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Zhu Y, Xin P, Man Y, Zhang X, Sun L. Suture passer combined with two-hole laparoscopic peritoneal dialysis catheterization in patients undergoing peritoneal dialysis. Ren Fail 2024; 46:2349123. [PMID: 38727002 PMCID: PMC11089914 DOI: 10.1080/0886022x.2024.2349123] [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] [Received: 12/27/2023] [Accepted: 04/20/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Laparoscopic techniques are being widely applied for peritoneal dialysis (PD) catheter (PDC) placement. The suture passer is a novel fixation tool that aims to reduce catheter migration. We compared the clinical value of the suture passer combined with two-hole laparoscopic PDC placement to open surgical placement by evaluating preoperative and postoperative conditions, as well as the onset of complications in both groups. METHODS A retrospective study was conducted including 169 patients who underwent PDC placement surgery from January 2021 to May 2023. Based on the method employed, patients were divided into two groups: the suture passer combined with a two-hole laparoscopy group (SLG) and the open surgical group (SG). Comprehensive patient information, including general data, preoperative and postoperative indicators, peritoneal function after surgery, and the incidence rate of complications, were collected and analyzed. RESULTS The SLG showed a statistically significant decrease in operative time, intraoperative blood loss, and 6-month postoperative drift rate compared to the SG (p < 0.05). No statistically significant differences were observed between the two groups in terms of sex, age, primary disease, hospitalization time, hospitalization costs, preoperative and postoperative examination indicators, peritonitis, and omental wrapping. CONCLUSIONS Suture passer combined with two-hole laparoscopic PDC placement, characterized by simplicity and facilitating secure catheter fixation, was deemed safe and effective for patients undergoing PD. It reduces the catheter migration rate and improved surgical comfort. Overall, this technique demonstrates favorable outcomes in clinical practice.
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Affiliation(s)
- Yinan Zhu
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Peiqin Xin
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Yulin Man
- Department of Nephrology, Linyi People’s Hospital, Linyi, China
| | - Xiaoming Zhang
- Department of General Surgery, Linyi People’s Hospital, Linyi, China
| | - Lina Sun
- Department of Nephrology, Linyi People’s Hospital, Linyi, China
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Qureshi MA, Maierean S, Crabtree JH, Clarke A, Armstrong S, Fissell R, Jain AK, Jassal SV, Hu SL, Kennealey P, Liebman S, McCormick B, Momciu B, Pauly RP, Pellegrino B, Perl J, Pirkle JL, Plumb TJ, Seshasai R, Shah A, Shah N, Shen J, Singh G, Tennankore K, Uribarri J, Vasilevsky M, Yang R, Quinn RR, Nadler A, Oliver MJ. The Association of Intra-Abdominal Adhesions with Peritoneal Dialysis Catheter-Related Complications. Clin J Am Soc Nephrol 2024; 19:472-482. [PMID: 38190176 PMCID: PMC11020425 DOI: 10.2215/cjn.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND This study investigated the association of intra-abdominal adhesions with the risk of peritoneal dialysis (PD) catheter complications. METHODS Individuals undergoing laparoscopic PD catheter insertion were prospectively enrolled from eight centers in Canada and the United States. Patients were grouped based on the presence of adhesions observed during catheter insertion. The primary outcome was the composite of PD never starting, termination of PD, or the need for an invasive procedure caused by flow restriction or abdominal pain. RESULTS Seven hundred and fifty-eight individuals were enrolled, of whom 201 (27%) had adhesions during laparoscopic PD catheter insertion. The risk of the primary outcome occurred in 35 (17%) in the adhesion group compared with 58 (10%) in the no adhesion group (adjusted HR, 1.64; 95% confidence interval [CI], 1.05 to 2.55) within 6 months of insertion. Lower abdominal or pelvic adhesions had an adjusted HR of 1.80 (95% CI, 1.09 to 2.98) compared with the no adhesion group. Invasive procedures were required in 26 (13%) and 47 (8%) of the adhesion and no adhesion groups, respectively (unadjusted HR, 1.60: 95% CI, 1.04 to 2.47) within 6 months of insertion. The adjusted odds ratio for adhesions for women was 1.65 (95% CI, 1.12 to 2.41), for body mass index per 5 kg/m 2 was 1.16 (95% CI, 1.003 to 1.34), and for prior abdominal surgery was 8.34 (95% CI, 5.5 to 12.34). Common abnormalities found during invasive procedures included PD catheter tip migration, occlusion of the lumen with fibrin, omental wrapping, adherence to the bowel, and the development of new adhesions. CONCLUSIONS People with intra-abdominal adhesions undergoing PD catheter insertion were at higher risk for abdominal pain or flow restriction preventing PD from starting, PD termination, or requiring an invasive procedure. However, most patients, with or without adhesions, did not experience complications, and most complications did not lead to the termination of PD therapy.
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Affiliation(s)
- Mohammad Azfar Qureshi
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Serban Maierean
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John H. Crabtree
- Division of Nephrology and Hypertension, Harbor-University of California Los Angeles Medical Center, Torrance, California
| | - Alix Clarke
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean Armstrong
- College of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rachel Fissell
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Arsh K. Jain
- Department of Medicine, Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Sarbjit V. Jassal
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Susie L. Hu
- Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Peter Kennealey
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Scott Liebman
- Department of Medicine, Division of Nephrology, University of Rochester, Rochester, New York
| | - Brendan McCormick
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Bogdan Momciu
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Robert P. Pauly
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Beth Pellegrino
- Division of Nephrology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Jeffrey Perl
- Division of Nephrology, Division of Nephrology St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James L. Pirkle
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Troy J. Plumb
- Division of Nephrology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Rebecca Seshasai
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ankur Shah
- Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Nikhil Shah
- Faculty of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Jenny Shen
- The Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, California
| | | | - Karthik Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University and Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Jaime Uribarri
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Murray Vasilevsky
- Division of Nephrology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Yang
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert R. Quinn
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ashlie Nadler
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Matthew J. Oliver
- Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
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Zhang X, Hu Y, Jing F, Tian C, Wei Q, Li K, Zheng L, Liu J, Zhang J, Bian Y. Confirmation of intestinal and bladder perforations in a peritoneal dialysis patient using SPECT/CT: a case report and review of literature. Front Med (Lausanne) 2024; 10:1327295. [PMID: 38259858 PMCID: PMC10800964 DOI: 10.3389/fmed.2023.1327295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Background Peritoneal dialysis (PD) is a common treatment method for patients with renal failure. While peritonitis and tube floating migration are commonly observed complications, visceral perforation caused by PD is relatively rare. We present a case report of a patient undergoing PD due to renal failure, who encountered two instances of visceral perforation. In both occurrences, Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) played a pivotal role in providing accurate diagnoses and precise localization of the perforation sites. This report underscores the paramount significance of SPECT/CT in diagnosing visceral perforations in the context of PD. Case presentation A 73-year-old elderly male has been undergoing PD for 1 year due to renal failure. Recently, there has been impaired drainage of the PD catheter. The clinical team suspected the occurrence of peritonitis. The patient underwent a 99mTc Sodium Pertechnetate (99mTc-NaTcO4) SPECT/CT examination, which identified intestinal perforation. After 20 days of conservative treatment, a SPECT/CT follow-up examination revealed the resolution of the intestinal perforation, but a new bladder perforation emerged. The dialysis catheter was methodically and gradually withdrawn in stages while simultaneously performing bladder decompression. Following these interventions, the patient remained free from peritonitis and cystitis. Conclusion The utilization of SPECT/CT proved to be highly valuable in the accurate diagnosis of visceral perforation, a relatively rare complication observed in PD patients.
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Affiliation(s)
- Xinchao Zhang
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, China
| | - Yujing Hu
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, China
| | - Fenglian Jing
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Congna Tian
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, China
| | - Qiang Wei
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, China
| | - Kang Li
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, China
| | - Lu Zheng
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, China
| | - Jiale Liu
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, China
| | - Jingjie Zhang
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, China
| | - Yanzhu Bian
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, China
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Zhang X, Xiang S, Wang Y, Liu G, Xie X, Han F, Chen J. Laparoscopic vs open surgical insertion of peritoneal dialysis catheters: A propensity score-matched cohort study. Curr Probl Surg 2024; 61:101425. [PMID: 38161061 DOI: 10.1016/j.cpsurg.2023.101425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Xiaohui Zhang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Shilong Xiang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Yaomin Wang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Guangjun Liu
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Xishao Xie
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Fei Han
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, China.
