for Failed PD Catheters: Outcome in a University Hospital. J Vasc Access 2015; 16 Suppl 9:S93-5. [DOI: 10.5301/jva.5000374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose A disfunctioning peritoneal dialysis (PD) catheter has been reported in upto 35%. We report different salvage techniques used and its outcome. Methods We retrospectively reviewed our database on PD patients from 2009 to 2014. Operational data and data on PD catheter function were checked. Results From 2009 to 2014, we operated on 32 patients. Malfunction of their PD catheter was found in 23 patients and hernias in nine patients. Different laparoscopic techniques were used, including reposition of the catheter, fixation of the catheter, removal of adhesions and omentectomy. Of these 23 patients, 18 (78%) had a normal functioning catheter after the operation. Nine patients of the total of 32 patients had a correction of their hernia. In all cases, a non-absorbable mesh was used. Of those nine patients with a hernia, eight (89%) had a normal functioning catheter after the procedure. Conclusions The salvage of the catheter by means of a laparoscopic procedure or correction of a hernia is worthwhile and can save up to 81% of the catheters.
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Percutaneous versus Surgical Insertion of PD Catheters in Dialysis Patients: A Meta-Analysis. J Vasc Access 2015; 16:498-505. [DOI: 10.5301/jva.5000439] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 12/20/2022] Open
Abstract
Purpose Several small studies have suggested that the percutaneous method of peritoneal dialysis (PD) catheter insertion is effective and has a lower complication rate than surgical techniques (open, laparoscopic or peritoneoscopic), although no randomized, controlled study has compared these methods. Our objective was to compare percutaneous PD catheter insertion vs surgical placement in terms of 1-year catheter survival, catheter dysfunction, fluid leak and incidence of peritonitis. Methods We searched Medline for English-language literature from 1966 through June 2014, along with national conference proceedings and reference lists of all included publications to identify relevant studies. Inclusion criteria were having a measure of catheter survival at 1 year, catheter dysfunction, peritonitis rate per patient-month or fluid leak as outcomes. Studies were excluded if they were not in English or if they included pediatric patients. Random effects models were used to derive the pooled risk ratios, differences in patency and their variations. Results Thirteen studies with a total of 2,681 subjects met the inclusion criteria. There was no significant difference in 1-year catheter survival in percutaneous vs surgical PD catheter placement (relative risk [RR] = 0.81; 95% confidence interval [CI]: 0.59-1.11, p = 0.19). Catheter dysfunction also did not differ significantly between the groups (pooled odds ratio [OR] = 0.86; 95% CI: 0.57-1.29, p = 0.46). The prevalence of peritoneal fluid leak also was similar for percutaneous and surgical groups (OR = 1.10; 95% CI: 0.58-2.09, p = 0.77). However, there was a significant lower incidence of peritonitis among those with percutaneous placement (incidence rate ratio [IRR] = 0.77; 95% CI: 0.62-0.96, p = 0.02). Significant heterogeneity was detected across studies ( I2 = 78.4%, p<0.0001). Conclusions Our results suggest that there is no significant difference in catheter survival between percutaneous and surgical placement of PD catheters. Whether there are significant benefits from percutaneous placement in terms of peritonitis rates requires further robust studies. These findings have significant implications for future design of clinical trials in the placement of PD catheters and the delivery of dialysis-related services.