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Haggerty SP, Kumar SS, Collings AT, Alli VV, Miraflor E, Hanna NM, Athanasiadis DI, Morrell DJ, Ansari MT, Abou-Setta A, Walsh D, Stefanidis D, Slater BJ. SAGES peritoneal dialysis access guideline update 2023. Surg Endosc 2024; 38:1-23. [PMID: 37989887 DOI: 10.1007/s00464-023-10550-8] [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] [Received: 09/08/2023] [Accepted: 10/17/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Minimally invasive surgery has been used for both de novo insertion and salvage of peritoneal dialysis (PD) catheters. Advanced laparoscopic, basic laparoscopic, open, and image-guided techniques have evolved as the most popular techniques. The aim of this guideline was to develop evidence-based guidelines that support surgeons, patients, and other physicians in decisions on minimally invasive peritoneal dialysis access and the salvage of malfunctioning catheters in both adults and children. METHODS A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons reviewed the literature since the prior guideline was published in 2014 and developed seven key questions in adults and four in children. After a systematic review of the literature, by the panel, evidence-based recommendations were formulated using the Grading of Recommendations Assessment, Development and Evaluation approach. Recommendations for future research were also proposed. RESULTS After systematic review, data extraction, and evidence to decision meetings, the panel agreed on twelve recommendations for the peri-operative performance of laparoscopic peritoneal dialysis access surgery and management of catheter dysfunction. CONCLUSIONS In the adult population, conditional recommendations were made in favor of: staged hernia repair followed by PD catheter insertion over simultaneous and traditional start over urgent start of PD when medically possible. Furthermore, the panel suggested advanced laparoscopic insertion techniques rather than basic laparoscopic techniques or open insertion. Conditional recommendations were made for either advanced laparoscopic or image-guided percutaneous insertion and for either nonoperative or operative salvage. A recommendation could not be made regarding concomitant clean-contaminated surgery in adults. In the pediatric population, conditional recommendations were made for either traditional or urgent start of PD, concomitant clean or clean-contaminated surgery and PD catheter placement rather than staged, and advanced laparoscopic placement rather than basic or open insertion.
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Affiliation(s)
- Stephen P Haggerty
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
| | - Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Amelia T Collings
- Department of Surgery, Hiram C. Polk, Jr., University of Louisville, Louisville, KY, USA
| | - Vamsi V Alli
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Emily Miraflor
- Department of Surgery, UCSF East Bay, University of California, San Francisco, CA, USA
| | - Nader M Hanna
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - David J Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mohammed T Ansari
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ahmed Abou-Setta
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Danielle Walsh
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
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Sakurada T, Kojima S, Yamada S, Koitabashi K, Taki Y, Matsui K, Murasawa M, Kawarazaki H, Shimizu S, Kobayashi H, Asai T, Hashimoto K, Hoshino T, Sugitani S, Maoka T, Nagase A, Sato H, Fukuoka K, Sofue T, Koibuchi K, Nagayama K, Washida N, Koide S, Okamoto T, Ishii D, Furukata S, Uchiyama K, Takahashi S, Nishizawa Y, Naito S, Toda N, Naganuma T, Kikuchi H, Suzuki T, Komukai D, Kimura T, Io H, Yoshikawa K, Naganuma T, Morishita M, Oshikawa J, Tamagaki K, Fujisawa H, Ueda A, Kanaoka T, Nakamura H, Yanagi M, Udagawa T, Yoneda T, Sakai M, Gunji M, Osaki S, Saito H, Yoshioka Y, Kaneshiro N. A multi-institutional, observational study of outcomes after catheter placement for peritoneal dialysis in Japan. Perit Dial Int 2023; 43:457-466. [PMID: 37632293 DOI: 10.1177/08968608231193240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This multi-institutional, observational study examined whether the outcomes after peritoneal dialysis (PD) catheter placement in Japan meet the audit criteria of the International Society for Peritoneal Dialysis (ISPD) guideline and identified factors affecting technique survival and perioperative complications. METHODS Adult patients who underwent first PD catheter placement for end-stage kidney disease between April 2019 and March 2021 were followed until PD withdrawal, kidney transplantation, transfer to other facilities, death, 1 year after PD start or March 2022, whichever came first. Primary outcomes were time to catheter patency failure and technique failure, and perioperative infectious complications within 30 days of catheter placement. Secondary outcomes were perioperative complications. Appropriate statistical analyses were performed to identify factors associated with the outcomes of interest. RESULTS Of the total 409 patients, 8 who underwent the embedded catheter technique did not have externalised catheters. Of the 401 remaining patients, catheter patency failure occurred in 25 (6.2%). Technical failure at 12 months after PD catheter placement calculated from cumulative incidence function was 15.3%. On Cox proportional hazards model analysis, serum albumin (hazard ratio (HR) 0.44; 95% confidence interval (CI) 0.27-0.70) and straight type catheter (HR 2.14; 95% CI 1.24-3.69) were the independent risk factors for technique failure. On logistic regression analysis, diabetes mellitus was the only independent risk factor for perioperative infectious complications (odds ratio 2.70, 95% CI 1.30-5.58). The occurrence rate of perioperative complications generally met the audit criteria of the ISPD guidelines. CONCLUSION PD catheter placement in Japan was proven to be safe and appropriate.
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Affiliation(s)
- Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Shigeki Kojima
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Shohei Yamada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | | | - Yasuhiro Taki
- Department of Nephrology, Inagi Municipal Hospital, Tokyo, Japan
| | - Katsuomi Matsui
- Division of Nephrology and Hypertension, St Marianna University School of Medicine Yokohama City Seibu Hospital, Kanagawa, Japan
| | - Masaru Murasawa
- Department of Nephrology, Gyotoku General Hospital, Chiba, Japan
| | - Hiroo Kawarazaki
- Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Sayaka Shimizu
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto University, Japan
| | - Hironori Kobayashi
- Department of Nephrology, Japanese Red Cross Asahikawa Hospital, Hokkaido, Japan
| | - Toshihiro Asai
- Department of Urology, Osaka City General Hospital, Japan
| | - Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, Nagano, Japan
| | - Taro Hoshino
- Department of Nephrology, Japanese Red Cross Saitama Hospital, Japan
| | - Seita Sugitani
- Department of Nephrology, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Tomochika Maoka
- Department of Nephrology, NTT Medical Center Sapporo, Hokkaido, Japan
| | - Akihiko Nagase
- Department of Nephrology and Hypertension, Dokkyo Medical University, Tochigi, Japan
| | - Hirotaka Sato
- Department of Nephrology, Shimane Prefectural Central Hospital, Japan
| | - Kosuke Fukuoka
- Department of Nephrology, Kurashiki Central Hospital, Okayama, Japan
| | - Tadashi Sofue
- Department of CardioRenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Japan
| | - Kiyoto Koibuchi
- Department of Nephrology and Dialysis, Saiseikai Yokohamashi Tobu Hospital, Japan
| | | | - Naoki Washida
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | - Takayuki Okamoto
- Department of Nephrology, Kyowakai Medical Corporation Kyoritsu Hospital, Hyogo, Japan
| | - Daisuke Ishii
- Department of Urology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Satoshi Furukata
- Department of Nephrology, Fukaya Red Cross Hospital, Saitama, Japan
| | - Kiyotaka Uchiyama
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Takahashi
- Department of Nephrology, National Hospital Organization Kure Medical Center, Hiroshima, Japan
| | - Yoshiko Nishizawa
- Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
| | - Shotaro Naito
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Naohiro Toda
- Department of Nephrology, Kansai Electric Power Hospital, Osaka, Japan
| | - Tsukasa Naganuma
- Department of Nephrology, Yamanashi Prefectural Central Hospital, Japan
| | - Hidetoshi Kikuchi
- Department of Nephrology, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Tomo Suzuki
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Daisuke Komukai
- Department of Nephrology, Kawasaki-Saiwai Hospital, Kanagawa, Japan
| | - Takahide Kimura
- Department of Nephrology, International University of Health and Welfare Atami Hospital, Shizuoka, Japan
| | - Hiroaki Io
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kazuhiro Yoshikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, Iwate Medical University School of Medicine, Japan
| | | | | | - Jin Oshikawa
- Department of Nephrology, Yokohama Sakae Kyosai Hospital, Kanagawa, Japan
| | - Keiichi Tamagaki
- Division of Nephrology, Department of Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Hajime Fujisawa
- Department of Nephrology, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan
| | - Atsushi Ueda
- Department of Nephrology, Hitachi General Hospital, Ibaraki, Japan
| | - Tomohiko Kanaoka
- Department of Medical Science and Cardiorenal Medicine, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | | | - Mai Yanagi
- Department of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Takashi Udagawa
- Department of Nephrology, Nippon Koukan Hospital, Kanagawa, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Japan
| | - Masashi Sakai
- Department of Nephrology, Fujisawa City Hospital, Kanagawa, Japan
| | - Masanobu Gunji
- Department of Nephrology, Mito Saiseikai General Hospital, Ibaraki, Japan
| | - Shinichi Osaki
- Department of Surgery, Gengendo Kimitsu Hospital, Chiba, Japan
| | - Hisako Saito
- Department of Nephrology, Showa General Hospital, Tokyo, Japan
| | - Yuuki Yoshioka
- Department of Nephrology, Tachikawa General Hospital, Niigata, Japan
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7
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Kou HW, Yeh CN, Tsai CY, Liu SH, Ho WY, Lee CW, Wang SY, Chang MY, Tian YC, Hsu JT, Hwang TL. Clinical Benefits of Laparoscopic Adhesiolysis during Peritoneal Dialysis Catheter Insertion: A Single-Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1014. [PMID: 37374218 DOI: 10.3390/medicina59061014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: In peritoneal dialysis (PD) therapy, intra-abdominal adhesions (IAAs) can cause catheter insertion failure, poor dialysis function, and decreased PD adequacy. Unfortunately, IAAs are not readily visible to currently available imaging methods. The laparoscopic approach for inserting PD catheters enables direct visualization of IAAs and simultaneously performs adhesiolysis. However, a limited number of studies have investigated the benefit/risk profile of laparoscopic adhesiolysis in patients receiving PD catheter placement. This retrospective study aimed to address this issue. Materials and Methods: This study enrolled 440 patients who received laparoscopic PD catheter insertion at our hospital between January 2013 and May 2020. Adhesiolysis was performed in all cases with IAA identified via laparoscopy. We retrospectively reviewed data, including clinical characteristics, operative details, and PD-related clinical outcomes. Results: These patients were classified into the adhesiolysis group (n = 47) and the non-IAA group (n = 393). The clinical characteristics and operative details had no remarkable between-group differences, except the percentage of prior abdominal operation history was higher and the median operative time was longer in the adhesiolysis group. PD-related clinical outcomes, including incidence rate of mechanical obstruction, PD adequacy (Kt/V urea and weekly creatinine clearance), and overall catheter survival, were all comparable between the adhesiolysis and non-IAA groups. None of the patients in the adhesiolysis group suffered adhesiolysis-related complications. Conclusions: Laparoscopic adhesiolysis in patients with IAA confers clinical benefits in achieving PD-related outcomes comparable to those without IAA. It is a safe and reasonable approach. Our findings provide new evidence to support the benefits of this laparoscopic approach, especially in patients with a risk of IAAs.
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Affiliation(s)
- Hao-Wei Kou
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Chun-Yi Tsai
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Shou-Hsuan Liu
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Wen-Yu Ho
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Ming-Yang Chang
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Ya-Chung Tian
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Tsann-Long Hwang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
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8
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Jacobs L, Salaouatchi M, Taghavi M, Sanoussi S, Nortier J, Mesquita M. Jejunal perforation secondary to blind insertion of peritoneal dialysis catheter: a case report and review of literature. BMC Nephrol 2023; 24:116. [PMID: 37106351 PMCID: PMC10134622 DOI: 10.1186/s12882-023-03155-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) depends upon a functioning and durable access to the peritoneal cavity. Many techniques exist to insert a peritoneal catheter, showing similar outcomes and benefits. Blind percutaneous insertion represents a bedside intervention predominantly performed by nephrologists requiring only local anesthesia, sedation and minimal transcutaneous access. Although current guidelines recommend insertion techniques allowing visualization of the peritoneal cavity, the blind percutaneous approach is still widely used and has been proven safe and effective to bring durable peritoneal dialysis access. Herein, we described a rare case of jejunal perforation secondary to blind PD catheter placement, and conduct a review of the current medical literature describing early bowel perforations secondary to PD catheter placement, gathering descriptions of symptomatology and outcomes and their relations to the insertion technique. CLINICAL PRESENTATION We herein describe the case of a 48 year-old patient with a history of appendectomy who suffered from triple jejunal perforation after blind percutaneous insertion and subsequent embedment of his peritoneal catheter. Accurate diagnosis was made 1 month after insertion due to atypical clinical presentation and because physicians had no access to the peritoneal cavity after catheter embedment. After surgical repair and broad-spectrum antibiotics, the patient was switched to HD. CONCLUSION Early catheter-related visceral injury is a rare, yet threatening condition that is almost always causing a switch to hemodialysis or death. Our review highlights that laparoscopic catheter placement might bring better outcomes if perforation occurs, as it allows immediate diagnosis and treatment. On the contrary, catheter embedment may delay clinical diagnosis and therefore bring worse outcomes.
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Affiliation(s)
- Lucas Jacobs
- Nephrology and Dialysis Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Mohammed Salaouatchi
- Nephrology and Dialysis Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maxime Taghavi
- Nephrology and Dialysis Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Said Sanoussi
- Radiology Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Joelle Nortier
- Nephrology and Dialysis Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Mesquita
- Nephrology and Dialysis Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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9
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Keshvari A, Meshkati Yazd SM, Keramati MR, Kamran H, Shahriarirad R, Mivefroshan A, Kiani F. Evaluation of the effectiveness of prophylactic omentopexy during laparoscopic insertion of peritoneal dialysis catheter: a case-control clinical trial. Int Urol Nephrol 2023:10.1007/s11255-023-03522-3. [PMID: 36828921 DOI: 10.1007/s11255-023-03522-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/17/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION The laparoscopic omentopexy has been described for the prevention of peritoneal dialysis catheter obstruction due to omental wrapping of the catheter. As there are some controversies and limited data regarding the outcomes of prophylactic omentopexy, we designed a study to evaluate the efficacy of prophylactic omentopexy in preventing catheter dysfunction in patients undergoing laparoscopic catheter placement. MATERIALS AND METHODS In this randomized clinical trial, patients with end-stage renal disease during 3 months were divided into two groups of peritoneal dialysis catheter implants with and without omentopexy and subsequently evaluated regarding postoperative features. RESULTS A total of 43 patients were evaluated, including 22 undergoing prophylactic omentopexies. There was no significant difference among the baseline features of the patients. There was also no significant difference regarding postoperative features, including peritonitis, leakage, reoperation, need for catheter removal, and mortality. CONCLUSION Prophylactic omentopexy did not cause any significant differences in complications. In addition, there was no benefit for decreasing postoperative outflow obstruction due to omental wrapping following peritoneal dialysis catheter insertion.
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Affiliation(s)
- Amir Keshvari
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Colorectal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Keramati
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Colorectal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Kamran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.,Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.,Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azam Mivefroshan
- Nephrology and Renal Transplant Research Center, Urmia University of Medical Science, Urmia, Iran
| | - Fakhroddin Kiani
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.
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10
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Peng J, Lin H, Cai C, Cai C, Yang L, Peng Y, Wu K. New method of internal fixation in laparoscopic Tenckhoff catheter placement. Semin Dial 2022; 35:498-503. [PMID: 35460108 DOI: 10.1111/sdi.13087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/23/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite obvious advantages of peritoneal dialysis (PD), mechanical complications are responsible for the failure of PD at early stage. Suture fixation in laparoscopic PD catheter method could reduce mechanical complications. In our study, a simple method to fix PD catheter was developed. METHODS Tenckhoff catheter placement was performed in 49 consecutive patients. In the technique, only two trocars were used. With the help of syringe needle and forceps, a loop of silk was prepared at the abdominal wall. The PD catheter was thread through the loop. The silk ligature was tied subcutaneously keeping the catheter suspended from the abdominal wall. Primary outcomes were catheter-related complications. Secondary outcomes were 6-month catheter survival rates and death within 30 days. Data were analyzed retrospectively. RESULTS The average operation time was 49.7 ± 15.8 min. Minimum follow-up time was 6 months. No catheter displacement or hernia was detected. One patient had omental wrapping after silk suture rupture, 2 patients had outflow obstruction, and 3 patients had leakage. No one died within 30 days postoperatively. Catheter survival was 95.8% at 6 months. CONCLUSIONS The method we described greatly reduced the risk of catheter displacement and omental wrap. Also, the required instrument and laparoscopic skill were simple.
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Affiliation(s)
- Jianwei Peng
- Department of Nephrology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Hanfei Lin
- Department of Nephrology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Chudan Cai
- Department of Nephrology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Cong Cai
- Department of Urology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lihua Yang
- Department of Nephrology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yanqiang Peng
- Department of Nephrology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Kefei Wu
- Department of Nephrology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
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11
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BLITZKOW ACB, BIAGINI G, SABBAG CA, BUFFARA-JUNIOR VA. LAPAROSCOPIC PERITONEAL DIALYSIS CATHETER PLACEMENT WITH RECTUS SHEATH TUNNELING: A ONE-PORT SIMPLIFIED TECHNIQUE. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1690. [PMID: 36134821 PMCID: PMC9484823 DOI: 10.1590/0102-672020220002e1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The success of peritoneal dialysis depends on the proper placement and functional longevity of the dialysis catheter. Laparoscopic implantation of a catheter through a rectus sheath tunneling can minimize the risks of catheter failure. AIMS This study aims to describe one-port simplified technique for laparoscopic placement of a peritoneal dialysis catheter with rectus sheath tunneling. METHODS The simplified laparoscopic insertion of a Tenckhoff catheter with rectus sheath tunneling was performed in 16 patients with chronic renal failure. RESULTS During the follow-up period, no major complications occurred. Three patients were excluded. One was referred to the renal transplant some weeks after implantation, and one died for other reasons during the follow-up. Another patient needed adhesiolysis due to previous surgery, so an additional port was necessary. The other 13 catheters worked properly, and no postoperative hemorrhage, early leaks, hernia, or catheter migration occurred. One patient had a tunnel infection 11 months after the implant. No peritonitis was observed during the follow-up. CONCLUSIONS The technique is simple, reproducible, and safe, with good results in catheter function, few complications, and a high catheter survival rate. It does not require a special device or trocar and avoids excessive port sites.
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Affiliation(s)
- Ana Carolina Buffara BLITZKOW
- Paraná Kidney Institute, Peritoneal Dialysis Service - Curitiba
(PR), Brazil;,Santa Cruz Hospital, General Surgery Department - Curitiba (PR),
Brazil;,Pilar Hospital, General Surgery Department - Curitiba (PR),
Brazil
| | - Gilson BIAGINI
- Paraná Kidney Institute, Peritoneal Dialysis Service - Curitiba
(PR), Brazil
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12
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Abstract
The practice and clinical outcomes of peritoneal dialysis (PD) have demonstrated significant improvement over the past 20 years. The aim of this review is to increase awareness and update healthcare professionals on current PD practice, especially with respect to patient and technique survival, patient modality selection, pathways onto PD, understanding patient experience of care and use prior to kidney transplantation. These improvements have been impacted, at least in part, by greater emphasis on shared decision-making in dialysis modality selection, the use of advanced laparoscopic techniques for PD catheter implantation, developments in PD connecting systems, glucose-sparing strategies, and modernising technology in managing automated PD patients remotely. Evidence-based clinical guidelines such as those prepared by national and international societies such as the International Society of PD have contributed to improved PD practice underpinned by a recognition of the place of continuous quality improvement processes.