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Park YS, Min SI, Kim DK, Oh KH, Min SK, Kim SM, Ha J. The outcomes of percutaneous versus open placement of peritoneal dialysis catheters. World J Surg 2014; 38:1058-64. [PMID: 24305922 DOI: 10.1007/s00268-013-2346-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peritoneal dialysis catheters (PDCs) can be inserted by a percutaneous, open surgical, or laparoscopic approach. Considerable controversy surrounds the mode of catheter placement and its impact on technical success. We compared the complications and survival characteristics of PDCs that were inserted by the open approach versus those inserted percutaneously. METHODS We reviewed the outcomes of 167 patients who received PDCs between September 2009 and February 2012. Of these, 89 were placed percutaneously and 78 were placed by open surgical techniques. The mechanical complication rates, including catheter bleeding, wrapping, migration, leakage, and technical failure of intraperitoneal placement were compared between the two groups. Additionally, peritonitis episodes, exit site infection rates, and tunnel infection rates were compared between groups. RESULTS The incidence of one or more previous intra-abdominal surgeries was significantly higher in the open group (4.5 percutaneous vs 21.7 % open; P = 0.001). Although the overall number of complications did not differ between the two groups, the incidence of early mechanical complications (11.2 vs 0 %; P = 0.002) and the number of catheter removals due to mechanical complications (7.9 vs 1.3 %; P = 0.047) were higher in the percutaneous group. Of the 15 mechanical complications in the percutaneous group, one third were due to technical failures compared to none in the open group (5.6 vs 0 %; P = 0.034). The 1 year survival rate of the PDCs for the percutaneous and open groups was 89.9 and 93.3 %, respectively (P = 0.249). CONCLUSIONS The placement modality did not affect catheter survival. However, early mechanical complications, including technical failures, were more frequent in the percutaneous group, despite the proportion of patients with a history of one or more previous intra-abdominal surgeries being significantly lower in that group. The direct visualized open method of catheter insertion may provide the most reliable and secure access for a PDC.
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Affiliation(s)
- Young Suk Park
- Department of General Surgery, Seoul National University Hospital, Seoul, South Korea,
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Perl J, Pierratos A, Kandasamy G, McCormick BB, Quinn RR, Jain AK, Huang A, Paterson JM, Oliver MJ. Peritoneal dialysis catheter implantation by nephrologists is associated with higher rates of peritoneal dialysis utilization: a population-based study. Nephrol Dial Transplant 2014; 30:301-9. [PMID: 25414373 DOI: 10.1093/ndt/gfu359] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The likelihood of peritoneal dialysis (PD) utilization following a PD catheter insertion attempt is poorly described. We explored the risk factors for PD nonuse, focusing on the method of PD catheter implantation. METHODS This population-based retrospective cohort study employed Ontario administrative health data to identify 3886 predialysis adults who had an incident PD catheter implantation between 2002 and 2010. The impact of the method of catheter implantation including open-surgical (open, n = 1884), surgical-laparoscopic (laparoscopic, n = 1154), nephrology-percutaneous (nephrology, n = 498) and radiology-percutaneous (radiology, n = 350) on rates of PD utilization (defined as four consecutive weeks of PD) was examined. RESULTS Eighty-three percent of study patients received PD. After adjustment, relative to patients with openly inserted catheters, PD utilization was greater for those with nephrology-inserted catheters [adjusted hazard ratio (aHR) 1.59, 95% confidence interval (CI) 1.29-1.95] and similar for radiology-inserted catheters [aHR 1.16, 95% CI 0.94-1.43] or laparoscopic-inserted catheters [aHR 0.97 (95% CI 0.86-1.09)]. Among PD nonusers, death occurred in 10% of the open group, 6% of the laparoscopic group, 27% of the radiology group and in fewer than 3% of the nephrology group. Sixty-nine percent received hemodialysis in the open group, 63% in the laparoscopic group, 61% in the radiology group and 88% in the nephrology group. Those remaining predialysis comprised 12% of the open group, 22% of the laparoscopic group, 11% of the radiology group and <3% of the nephrology group. CONCLUSIONS Nephrology insertion resulted in lower overall rates of PD nonuse, particularly due to death or remaining predialysis. Greater use may be related to insertion timing, technique or greater commitment on the part of nephrologists to the success of PD.