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Affiliation(s)
- Ayman Karkar
- Medical Affairs - Renal Care, Scientific Office, Baxter A.G., Dubai, United Arab Emirates
| | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, UK
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13
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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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14
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Agarwal A, Whitlock RH, Bamforth RJ, Ferguson TW, Sabourin JM, Hu Q, Armstrong S, Rigatto C, Tangri N, Dunsmore S, Komenda P. Percutaneous Versus Surgical Insertion of Peritoneal Dialysis Catheters: A Systematic Review and Meta-Analysis. Can J Kidney Health Dis 2021; 8:20543581211052731. [PMID: 34795905 PMCID: PMC8593295 DOI: 10.1177/20543581211052731] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Home-based peritoneal dialysis (PD) is an alternative to facility-based hemodialysis and has lower costs and greater freedom for patients with kidney failure. For a patient to undergo PD, a safe and reliable method of accessing the peritoneum is needed. However, different catheter insertion techniques may affect patient health outcomes. Objective: To compare the risk of infectious and mechanical complications between surgical (open and laparoscopic) PD catheter insertion and percutaneous catheter insertion. Design: Systematic review and meta-analysis. Setting: We searched for observational studies and randomized controlled trials (RCTs) in CENTRAL, EMBASE, MEDLINE, PubMed, and SCOPUS from inception until June 2018. Data were extracted by 2 independent reviewers based on a preformed template. Patients: Adult (aged 18+) patients with kidney failure who underwent a PD catheter insertion procedure. Measurements: We analyzed leak, malfunction, and bleed as early complications (occurring within 1 month of catheter insertion). Infectious complications (exit-site infections, tunnel infections, and peritonitis) were presented as both early complications and with the longest duration of follow-up. Methods: Random effects meta-analyses with the generic inverse variance method to estimate pooled rate ratios and 95% confidence intervals. We quantified heterogeneity by using the I2 statistic for inconsistency and assessed heterogeneity using the χ2 test. Sensitivity analysis was performed by removing studies at high risk of bias as measured with the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Results: Twenty-four studies (22 observational, 2 RCTs) with 3108 patients and 3777 catheter insertions were selected. Data from 2 studies were unable to be extracted and were qualitatively assessed. In the remaining 22 studies, percutaneous insertion was associated with a lower risk of both exit-site infections (risk ratio [RR] = 0.36, 95% confidence interval [CI] = 0.24-0.53, I2 = 0%) and peritonitis (RR = 0.52, 95% CI = 0.36-0.77, I2 = 3%) within 1 month of the procedure. There was no difference in mechanical complication rates between the 2 techniques. Limitations: Lack of consistency in the time periods for the various outcomes reported, risk of bias concerns with respect to population comparability, and the inability to analyze individual component causes of primary nonfunction (catheter obstruction, catheter migration, and leak). Conclusions: Our meta-analysis suggests differences in early infectious complications in favor of percutaneous insertion and no significant differences in mechanical complications compared with surgical insertion. These findings have implications on the direction of PD programs in terms of maximizing operating room resources.
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Affiliation(s)
- Anirudh Agarwal
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Reid H Whitlock
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Ryan J Bamforth
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Thomas W Ferguson
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Jenna M Sabourin
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Qiming Hu
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Sean Armstrong
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Claudio Rigatto
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Navdeep Tangri
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Sara Dunsmore
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Paul Komenda
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
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15
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Develay O, Rifaat M, Benarbia S, Caramaro S. Technique d’implantation chirurgicale des cathéters de dialyse péritonéale. Expérience d’un centre. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i4.63213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Alors que la réalisation d'un abord vasculaire est un acte fréquent pour un chirurgien qui travaille avec un centre d'hémodialyse, l'implantation d'un cathéter de dialyse péritonéale s'avère souvent plus rare en raison d'un nombre inférieur de patients pris en charge en dialyse péritonéale (DP). Certains centres vont parfois avoir moins de dix nouveaux patients par an traités par DP ; lorsque un chirurgien débute cette activité, il est important que sa technique d'implantation du cathéter de DP soit d'emblée maitrisée pour permette au néphrologue de prendre en charge son patient dans les meilleures conditions avec un cathéter de DP fonctionnel quelle que soit la modalité de DP. L'implantation en ambulatoire, sous anesthésie locale ou générale, permet de limiter la durée d'hospitalisation. L'utilisation de cathéters en col de cygne à extrémité droite, un trajet pre péritonéale tangentiel, la vérification fonctionnelle per opératoire terminée par une introduction de 100 ml de dialysat, une première réfection du pansement et une première utilisation au dixième jour permettent dans notre expérience d'avoir un cathéter fonctionnel dans 93,5 % des cas.
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16
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van Laanen JHH, Litjens EJ, Snoeijs M, van Loon MM, Peppelenbosch AG. Introduction of advanced laparoscopy for peritoneal dialysis catheter placement and the outcome in a University Hospital. Int Urol Nephrol 2021; 54:1391-1398. [PMID: 34661825 PMCID: PMC8521505 DOI: 10.1007/s11255-021-03020-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/05/2021] [Indexed: 11/29/2022]
Abstract
Background Peritoneal dialysis (PD) catheters can be obstructed by omental wrapping or migration, leading to catheter malfunction. Multiple catheter placement techniques have been described. Advanced laparoscopy with fixation of the catheter and omentum has been reported to improve functional outcome compared to basic laparoscopy without fixation. This feasibility study describes surgical technique, complications, and comparison of the functional outcome of advanced versus basic laparoscopic catheter placement. Methods Between July 2016 and April 2019, the advanced laparoscopy technique was applied in all eligible patients. Two experienced surgeons placed the catheters in a standardized procedure. Peri-operative complications and functional outcome of the catheter were scored. Results were compared to a historical cohort retrieved from our RCT performed earlier using basic laparoscopy. Findings The basic laparoscopic group (BLG) consisted of 46 patients and the advanced laparoscopic group (ALG) of 32. Complication rate in both groups was similar and low with 7% in the BLG and 6% in the ALG (p = 1.0). There was a trend toward better functional catheter outcome in the ALG (88%) compared to the BLG (70%) (p = 0.1). Part of the catheter failures in the ALG could be related to the learning curve. After revision surgery, 94% of patients in the ALG had a functional catheter. These findings lead to the set-up of a multi-center randomized-controlled trial, currently running, comparing basic to advanced laparoscopic techniques.
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Affiliation(s)
- J H H van Laanen
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E J Litjens
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M Snoeijs
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M M van Loon
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A G Peppelenbosch
- Department of Operative Care and Vascular Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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17
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Huang L, Xue C, Chen S, Zhou S, Yang B, Ruan M, Qian Y, Wu J, Zhang Y, Zhao X, Mei C, Xu J, Mao Z. Comparison of Outcomes between Percutaneous and Surgical Placement of Peritoneal Dialysis Catheters in Uremic Patients: A Meta-Analysis. Blood Purif 2021; 51:328-344. [PMID: 34544079 DOI: 10.1159/000516145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The optimal technique for inserting peritoneal dialysis catheters in uremic patients remains debated. This meta-analysis aimed to summarize the current evidence evaluating the efficacy and safety of percutaneous insertion methods compared to surgical methods. METHOD A literature search was performed in the PubMed, EMBASE, Cochrane, and Web of Science databases. The primary outcome was defined as catheter survival. The secondary outcomes were mechanical and infectious complications related to catheter insertion. RESULTS Twenty studies were finally identified, including 2 randomized controlled trials. The pooled results of catheter survival, overall mechanical complications, and infectious complications were not significant (odds ratio [OR] = 1.10, 95% confidence interval (CI) = 0.76-1.57, p = 0.62; OR = 0.73, 95% CI = 0.48-1.11, p = 0.14; and OR = 0.64, 95% CI = 0.37-1.09, p = 0.14, respectively). Comparison stratified by the blind percutaneous method versus open surgery indicated a lower overall number of mechanical complications (OR = 0.54, 95% CI = 0.31-0.93, I2 = 72%) and malposition rate (OR = 0.56, 95% CI = 0.34-0.90, I2 = 0%). The leakage rate was higher in the blind percutaneous group than in the open surgery group (OR = 2.55, 95% CI = 1.72-3.79, I2 = 0%); the guided percutaneous method achieved a similar leakage risk to the surgical methods. CONCLUSIONS The blind percutaneous method performed better with fewer overall mechanical complications and less malposition than open surgery. The leakage risk was higher in the blind percutaneous group, while the guided percutaneous placement group showed similar outcomes to the surgical method groups. Percutaneous methods also had a lower infection risk, which needs further evidence to be confirmed.
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Affiliation(s)
- Linxi Huang
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Graduate School of Clinical Medicine, Second Military Medical University, Shanghai, China
| | - Cheng Xue
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Sixiu Chen
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Graduate School of Clinical Medicine, Second Military Medical University, Shanghai, China
| | - Shoulian Zhou
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Graduate School of Clinical Medicine, Second Military Medical University, Shanghai, China
| | - Bo Yang
- Internal Medicine III (Nephrology & Endocrinology), Navel Medical Center of PLA, Second Military Medical University, Shanghai, China
| | - Mengna Ruan
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yixin Qian
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jun Wu
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yuqiang Zhang
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xuezhi Zhao
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Changlin Mei
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jing Xu
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhiguo Mao
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
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18
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Smith B, Mirhaidari S, Shoemaker A, Douglas D, Dan AG. Outcomes of Laparoscopic Peritoneal Dialysis Catheter Placement Using an Optimal Placement Technique. JSLS 2021; 25:JSLS.2020.00115. [PMID: 33879992 PMCID: PMC8035820 DOI: 10.4293/jsls.2020.00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Peritoneal dialysis (PD) is a widely employed renal replacement modality. A prospective study was conducted to determine the short-term and midterm outcomes and complication rates associated with a standardized optimal laparoscopic peritoneal dialysis catheter placement technique. Methods: All patients undergoing laparoscopic PD catheter placement by one surgeon using our standardized method over a 5-year period were entered into a prospective database. Patients were evaluated preoperatively and postoperatively through office visits. Development of complications was assessed using follow up telephone or mail surveys. Results: A total of 100 patients with a mean age of 56 years underwent laparoscopic PD catheter placement over the 5-year study period. In total, 103 laparoscopic PD catheter placement attempts were made in 100 patients. Placement was successful in 98 (95.1%) attempts and no placement required conversion to an open operation. Omentopexy was performed in 82 (83.7%) patients. There was no mortality reported within 30 days of the index operation. For patients who successfully underwent laparoscopic PD placement, early complications developed in 9 (9.2%) patients, of which 6 (6.1%) complications were directly related to the PD catheter. Midterm complications developed in 25 (25.5%) patients. Complication-related catheter repositioning was required for 12 (12.2%) catheters and catheter-related complication removal was required for 18 (18.4%) catheters. Conclusion: Laparoscopic placement of PD catheters can be successfully performed using a combination of described standardized laparoscopic maneuvers for optimal placement resulting in acceptable perioperative and short and midterm complication rates with negligible mortality rates.
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Affiliation(s)
- Brandon Smith
- Department of Surgery, Summa Health Akron City Hospital, Akron, Ohio USA
| | - Shayda Mirhaidari
- Department of Surgery, Summa Health Akron City Hospital, Akron, Ohio USA
| | - Ashley Shoemaker
- Department of Surgery, Summa Health Akron City Hospital, Akron, Ohio USA
| | - Deborah Douglas
- Department of Surgery, Summa Health Akron City Hospital, Akron, Ohio USA
| | - Adrian G Dan
- Department of Surgery, Summa Health Akron City Hospital, Akron, Ohio USA
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Abdijalil G, Shuijuan S. Laparoscopic versus open-surgery catheter placement in peritoneal dialysis patients: A meta-analysis of outcomes. Indian J Nephrol 2021; 32:8-15. [PMID: 35283566 PMCID: PMC8916142 DOI: 10.4103/ijn.ijn_482_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/03/2021] [Accepted: 02/24/2021] [Indexed: 11/07/2022] Open
Abstract
The peritoneal dialysis catheter (PDC) can be placed either through the laparoscopic technique, percutaneous technique or surgical procedures. The utilization of these PDC placement procedures is based on successful placement and reduced risk of development of complications. The main objective of this study was to compare the complications associated with laparoscopic vs. open-surgery PDC placement procedure. Literature for this review was obtained from PubMed and Google Scholar databases. The literature search was limited to studies published in the period between 1998 and 2019. The meta-analysis was done using Stata Version 12. The results showed significant difference in catheter malfunction between the laparoscopic and open-surgery group (relative risk [RR] =0.58; 95% CI: 0.42–0.8; P = 0.031). Furthermore, there was no significant statistical difference in dialysate leakage (RR = 0.77; 95% CI: 0.51–1.17, P = 0.116) peritonitis (RR = 0.8; 95% CI: 0.6–1.06, P = 0.349) and exit-site infection (RR = 0.84; 95% CI: 0.65–1.09, P = 0.834) between the laparoscopic and open-surgery PDC placement groups. In conclusion, the laparoscopic PDC placement procedure was superior to open surgery in regards to catheter malfunction. Additionally, the choice of treatment procedure should put in consideration factors such as cost and comfortability of the patient.
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Morris CS. Interventional Radiology Placement and Management of Tunneled Peritoneal Dialysis Catheters: A Pictorial Review. Radiographics 2020; 40:1789-1806. [DOI: 10.1148/rg.2020200063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Christopher S. Morris
- From the Department of Radiology, Larner College of Medicine, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401
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Watchful waiting is an appropriate option for peritoneal dialysis candidates with an asymptomatic ventral hernia. Hernia 2020; 25:709-715. [PMID: 32556634 DOI: 10.1007/s10029-020-02248-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/08/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Expert consensus recommends that all ventral hernias be repaired prior to, or concomitantly with, peritoneal dialysis (PD) catheter insertion. We examined the clinical outcomes of patients undergoing initial PD catheter insertion, with asymptomatic ventral hernias that were not repaired and rather managed using a watchful waiting approach. METHODS A single-center, retrospective review of patients undergoing PD catheter insertion from 2005-2019 was performed. Patients who did not undergo repair of a pre-existing ventral hernia at the time of their initial PD catheter insertion were included. The primary endpoint was ventral hernia repair following PD catheter insertion. RESULTS Forty-one patients were included. Most patients presented with an umbilical hernia (78%). Six patients (15%) underwent ventral hernia repair at a median postoperative interval of 12 months [IQR 8-16], due to abdominal discomfort and hernia enlargement (n = 2) and incarceration (n = 2). Two patients remained asymptomatic, yet underwent ventral hernia repair at the time of renal transplantation. The cumulative incidence of ventral hernia repair within 12 and 24 months of PD catheter insertion was 13% and 21%, respectively. CONCLUSION Watchful waiting may be an acceptable option for select patients with asymptomatic ventral hernias at the time of initial PD catheter placement. These findings highlight the need to better identify factors associated with asymptomatic ventral hernias that do not warrant concomitant repair to aid surgeons in the decision-making process.
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Sun ML, Zhang Y, Wang B, Ma TA, Jiang H, Hu SL, Zhang P, Tuo YH. Randomized controlled trials for comparison of laparoscopic versus conventional open catheter placement in peritoneal dialysis patients: a meta-analysis. BMC Nephrol 2020; 21:60. [PMID: 32093633 PMCID: PMC7038608 DOI: 10.1186/s12882-020-01724-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 02/12/2020] [Indexed: 01/30/2023] Open
Abstract
Background The application of laparoscopic catheterization technology in peritoneal dialysis (PD) patients has recently increased. However, the advantages and disadvantages of laparoscopic versus conventional open PD catheter placement are still controversial. The aim of this meta-analysis is to assess the complications of catheterization in PD patients and to provide a reference for choosing a PD-catheter placement technique in the clinic. Methods We searched numerous databases, including Embase, PubMed, CNKI and the Cochrane Library, for published randomized controlled trials (RCTs). Results Eight relevant studies (n = 646) were included in the meta-analysis. The pooled results showed a lower incidence of catheter migration (OR: 0.42, 95% CI: 0.19 to 0.90, P: 0.03) and catheter removal (OR: 0.41, 95% CI: 0.21 to 0.79, P: 0.008) but a higher incidence of bleeding (OR: 3.25, 95% CI: 1.18 to 8.97, P: 0.02) with a laparoscopic approach than with a conventional approach. There was no significant difference in the incidence of omentum adhesion (OR: 0.32, 95% CI: 0.05 to 2.10, P: 0.24), hernia (OR: 0.38, 95% CI: 0.09 to 1.68, P: 0.20), leakage (OR: 0.69, 95% CI: 0.38 to 1.26, P: 0.23), intestinal obstruction (OR: 0.96, 95% CI: 0.48 to 1.91, P: 0.90) or perforation (OR: 0.95, 95% CI: 0.06 to 15.42, P: 0.97). The statistical analysis showed no significant difference in early (OR: 0.44, 95% CI: 0.15 to 1.33, P: 0.15), late (OR: 0.89, 95% CI: 0.41 to 1.90, P: 0.76) or total (OR: 0.68, 95% CI: 0.42 to 1.12, P: 0.13) peritonitis infections between the 2 groups, and there are no no significant difference in early (OR: 0.39, 95% CI: 0.06 to 2.36, P: 0.30), late (OR: 1.35, 95% CI: 0.78 to 2.33, P: 0.16) or total (OR: 1.20, 95% CI: 0.71 to 2.02, P: 0.17) tunnel or exit-site infections between the 2 groups. Conclusion Laparoscopic catheterization and conventional open catheter placement in PD patients have unique advantages, but laparoscopic PD catheterization may be superior to conventional open catheter placement. However, this conclusion needs to be confirmed with further large-sample-size, multi-centre, high-quality RCTs.