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Affiliation(s)
- Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada Division of Nephrology, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andreas Pierratos
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada Ontario Renal Network, Toronto, Ontario, Canada
| | | | | | - Robert R Quinn
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Arsh K Jain
- Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Anjie Huang
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - J Michael Paterson
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Matthew J Oliver
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
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Restrepo CA, Buitrago CA, Holguin C. Implantation of peritoneal catheters by laparotomy: nephrologists obtained similar results to general surgeons. Int J Nephrol Renovasc Dis 2014; 7:383-90. [PMID: 25364270 PMCID: PMC4211916 DOI: 10.2147/ijnrd.s68888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the complications and costs of minilaparotomies performed by a nephrologist (group A) compared with conventional laparotomies performed by a surgeon (group B) for peritoneal catheter implantation. Setting Two university hospitals (Santa Sofia and Caldas) in Manizales, Caldas, Colombia. Methods The study included stage 5 chronic kidney disease patients, with indication of renal replacement therapy, who were candidates for peritoneal dialysis and gave informed consent for a peritoneal catheter implant. Minilaparotomies were performed by a nephrologist in a minor surgery room under local anesthesia. Conventional laparotomies were performed by a surgeon in an operating room under general anesthesia. Results Two nephrologists inserted 157 peritoneal catheters, and seven general surgeons inserted 185 peritoneal catheters. The groups had similar characteristics: the mean age was 55 years, 49.5% were men, and the primary diagnoses were diabetic nephropathy, hypertensive nephropathy, and unknown etiology. The implant was successful for 98.09% of group A and 99.46% of group B. There was no procedure-related mortality. The most frequent complications in the first 30 days postsurgery in group A versus group B, respectively, were: peritonitis (6.37% versus 3.78%), exit-site infection (3.82% versus 2.16%), tunnel infection (0% versus 0.54%), catheter entrapment by omentum (1.27% versus 3.24%), peritoneal effluent spillover (1.91% versus 2.16%), draining failure (4.46% versus 6.49%), hematoma (0% versus 1.08%), catheter migration with kinking (3.18% versus 2.70%), hemoperitoneum (1.27% versus 0%), and hollow viscera accidental puncture (1.91% versus 0.54%). There were no statistically significant differences in the number of complications between groups. In 2013, the cost of a surgeon-implanted peritoneal dialysis catheter in Colombia was US $366 (666,000 COP), whereas the cost of a nephrologist-implanted catheter was US $198 (356,725 COP). Conclusion Nephrologist-performed minilaparotomies had similar effectiveness to surgeon-performed conventional laparotomies and were cost-effective; however, the nonuse of general anesthesia may be related with hollow viscera puncture during the procedure.
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Affiliation(s)
- Cesar A Restrepo
- Division of Nephrology, Department of Health Sciences, Caldas University. Caldas, Colombia
| | | | - Cielo Holguin
- Division of Nephrology, Department of Health Sciences, Caldas University. Caldas, Colombia
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Guidelines for laparoscopic peritoneal dialysis access surgery. Surg Endosc 2014; 28:3016-45. [DOI: 10.1007/s00464-014-3851-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
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Medani S, Hussein W, Shantier M, Flynn R, Wall C, Mellotte G. Comparison of Percutaneous and Open Surgical Techniques for First-Time Peritoneal Dialysis Catheter Placement in the Unbreached Peritoneum. Perit Dial Int 2014; 35:576-85. [PMID: 25082842 DOI: 10.3747/pdi.2013.00003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/02/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The percutaneous Seldinger method of peritoneal dialysis catheter (PDC) insertion has gained favor over recent years whereas traditionally it was reserved for patients considered not fit for general anesthesia. This blind technique is believed to be less safe, and is hence avoided in patients with previous laparotomy incisions. Reports on the success of this method may therefore be criticized for selection bias. In those with no prior abdominal surgery the optimal method of insertion has not been established. METHODS We retrospectively reviewed the outcomes of first-time PDC placements comparing the percutaneous (group P) and surgical (group S) insertion techniques in patients without a history of previous abdominal surgery in a single center between January 2003 and June 2010. We assessed catheter survival at 3 and 12 months post-insertion and compared complication rates between the two groups. RESULTS A total of 63 percutaneous and 64 surgical catheter insertions were analyzed. No significant difference was noted in catheter survival rates between group P and group S (86.2% vs 80% at 3 months, p = 0.37; and 78.3% vs 71.2% at 12 months, p = 0.42 respectively). Early and overall peritonitis rates were similar (5% vs 5.3%; p = 1, and 3.5 vs 4.9 episodes per 100 patient-months; p = 0.13 for group P and group S respectively). There were also no significant differences between the two groups in exit site leaks (15.9% in group P vs 6.3% in group S; p = 0.15), poor initial drainage (9.5% in group P vs 10.9% in group S, p = 0.34) or secondary drainage failure (7.9% in group P vs 18.8% in group S, p = 0.09). CONCLUSION This study illustrates the success and safety of percutaneous PDC insertion compared with the open surgical technique in PD naive patients without a history of prior abdominal surgery. Catheter survival was favorable with percutaneous insertion in this low-risk patient population but larger prospective studies may help to determine whether either method is superior. The percutaneous technique can be recommended as a minimally invasive, cost-effective procedure that facilitates implementing an integrated care model in nephrology practice.