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Affiliation(s)
- Mei-Lan Sun
- Department of Blood Purification Center, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Yong Zhang
- Department of Nephrology, Jianli People's Hospital, Jingzhou, Hubei, China
| | - Bo Wang
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital of China Three Gorges University, Yichang, Hubei, China
| | - Te-An Ma
- Department of Nephrology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Hong Jiang
- Department of Nephrology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Shou-Liang Hu
- Department of Nephrology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Piao Zhang
- Department of Nephrology, Nanjing General Hospital of Nanjing Military Command, Nanjing, Jiangsu, China
| | - Yan-Hong Tuo
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Affiliation(s)
- J.H. Crabtree
- Department of Surgery Southern California Permanente Medical Group Kaiser Permanente Bellflower Medical Center Bellflower, California, USA
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24
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Crabtree JH. Hernia Repair without Delay in Initiating or Continuing Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080602600209] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John H. Crabtree
- Department of Surgery Southern California Permanente Medical Group Kaiser Permanente Bellflower Medical Center Bellflower, California, USA
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Crabtree JH, Burchette RJ. Prospective Comparison of Downward and Lateral Peritoneal Dialysis Catheter Tunnel-Tract and Exit-Site Directions. Perit Dial Int 2020. [DOI: 10.1177/089686080602600612] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveGuidelines for optimal peritoneal dialysis access support both downward and lateral exit-site directions. Numerous clinical reports support the superiority of downward exit sites but none substantiate lateral configurations.MethodsThis prospective study compared infectious and mechanical complications between 85 catheters with a preformed arcuate bend to produce a downward exit site and 93 catheters with a straight intercuff segment configured to create a lateral exit site.ResultsKaplan–Meier survivals were not different for time to first exit-site infection ( p = 0.62), tunnel infection ( p = 0.89), or peritonitis ( p = 0.38) for downward and lateral exit-site directions. Poisson regression showed no differences in rates (episodes/patient-year) of exit-site infection (0.26 vs 0.27, p = 0.86), tunnel infection (0.02 vs 0.03, p = 0.79), peritonitis (0.42 vs 0.43, p = 0.87), or catheter loss (0.06 vs 0.09, p = 0.29) for downward and lateral exit sites. Kaplan–Meier analyses of antibiotic-free intervals for exit-site ( p = 0.94) and peritonitis infections ( p = 0.72) were not different for the two groups. There was one case of catheter tip displacement with flow dysfunction in each group. There were no pericatheter hernias or spontaneous cuff extrusions. Catheter survival between groups was not different ( p = 0.20).ConclusionsCatheter types employing downward and lateral tunnel-tract and exit-site configurations produce equivalent outcomes for infectious and mechanical complications.
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Affiliation(s)
- John H. Crabtree
- Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower
| | - Raoul J. Burchette
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, California, USA
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26
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Crabtree JH. Fluoroscopic Placement of Peritoneal Dialysis Catheters: A Harvest of the Low-Hanging Fruits. Perit Dial Int 2020. [DOI: 10.1177/089686080802800207] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John H. Crabtree
- Department of Surgery Southern California Permanente Medical Group Kaiser Permanente Bellflower Medical Center Bellflower, California, USA
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Jo YI, Shin SK, Lee JH, Song JO, Park JH. Immediate Initiation of CAPD following Percutaneous Catheter Placement without Break-in Procedure. Perit Dial Int 2020. [DOI: 10.1177/089686080702700215] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveTo evaluate the effect of a modified method of percutaneous catheter placement without a break-in procedure on the development of catheter-related complications in patients on continuous ambulatory peritoneal dialysis (CAPD).DesignA prospective, observational clinical study.SettingPeritoneal dialysis (PD) units of two university-based hospitals.Patients and MethodsThis study included 51 consecutive patients on CAPD. A straight double-cuffed Tenckhoff catheter with a straight intraperitoneal segment was used, and all catheters were inserted using a modified percutaneous placement method under local anesthesia. The catheter was introduced directly into the deep pelvis through an intramuscular tract, which had been created by tapered dilators. Peritoneal dialysis was initiated immediately after catheter insertion without a break-in procedure. Catheter-related complications were surveyed during the 12 months after initiation of CAPD.ResultsWithin the first month, only 1 pericatheter leakage (1.9%) was detected. There were no cases of visceral perforation or severe hemorrhage during catheter insertions. Catheter malfunction due to catheter tip migration, exit-site infection, and peritonitis developed in only 1.9%, 3.9%, and 3.9% of patients, respectively. After 1 month following catheter insertion, no further incidences of pericatheter leakage occurred during the follow-up period. All catheters, except one that was reinserted due to tip migration, survived throughout the study period.ConclusionThe rates of pericatheter leakage and other catheter-related complications are relatively low in CAPD patients using our percutaneous catheter placement method without a break-in procedure. This procedure is comparatively simple and less invasive than other catheter placement methods, and allows for immediate start of PD after catheter insertion, without a break-in procedure.
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Affiliation(s)
- Young-Il Jo
- Division of Nephrology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul
| | - Sug Kyun Shin
- Renal Division, Yonsei University Medical Center, NHIC Ilsan Hospital, Koyang, Korea
| | - Jong-Ho Lee
- Division of Nephrology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul
| | - Jong-Oh Song
- Division of Nephrology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul
| | - Jung-Hwan Park
- Division of Nephrology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul
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28
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Smith BM, Dan AG. Operative Technique for Laparoscopic Placement of Continuous Ambulatory Peritoneal Dialysis Catheter. J Laparoendosc Adv Surg Tech A 2020; 30:815-819. [PMID: 32074477 DOI: 10.1089/lap.2019.0750] [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: 11/13/2022] Open
Abstract
Background: Peritoneal dialysis (PD) is an increasingly utilized treatment modality for renal replacement therapy that affords medical and lifestyle benefits to the patient and financial savings to the health care system. Successful long-term use of PD is reliant upon an optimally functioning catheter. Many potential catheter-related complications can be avoided through utilizing optimal placement technique. As widespread use of PD as a renal replacement modality continues to increase, the need for a safe, standardized, catheter placement technique has become more evident. Objectives: To present a succinct synopsis of the rationale and elements of our current surgical management strategy for patients undergoing evaluation for PD and to provide a detailed stepwise description of our operative technique for PD catheter placement. This review describes potential pitfalls that may prevent optimal catheter function and describes each step taken to prevent potential complications. This description is combined with intraoperative photographs to highlight key steps. Conclusion: Following a defined reproducible stepwise approach, laparoscopic placement of continuous ambulatory peritoneal dialysis catheters can be performed safely and known potential complications hindering optimal catheter function can be addressed prophylactically.
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Affiliation(s)
- Brandon M Smith
- Department of Surgery, Summa Health Akron City Hospital, Akron, Ohio, USA.,Department of Surgery, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Adrian G Dan
- Department of Surgery, Summa Health Akron City Hospital, Akron, Ohio, USA.,Department of Surgery, Northeast Ohio Medical University, Rootstown, Ohio, USA
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Grieff M, Mamo E, Scroggins G, Kurchin A. The ‘Pull’ Technique for Removal of Peritoneal Dialysis Catheters: A Call for Re-Evaluation of Practice Standards. Perit Dial Int 2020; 37:225-229. [DOI: 10.3747/pdi.2016.00152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/26/2016] [Indexed: 11/15/2022] Open
Abstract
BackgroundThe most commonly used peritoneal dialysis (PD) catheters have silicon tubing with attached Dacron cuffs. The current standard of care for PD catheter removal is by complete surgical dissection, withdrawing both the tubing and the cuffs. The intention is to avoid infection of any residual part of the catheter. We retrospectively analyzed our results with the alternative ‘pull’ technique, by which the silicon tube is pulled out, leaving the Dacron cuffs within the abdominal wall. This technique never gained popularity due to concern that the retained cuffs would get infected.MethodsWe reviewed our experience from an 18-month period, between January 2014 and June 2015. There were 46 catheter removals in 40 patients. All the catheters were of the double-cuffed coiled Tenckhoff type (Covidien, Dublin, Ireland).ResultsOf the 46 catheter removals by the ‘pull’ technique, there was only 1 case of retained cuff infection.ConclusionsThe ‘pull’ technique is a safe method for Tenckhoff catheter removal with low risk of infection. We strongly recommend it as the procedure of choice.
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Affiliation(s)
- Marvin Grieff
- Department of Medicine, Rochester, NY, USA
- Rochester General Hospital, Rochester, NY, USA; and University of Rochester School of Medicine, Rochester, NY, USA
| | - Elizabeth Mamo
- Medical Library, Department of Information Technology, Rochester, NY, USA
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30
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Sakurada T, Ueda A, Komukai D, Uchiyama K, Tsujimoto Y, Yuasa H, Ryuzaki M, Ito Y, Tomo M, Nakamoto H. Outcomes after peritoneal dialysis catheter placement by laparoscopic surgery versus open surgery: systematic review and meta-analysis. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0232-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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31
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Shahbandari M, Amiran A. Comparison of the complications of open surgery versus laparoscopic technique in insertion of peritoneal dialysis catheter. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:85. [PMID: 31620184 PMCID: PMC6788176 DOI: 10.4103/jrms.jrms_1097_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/01/2019] [Accepted: 09/07/2019] [Indexed: 01/30/2023]
Abstract
Background: Invention of peritoneal dialysis (PD) has opened new windows for patients under dialysis due to its fewer time requirement and being ambulatory in comparison to hemodialysis. Open surgery and laparoscopic technique have been utilized for peritoneal catheter embedding; however, data about the superior technique are controversial. This study aimed to assess the outcomes of open surgery versus laparoscopic technique and compare their complications in those with survival of over and less than a year in patients who need PD for the first time. Materials and Methods: This randomized clinical trial study was conducted on 121 cases admitted for PD. Patients were randomly divided into two groups undergoing either open or laparoscopic surgery for embedding PD catheter. Patients’ demographics, as well as PD function and complications, were followed for a 12-month duration and compared between the two groups. Results: Catheter survival for over 12 months occurred in 39 patients (65%) underwent laparoscopic surgery, and 45 (73.8%) patients underwent open surgery (P = 0.09). Complications, including catheter obstruction, leak, abdominal hernia, and peritonitis, were not statistically different between the two techniques over 12 months of survival (P > 0.05). Complications among the catheters with less than a year survival, including obstruction, leak, catheter displacement, hernia, and peritonitis, were not significantly different comparing open surgery with laparoscopic technique (P > 0.05). Conclusion: Considering complications, PD catheter implantation through laparoscopic surgery was not statistically different from open surgery, neither for those with less than 12 months of survival nor for those with over a year.
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Affiliation(s)
- Morteza Shahbandari
- Department of General Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Amiran
- Department of General Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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32
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Crabtree JH, Shrestha BM, Chow KM, Figueiredo AE, Povlsen JV, Wilkie M, Abdel-Aal A, Cullis B, Goh BL, Briggs VR, Brown EA, Dor FJMF. Creating and Maintaining Optimal Peritoneal Dialysis Access in the Adult Patient: 2019 Update. Perit Dial Int 2019; 39:414-436. [PMID: 31028108 DOI: 10.3747/pdi.2018.00232] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/14/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- John H Crabtree
- Division of Nephrology and Hypertension, Harbor-University of California Los Angeles Medical Center, Torrance, CA, USA
| | - Badri M Shrestha
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Kai-Ming Chow
- Division of Nephrology, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, Chinese University of Hong Kong
| | - Ana E Figueiredo
- School of Health Sciences, Nursing School - Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Johan V Povlsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Ahmed Abdel-Aal
- Department of Radiology, Section of Interventional Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brett Cullis
- Hilton Life Renal Unit, Pietermaritzburg, South Africa
| | - Bak-Leong Goh
- Department of Nephrology, Hospital Serdang, Kuala Lumpur, Malaysia
| | - Victoria R Briggs
- Department of Nephrology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Frank J M F Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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Prabhakar N, Aljamal YN, Saleem HY, Baloul MS, Nyberg SL, Farley DR. Outcomes of laparoscopic and open CAPD catheter placement: A single-center experience. Surg Open Sci 2019; 1:20-24. [PMID: 32754688 PMCID: PMC7391912 DOI: 10.1016/j.sopen.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 11/26/2022] Open
Abstract
Background Continuous Ambulatory Peritoneal Dialysis (CAPD) catheter placement is typically a straightforward surgical procedure performed on chronically ill patients with end-stage renal disease (ESRD). Post-operative outcomes and reoperative rates vary greatly in the medical literature. We report our experience using both minimally invasive and open techniques in placing CAPD catheters and offer our surgical outcomes. Methods This study is an IRB-approved, retrospective review (2005–2018) of all patients undergoing CAPD catheter placement at Mayo Clinic-Rochester. Analysis focused on specific patient outcomes, including early (< 30 days) versus late (≥ 30 days) complication and reoperation rates. Results A total of 173 patients with ESRD (mean ASA score = 3.1) underwent laparoscopic (n = 22) and open (n = 151) CAPD catheter placement (mean follow-up = 309 days; range: 1–3497 days). The total index operation complication rate was 41%. The total index reoperation rate was 37% and was similar in open and laparoscopic approaches. CAPD catheters malfunctioned in 19 patients (11% of total) and each underwent reoperation. CAPD catheter infections occurred in 30 patients (17% of total), and 24 required reoperation; 6 patients were treated successfully with antibiotics. CAPD catheter migrations occurred in 21 patients (12% of total) and all underwent reoperation. Conclusion Although CAPD catheter placements in patients with ESRD are technically easy to accomplish, the long term outcomes suggest as many as one in three patients will struggle with catheter function or infection. This study has led to changes in our technical CAPD catheter placement procedures, as well as the post-operative patient care algorithm. Open CAPD catheter placement is faster than using a laparoscopic approach One in 3 patients with CAPD catheters will struggle with tube dysfunction or infection Laparoscopic CAPD catheter placement is technically easy to perform
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34
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Szeto CC, Lo WK, Li PK. Clinical practice guidelines for the provision of renal service in Hong Kong: Peritoneal Dialysis. Nephrology (Carlton) 2019; 24 Suppl 1:27-40. [PMID: 30900337 DOI: 10.1111/nep.13505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Cheuk Chun Szeto
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and TherapeuticsPrince of Wales Hospital, The Chinese University of Hong Kong Shatin Hong Kong SAR, China
| | - Wai Kei Lo
- Department of MedicineTung Wah Hospital Hong Kong SAR, China
- Dialysis CentreGleneagles Hospital Hong Kong SAR, China
| | - Philip Kam‐Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and TherapeuticsPrince of Wales Hospital, The Chinese University of Hong Kong Shatin Hong Kong SAR, China
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35
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Impact of Intra-Abdominal Adhesion on Dialysis Outcome in Peritoneal Dialysis Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1978765. [PMID: 30356377 PMCID: PMC6176331 DOI: 10.1155/2018/1978765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/22/2018] [Accepted: 09/05/2018] [Indexed: 11/17/2022]
Abstract
Background Peritoneal dialysis (PD) is an increasingly popular therapeutic option for patients with advanced renal failure. However, intra-abdominal adhesions (IAA) represent a major unsolved problem in adequate PD performance. In this study, we investigated the role of previous abdominal surgery on the presence of subsequent IAA as well as outcomes in those patients with PD who had subsequent IAA. Methods Two hundred and two patients who received continuous ambulatory peritoneal dialysis were prospectively enrolled in this study. We compared the PD adequacy indices and outcomes for technical failure in patients with and without subsequent IAA at presentation and a minimum of 2 years of follow-up. Results Subsequent IAA accounted for 19% (38/202) of patients. Patients who had previous abdominal surgery had higher risks of subsequent IAA especially those patients who had higher mean ages (P=0.023). PD adequacy indices including both 24-hour dialysate volume and peritoneal WCcr L/week/1.73 m2 were significantly lower in patients who had, as compared to those who did not have subsequent IAA (P=0.003 and 0.018, respectively). Although patients who had subsequent IAA had decreased PD adequacy, the development of technical failures during PD maintenance did not show significant differences at the 2-year minimum follow-up study. Conclusions Subsequent IAA is not rare, especially in high-risk patients including those with previous abdominal surgery and higher mean ages. Although decreased PD adequacy after IAA was found, the development of technical failures was not significantly different at the 2-year minimum follow-up study.
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Crabtree JH. Building Our Future to Provide the Most Optimal Peritoneal Access Through Surgeon Training Programs and Medical Device Development. Perit Dial Int 2018; 38:161-162. [PMID: 29848596 DOI: 10.3747/pdi.2018.00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- John H Crabtree
- Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, CA, USA
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Hu JC, Chiu KY, Wang SS, Chen CS, Ho HC, Yang CK, Chen CC, Wang SC, Lin CY, Hung SC, Cheng CL, Li JR. A Modified Application of Peritoneal Dialysis Catheter Implantation: A Revolution from the Laparoscope- to the Nephroscope-Assisted Surgery. J Endourol 2018; 32:502-508. [DOI: 10.1089/end.2018.0071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ju-Chuan Hu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Applied Chemistry, National Chi Nan University, Naitou, Taiwan
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chuan-Su Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hao-Chung Ho
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Che Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shu-Chi Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Yen Lin
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Sheng-Chun Hung
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chen-Li Cheng
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jian-Ri Li
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine and Nursing, Hung Kuang University, Taichung, Taiwan
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Shrestha BM, Shrestha D, Kumar A, Shrestha A, Boyes SA, Wilkie ME. Advanced Laparoscopic Peritoneal Dialysis Catheter Insertion: Systematic Review and Meta-Analysis. Perit Dial Int 2018; 38:163-171. [PMID: 29848597 DOI: 10.3747/pdi.2017.00230] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/20/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The optimal methodology of establishing access for peritoneal dialysis (PD) remains controversial. Previously published randomized controlled trials and cohort studies do not demonstrate an advantage for 1 technique over another. Four published meta-analyses comparing outcomes of laparoscopic versus open PD catheter (PDC) insertion have given inconsistent conclusions and are flawed since they group basic and advanced laparoscopy together. The aim of this systematic review and meta-analysis is to examine whether advanced laparoscopic interventions consisting of rectus sheath tunneling and adjunctive procedures produce a better outcome than open insertion or basic laparoscopy used only to verify the catheter position. METHODS A literature search using Medline, Embase, and Cochrane Database was performed, and meta-analysis was performed using RevMan 5.3.5 software (Nordic Cochrane Centre, The Cochrane Collaboration, London, UK). Outcomes evaluated incidence of catheter obstruction, migration, pericannular leak, hernia, infectious complications (peritonitis and exit-site infection) and catheter survival. RESULTS Of the 467 records identified, 7 cohort studies, including 1,045 patients, were included in the meta-analysis. When advanced laparoscopy was compared with open insertion, a significant reduction was observed in the incidence of catheter obstruction (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.03 - 0.63; p = 0.01), catheter migration (OR 0.12, 95% CI 0.06 - 0.26; p = 0.00001), pericannular leak (OR 0.27, 95% CI 0.11 - 0.64; p = 0.003), and pericannular and incisional hernias (OR 0.29, 95% CI 0.09 - 0.94; p = 0.04), as well as better 1- and 2-year catheter survival (OR 0.52, 95% CI 0.28 - 0.97; p = 0.04 and OR 0.50, 95% CI 0.28 - 0.92; p = 0.03, respectively). Compared with basic laparoscopy, catheter obstruction and migration were significantly lower in the advanced laparoscopic group, whereas catheter survival was similar in both groups. All outcomes, except catheter obstruction, were similar between the basic laparoscopy and open insertion. The infectious complications such as peritonitis and exit-site infections were similar between the 3 groups. CONCLUSIONS Advanced laparoscopy was associated with a significant superior outcome in comparison with open insertion and basic laparoscopy.