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Affiliation(s)
- Samar Medani
- Nephrology, Adelaide & Meath Hospital, Dublin, Ireland
| | - Wael Hussein
- Nephrology, Adelaide & Meath Hospital, Dublin, Ireland
| | | | - Robert Flynn
- Urology, Adelaide & Meath Hospital, Dublin, Ireland
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Efficacy and safety of fluoroscopic manipulation using the alpha-replacer for peritoneal catheter malposition. Clin Exp Nephrol 2014; 19:521-6. [DOI: 10.1007/s10157-014-1007-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
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Maher E, Wolley MJ, Abbas SA, Hawkins SP, Marshall MR. Fluoroscopic versus Laparoscopic Implantation of Peritoneal Dialysis Catheters: A Retrospective Cohort Study. J Vasc Interv Radiol 2014; 25:895-903. [DOI: 10.1016/j.jvir.2014.01.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/26/2013] [Accepted: 01/07/2014] [Indexed: 11/30/2022] Open
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Different outcomes of peritoneal catheter percutaneous placement by nephrologists using a trocar versus the Seldinger technique: the experience of two Brazilian centers. Int Urol Nephrol 2014; 46:2029-34. [PMID: 24853999 DOI: 10.1007/s11255-014-0738-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
Abstract
A good catheter implantation technique is important to allow effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with different techniques have been limited. The aim of this study was to investigate the rate of early catheter-related complications and catheter survival in two Brazilian centers, according to two different percutaneous methods of catheter implantation performed by nephrologist team. Adult incident patients recruited from January 2006 to July 2013 having undergone first peritoneal dialysis (PD) catheter implantation were included in the analysis. Mechanical and infectious early complication rates were defined as time to the first event occurring up to 3 months. Four hundred and forty-five consecutive Tenckhoff catheters were implanted by nephrologist team percutaneously after antibiotic prophylaxis in an operating room: trocar was used in 349 (78.4 %) and Seldinger technique (ST) in 99 (21.6 %). The ST was significantly associated with a lower rate of leak (16.3 vs 3 %, p = 0.03) and outflow failure due to tip catheter migration (22.6 vs 10.1 %, p = 0.04), while early infectious complication rates were similar between the two groups (p = 0.59). Long-term catheter survival was higher in Seldinger group (log-rank, p = 0.031). By Cox multivariate analysis, adjusted for age, sex, and diabetes, the ST remained independently associated with better catheter survival [HR 0.681 (0.462-0.910), p = 0.04]. As conclusion, our experience showed better PD outcomes with the ST than trocar method of catheter implantation by nephrologist.
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Al-Hwiesh AK. Percutaneous peritoneal dialysis catheter insertion by a nephrologist: a new, simple, and safe technique. Perit Dial Int 2014; 34:204-11. [PMID: 24084842 PMCID: PMC3968106 DOI: 10.3747/pdi.2012.00160] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 12/17/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Insertion of the peritoneal dialysis (PD) catheter by a nephrologist has been encouraged by several studies. The ultimate goal is to provide safe, timely, and effective catheter insertion without an unduly long wait time or delay. The success of PD depends partly on the ease of catheter insertion. We developed a new technique for percutaneous PD catheter insertion by nephrologists. Our new technique, in addition to being easy, proved to be safe and to eliminate the need for the peel-away sheath. METHODS Data were collected prospectively on all patients having a PD catheter inserted by a nephrologist using our new technique (40 catheters in 38 patients). All catheters were evaluated for infectious and mechanical complications. RESULTS The mean duration of the procedure from skin sterilization to the end of insertion was 24 ± 3 minutes. No bowel perforation or serious hemorrhage was recorded. Poor initial drainage was recorded in 12.5% of the catheters (n = 5) during the 4 weeks after insertion. The incidence of early exit-site leakage was 2.5% (1 catheter). Episodes of exit-site infection occurred in 5.0% and 12.5% of catheters (within 1 month and by the end of study period respectively). Two episodes of peritonitis were reported by the end of the 12-month period. Catheter survival was 95.0% and 87.5% at 6 months and 12 months respectively. CONCLUSIONS Percutaneous bedside placement of PD catheters using our new technique is safe and carries less morbidity in terms of bowel perforation, catheter-related infection, and exit-site leak. In addition, our new technique appears to have a high success rate and to offer considerable savings in terms of operating time.
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Affiliation(s)
- Abdullah Khalaf Al-Hwiesh
- Department of Internal Medicine, Nephrology Division, King Fahd University Hospital, Dammam University, Saudi Arabia
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Sood MM, Tangri N, Hiebert B, Kappel J, Dart A, Levin A, Manns B, Molzahn A, Naimark D, Nessim SJ, Rigatto C, Soroka SD, Zappitelli M, Komenda P. Geographic and facility-level variation in the use of peritoneal dialysis in Canada: a cohort study. CMAJ Open 2014; 2:E36-44. [PMID: 25077124 PMCID: PMC3985977 DOI: 10.9778/cmajo.20130050] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Peritoneal dialysis is associated with similar survival and similar improvement in quality of life and is less costly compared with in-centre hemodialysis. We examined facility and geographic variation in the use of peritoneal dialysis in Canada. METHODS We analyzed data from the Canadian Organ Replacement Register for the period January 2001 to December 2010. We identified patients for whom peritoneal dialysis was the primary modality at 90 days after initiation of dialysis. We used multilevel models to evaluate variation in use of peritoneal dialysis by facility and geographic region. RESULTS We analyzed data for 31 778 incident dialysis patients at 56 facilities in 13 geographic regions across Canada. Use of peritoneal dialysis at 90 days varied considerably across geographic regions (range 19.8%-36.1%) and declined over time, from 28.8% in 2001 to 22.5% in 2010. After adjustment for case mix and facility-level quality indicators, 9.3% and 3.4% of the variability was attributable to facility and geographic factors, respectively. In adjusted models, there was a substantial difference between geographic regions with the lowest and highest peritoneal dialysis use (odds ratio for high use 1.51, 95% confidence interval [CI] 1.33-1.73 v. odds ratio for low use 0.69, 95% CI 0.60-0.79). INTERPRETATION In Canada, substantial variability in the use of peritoneal dialysis attributable to facility and geographic region was not explained by differences in patient case mix. An opportunity exists to optimize use of this cost-effective therapy through changes in policy and standardization of criteria for initiation of peritoneal dialysis.
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Affiliation(s)
- Manish M Sood
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont
| | - Navdeep Tangri
- Seven Oaks Hospital, University of Manitoba, Winnipeg, Man
| | - Brett Hiebert
- Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Man
| | - Joanne Kappel
- Saskatoon Health Region, University of Saskatchewan, Saskatoon, Sask
| | - Allison Dart
- Health Sciences Centre, University of Manitoba, Winnipeg, Man
| | - Adeera Levin
- St Paul's Hospital, University of British Columbia, Vancouver, BC
| | - Braden Manns
- Foothills Hospital, University of Calgary, Calgary, Alta
| | - Anita Molzahn
- Faculty of Nursing, University of Alberta, Edmonton, Alta
| | - David Naimark
- Sunnybrook Hospital, University of Toronto, Toronto, Ont
| | | | | | | | | | - Paul Komenda
- Seven Oaks Hospital, University of Manitoba, Winnipeg, Man
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A novel adaptation of laparoscopic Tenckhoff catheter insertion technique to enhance catheter stability and function in automated peritoneal dialysis. Langenbecks Arch Surg 2013; 399:525-32. [PMID: 24317438 DOI: 10.1007/s00423-013-1147-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 11/15/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Automated peritoneal dialysis (APD) normally takes place overnight. Maintaining a stable PD catheter position, independent of body position, omental wrapping or catheter displacement secondary to bowel movements is essential in maintaining effective catheter function. METHODS We developed a new procedure of catheter placement through combining and adapting several previously described operative techniques including laparoscopic placement of a curled double cuff Tenckhoff catheter with subcutaneous tunneling superior to the rectus sheet, an oblique course through the abdominal wall, deep entry into the pelvic peritoneum and directed placement of the curled tip within the pouch of Douglas. Retrospective analysis of catheter function was conducted, evaluating catheter position, function, complication rate and catheter survival against findings for current insertion techniques described within literature. RESULTS Between March 2009 and November 2011, 54 patients underwent PD catheter insertion. The observation period was an average of 343 ± 273 days. All patients received abdominal plain film showing optimal catheter position in 89 %. Reported catheter function was very good in 85.2 %, with no or few alarms per week during APD, moderate in 9.3 % with occasional minor dysfunctions (≤ 2 alarms per night), and poor in 5.6 %, with regular alarm disturbance. In one case, primary dysfunction led to catheter replacement. At completion, stable catheter function with occasional minor dysfunction was achieved in 52 of 54 cases. Catheter-related complications (leakage, hydrocele formation, infection and need for replacement) were observed in 14.8 %. At the end of the observation period, 55.6 % of catheters remained in use. Patient dropout occurred through death (18.5 %), renal transplantation (7.4 %), renal recovery (1.9 %), removal secondary to infection or dysfunction (9.3 %) and conversion to HD due to poor dialysis quality (7.4 %). CONCLUSION The above technique combines and optimises previously described laparoscopic catheter implantation techniques, allowing increased catheter stability resulting in an undisturbed catheter function suitable for APD.
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The choice of peritoneal dialysis catheter implantation technique by nephrologists. Int J Nephrol 2013; 2013:940106. [PMID: 23431443 PMCID: PMC3569939 DOI: 10.1155/2013/940106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/05/2013] [Indexed: 11/29/2022] Open
Abstract
Peritoneal dialysis catheter (PDC) is the lifeline of peritoneal dialysis (PD) patients. One of the critical issues for successful PD is a well-functioning PDC which is timely inserted. It is the implantation technique rather than the catheter design that determines the outcome of the catheter. Dedication in acquiring the appropriate technique is vital to the success of a PD program. In this paper, we discuss the pros and cons of various techniques used for PDC implantation. A detailed description of PDC implantation by using the minilaparotomy method is presented. We strongly recommend mini-laparotomy as the method of choice for PDC implantation by nephrologists.
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Taro Y, Yoshimoto A, Kawakita M, Ueta H, Toda N, Utsunomiya N, Muguruma K, Segawa T, Suzuki T. Impact of the inclusion of a nephrologist on the surgical team for peritoneal catheter insertion. Perit Dial Int 2012; 32:346-8. [PMID: 22641740 DOI: 10.3747/pdi.2011.00139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yoshinori Taro
- Department of Nephrology, Kobe City Medical Center, General Hospital, Hyogo, Japan.
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Fourtounas C, Maroulis I, Karnabatidis D, Hardalias A, Vlachojannis JG. Salvage of a totally occluded peritoneal dialysis catheter by laparoscopic milking. Semin Dial 2012; 26:E8-E10. [PMID: 23013545 DOI: 10.1111/sdi.12006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mechanical problems of the Peritoneal Dialysis (PD) catheter remain a significant cause of temporary or even permanent transfer to hemodialysis. Until recently, the most popular approach was to remove the problematic PD catheter than to try to salvage it. We report a case of severe (two-way) PD catheter obstruction that appeared after spontaneous hemoperitoneum and did not resolve with multiple conservative measures. However, it was successfully salvaged by laparoscopic surgery and milking of a big intraluminal clot.
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Affiliation(s)
- Costas Fourtounas
- Department of Internal Medicine - Nephrology, Patras University Hospital, Patras, Greece.
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Voss D, Hawkins S, Poole G, Marshall M. Radiological versus surgical implantation of first catheter for peritoneal dialysis: a randomized non-inferiority trial. Nephrol Dial Transplant 2012; 27:4196-204. [PMID: 22810376 DOI: 10.1093/ndt/gfs305] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Voss
- Department of Renal Medicine, Middlemore Hospital, Counties-Manukau District Health Board, Otahuhu, Auckland, New Zealand.
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Medani S, Shantier M, Hussein W, Wall C, Mellotte G. A comparative analysis of percutaneous and open surgical techniques for peritoneal catheter placement. Perit Dial Int 2012; 32:628-35. [PMID: 22550118 DOI: 10.3747/pdi.2011.00187] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is the preferred available option of renal replacement therapy for a significant number of end-stage kidney disease patients. A major limiting factor to the successful continuation of PD is the long-term viability of the PD catheter (PDC). Bedside percutaneous placement of the PDC is not commonly practiced despite published data encouraging use of this technique. Its advantages include faster recovery and avoidance of general anesthesia. METHODS We carried out a retrospective analysis of the outcomes of 313 PDC insertions at our center, comparing all percutaneous PDC insertions between July 1998 and April 2010 (group P, n = 151) with all surgical PDC insertions between January 2003 and April 2010 (group S, n = 162). RESULTS Compared with group P patients, significantly more group S patients had undergone previous abdominal surgery or PDC insertion (41.8% vs 9.3% and 33.3% vs 3.3% respectively, p = 0.00). More exit-site leaks occurred in group P than in group S (20.5% vs 6.8%, p = 0.002). The overall incidence of peritonitis was higher in group S than in group P (1 episode in 19 catheter-months vs 1 episode in 26 catheter-months, p = 0.017), but the groups showed no significant difference in the peritonitis rate within 1 month of catheter insertion (5% in group P vs 7.4% in group S, p = 0.4) or in poor initial drainage or secondary drainage failure (9.9% vs 11.7%, p = 0.1, and 7.9% vs 12.3%, p = 0.38, for groups P and S respectively).Technical survival at 3 months was significantly better for group P than for group S (86.6% vs 77%, p = 0.037); at 12 months, it was 77.7% and 68.7% respectively (p = 0.126). No life-threatening complications attributable to the insertion of the PDC occurred in either group. CONCLUSIONS Our analysis demonstrates further encouraging outcomes of percutaneous PDC placement compared with open surgical placement. However, the members of the percutaneous insertion group were primarily a selected subset of patients without prior abdominal surgery or PDC insertion, therefore limiting the comparability of the groups. Studies addressing such confounding factors are required. Local expertise in catheter placement techniques may affect the generalizability of results.
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Affiliation(s)
- Samar Medani
- Nephrology, Adelaide and Meath Hospital, Dublin, Ireland.
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de Moraes TP, Campos RP, de Alcântara MT, Chula D, Vieira MA, Riella MC, Olandowski M, Divino-Filho JC, Pecoits-Filho R. Similar Outcomes of Catheters Implanted by Nephrologists and Surgeons: Analysis of the Brazilian Peritoneal Dialysis Multicentric Study. Semin Dial 2012; 25:565-8. [DOI: 10.1111/j.1525-139x.2012.01050.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ng EK, Goh BL, Chew SE, Tan CC, Ching CH, Sha’ariah MYW, Rozina MG. Multicenter Analysis on the Impact of Nephrologist-Initiated Catheter Insertion Program on Peritoneal Dialysis Penetration. Semin Dial 2012; 25:569-73. [DOI: 10.1111/j.1525-139x.2012.01051.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yip T, Lo WK. Should the "trocar and cannula" method be used for peritoneal catheter implantation? Perit Dial Int 2011; 30:506-8. [PMID: 20829550 DOI: 10.3747/pdi.2010.00046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Terence Yip
- Department of Medicine Tung Wah Hospital Hong Kong
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Uhlinova J, Pechter U, Kermes K, Ots-Rosenberg M. Peritoneal Dialysis Penetration and Peritonitis Rate at a Single Centre during Last Decade. Int J Nephrol 2011; 2011:470426. [PMID: 21747997 PMCID: PMC3124848 DOI: 10.4061/2011/470426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/06/2011] [Accepted: 04/19/2011] [Indexed: 11/20/2022] Open
Abstract
Peritoneal dialysis (PD) has been intensively offered at our centre to patients (pts) with end-stage renal disease (ESRD) from 2000, and the number of PD pts was noticed to raise. We aimed to analyse the PD population from the aspect of penetration and peritonitis rate during eleven years. Cumulative number of new RRT pts was 378 during the study period. We found high PD penetration rate: 53% (range 32–72%). The rate of peritonitis was as high as 9.8 during first study years, but it has declined progressively last year being 29.1 by September 2010 and 21.7 by December 2010. Most cases of peritonitis were due to gram-positive pathogens. We have demonstrated steady high single-centre PD penetration rate and improvement of management of patients during last decade probably because of the result of better pts education and a continued dedication of the staff.
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Affiliation(s)
- Jana Uhlinova
- Department of Internal Medicine, University of Tartu, 6 Puusepa Street, Tartu 51014, Estonia
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Reddy C, Dybbro PE, Guest S. Fluoroscopically guided percutaneous peritoneal dialysis catheter placement: single center experience and review of the literature. Ren Fail 2010; 32:294-9. [PMID: 20370443 DOI: 10.3109/08860220903548932] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Experiences with minimally invasive techniques for peritoneal dialysis (PD) catheter placement are being increasingly described. Percutaneous placement of catheters using ultrasound and fluoroscopic guidance has reduced the risk of complications and has led to successful long-term catheter function. An interventional radiology catheter placement capability was established at our facility and it serves as the basis for this report. We performed a retrospective analysis of patients in a tertiary care center in Northern California who required PD between July 2005 and October 2008. Patients underwent PD catheter placement in an interventional radiology suite by the radiologist using a percutaneous Seldinger technique that was guided by fluoroscopy. Sixty-four patients between the ages of 25 and 90 were referred for fluoroscopic PD catheter placement by an interventional radiologist. If clinically indicated, PD was initiated within days of catheter placement. Minor complications were noted: four with minor bleeding, three with catheter migration, and one with temporary exit-site leakage. No bowel or bladder perforations were encountered. Fluoroscopically guided PD catheter placement by interventional radiologists can be a safe and cost-effective strategy to initiate acute or chronic PD. This approach could reduce the need for temporary vascular access and expedite the initiation of PD therapy by eliminating the delays in catheter placement often associated with surgical consultation and operating room scheduling.
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Affiliation(s)
- C Reddy
- Department of Nephrology, Kaiser Permanente, Santa Clara, CA, USA.
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Wong LP, Liebman SE, Wakefield KA, Messing S. Training of surgeons in peritoneal dialysis catheter placement in the United States: a national survey. Clin J Am Soc Nephrol 2010; 5:1439-46. [PMID: 20498240 DOI: 10.2215/cjn.08751209] [Citation(s) in RCA: 25] [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 Peritoneal dialysis (PD) depends on timely and skilled placement of a PD catheter (PDC). Most PDCs are placed surgically, but little is known about the residency training of surgeons in this procedure. Inadequate residency training could limit surgical expertise in PDCs, resulting in high complication rates that discourage PD use. This study assessed surgical PDC training in the United States to explore this issue. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A survey was sent to program directors of 248 U.S. surgery residency programs regarding the amount of PDC training, attitudes toward PDCs, and barriers to PDC training. Results were compared between academic and private centers. RESULTS Ninety-three surgery programs (38%) responded: 82% provided training in PDC and 69% were academic centers. Most surgeons placed 2 to <or=5 catheters during residency. Forty-eight percent of program directors felt that PDC training was important, 61% felt PDC training affected outcomes and increased the likelihood surgeons would place PDCs in practice, and 62% of programs expressed willingness to provide more PDC training. Lack of referrals from nephrology was the most frequently cited barrier to PDC training. CONCLUSIONS Although many U.S. surgery residency programs provide PDC training, this training appears inadequate. Low PD use and lack of referrals limits surgical training at most centers. Nephrologists need to develop initiatives with surgeons to improve PDC training and outcomes.
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Affiliation(s)
- Leslie P Wong
- Northwest Kidney Centers, Seattle, Washington 98122, USA.
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Brum S, Rodrigues A, Rocha S, Carvalho MJ, Nogueira C, Magalhaes C, Mendonca D, Cabrita A. Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation. Nephrol Dial Transplant 2010; 25:3070-5. [DOI: 10.1093/ndt/gfq142] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Li PKT, Chow KM. Importance of peritoneal dialysis catheter insertion by nephrologists: practice makes perfect. Nephrol Dial Transplant 2009; 24:3274-6. [DOI: 10.1093/ndt/gfp447] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Goh BL, Ganeshadeva Yudisthra M, Lim TO. Establishing Learning Curve for Tenckhoff Catheter Insertion by Interventional Nephrologist Using CUSUM Analysis: How Many Procedures and in Which Situation? Semin Dial 2009; 22:199-203. [DOI: 10.1111/j.1525-139x.2008.00536.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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