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Affiliation(s)
- Badri M Shrestha
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom
| | - Donna Shrestha
- North Manchester General Hospital, Manchester, United Kingdom
| | - Avneesh Kumar
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom
| | | | - Simon A Boyes
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom
| | - Martin E Wilkie
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom
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Wang H, Wang Y, Zhu J, Chen X, Chen C, Xiang C, Jia H, Ding G. Wang's Forceps-Assisted Percutaneous Insertion and Fixation of Peritoneal Dialysis Catheter. Artif Organs 2018; 42:728-735. [PMID: 29602176 DOI: 10.1111/aor.13121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/27/2017] [Accepted: 01/02/2018] [Indexed: 01/23/2023]
Abstract
Percutaneous insertion of peritoneal dialysis catheters is theoretically most preferred by nephrologists because of the advantages of bedside performing, surgery independence, and minimal injury over other procedures of catheter placement such as open surgical dissection or laparoscopic operation. However, blindly placing catheters in the percutaneous procedure brings the risk of catheter malposition or bowel perforation; this largely retarded it's implementation. We had previously developed a novel technique termed "Wang's forceps-assisted catheter insertion and fixation," which had been successfully applied in the open surgical catheter insertion and displaced catheter reposition in our center. In this study, we further explored the possibility of applying the Wang's forceps in the procedure of percutaneous catheter insertion both in porcine model and patients with end stage renal disease (ESRD). A total of three miniature pigs successfully received percutaneous catheter insertion using Seldinger's technique with Wang's forceps assistance. The catheters were all placed in the right position and functioning well in dialysate drainage. This novel method of percutaneous catheter insertion was then performed on 20 ESRD patients. The procedure showed effective time-saving with the average operating time of 29.2 ± 3.53 min and was well tolerated by patients with minimal pain and injury. During a follow-up time of 6 months, no complications of catheter displacement, leakage, or blockade occurred. Our preliminary observation demonstrates that utilization of Wang's forceps in a percutaneous procedure conferred benefits of accurately placing and fixing catheters while preserving the merits of minimal invasion and simple performance.
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Affiliation(s)
- Huiming Wang
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
| | - Yujuan Wang
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
| | - Jili Zhu
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
| | - Xinghua Chen
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
| | - Cheng Chen
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
| | - Cuizhi Xiang
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
| | - Houjun Jia
- Division of General Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guohua Ding
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
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van Laanen JHH, Cornelis T, Mees BM, Litjens EJ, van Loon MM, Tordoir JHM, Peppelenbosch AG. Randomized Controlled Trial Comparing Open Versus Laparoscopic Placement of a Peritoneal Dialysis Catheter and Outcomes: The CAPD I Trial. Perit Dial Int 2018; 38:104-112. [PMID: 29386303 DOI: 10.3747/pdi.2017.00023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 10/16/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine the best operation technique, open versus laparoscopic, for insertion of a peritoneal dialysis (PD) catheter with regard to clinical success. Clinical success was defined as an adequate function of the catheter 2 - 4 weeks after insertion. METHODS All patients with end-stage renal disease who were suitable for PD and gave informed consent were randomized for either open surgery or laparoscopic surgery. A previous laparotomy was not considered an exclusion criterion. Laparoscopic placement had the advantage of pre-peritoneal tunneling, the possibility for adhesiolysis, and placement of the catheter under direct vision. Catheter fixation techniques, omentopexy, or other adjunct procedures were not performed. Other measured parameters were in-hospital morbidity and mortality and post-operative infections. RESULTS Between 2010 and 2016, 95 patients were randomized to this study protocol. After exclusion of 5 patients for various reasons, 44 patients received an open procedure and 46 patients a laparoscopic procedure. Gender, age, body mass index (BMI), hypertension, current hemodialysis, severe heart failure, and previous an abdominal operation were not significantly different between the groups. However, in the open surgery group, fewer patients had a previous median laparotomy compared with the laparoscopic group (6 vs 16 patients; p = 0.027). There was no statistically significant difference in mean operation time (36 ± 24 vs 38 ± 15 minutes) and hospital stay (2.1 ± 2.7 vs 3.1 ± 7.3 days) between the groups. In the open surgery group 77% of the patients had an adequate functioning catheter 2 - 4 weeks after insertion compared with 70% of patients in the laparoscopic group (p = not significant [NS]). In the open surgery group there was 1 post-operative death (2%) compared with none in the laparoscopic group (p = NS). The morbidity in both groups was low and not significantly different. In the open surgery group, 2 patients had an exit-site infection and 1 patient had a paramedian wound infection. In the laparoscopic group, 1 patient had a transient cardiac event, 1 patient had intraabdominal bleeding requiring reoperation, and 1 patient had fluid leakage that could be managed conservatively. The survival curve demonstrated a good long-term function of PD. CONCLUSION This randomized controlled trial (RCT) comparing open vs laparoscopic placement of PD catheters demonstrates equal clinical success rates between the 2 techniques. Advanced laparoscopic techniques such as catheter fixation techniques and omentopexy might further improve clinical outcome.
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Affiliation(s)
- Jorinde H H van Laanen
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tom Cornelis
- Jessa Hospital, Department of Nephrology, Hasselt, Belgium
| | - Barend M Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elisabeth J Litjens
- Department of Internal Medicine, Division of Nephrology Maastricht University Medical Center, Maastricht, The Netherlands
| | - Magda M van Loon
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan H M Tordoir
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arnoud G Peppelenbosch
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Crabtree JH. Rescue and Salvage Procedures for Mechanical and Infectious Complications of Peritoneal Dialysis. Int J Artif Organs 2018; 29:67-84. [PMID: 16485242 DOI: 10.1177/039139880602900107] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mechanical and infectious complications are the two most common reasons for removal of peritoneal dialysis catheters and permanent transfer of patients to in-center hemodialysis. Early and appropriate intervention can save many catheters, often without interrupting peritoneal dialysis. If peritoneal dialysis must be interrupted, other strategies may be employed to minimize the time on temporary hemodialysis and preserve peritoneal dialysis as renal replacement therapy. Procedures for managing dialysate leaks, abdominal wall hernias, infusion pain, and catheter flow dysfunction are described. Salvage techniques for catheter-related infections and peritonitis are presented. Clinical conditions are discussed where urgent removal of the dialysis catheter is indicated to protect the future integrity of the peritoneal membrane.
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Affiliation(s)
- J H Crabtree
- Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower, California 90706, USA.
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Peritoneal Dialysis Catheter Emplacement by Advanced Laparoscopy: 8-year Experience from a Medical Center of China. Sci Rep 2017; 7:9097. [PMID: 28831180 PMCID: PMC5567303 DOI: 10.1038/s41598-017-09596-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/25/2017] [Indexed: 11/08/2022] Open
Abstract
Laparoscopic experience and relevant reports about PD catheter emplacement in Chinese patients are seldom. In this study, we described our experience with advanced laparoscopy for PD catheter implantation in Chinese patients. There were one hundred and thirty Chinese patients accepted advanced laparoscopic approach for PD catheter emplacement in this study. Six of 26 patients with prior abdominal operations had abdominal adhesion, while six of 104 patients without prior abdominal surgeries showed abdominal adhesion. Operation time required 10 to 180 minutes. During a mean follow-up time of 26.46 months, the catheter complications were shown as outflow obstruction (n = 6, 4.62%), pericatheter leaking (n = 3, 2.31%), hydrocele of tunica vaginalis (n = 1, 0.77% in all), and umbilical hernia (n = 2, 1.54%). Cumulative revision-free survival probability for catheter loss from mechanical complications at 8 years was 0.95. During the postoperative follow-up ranged between 6 and 106 months, 98 patients (75.38%) were still on CAPD, 17 patients (13.08%) died, 8 patients (6.15%) were transferred to hemodialysis, 6 patients (4.62%) received kidney transplantation, and 1 patient (0.77%) showed improved renal function. These results showed that PD catheter placement with advanced laparoscopy is a safe and effective approach in Chinese patients with or without prior abdominal surgeries.
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Shen Q, Jiang X, Shen X, Yu F, Tu Q, Chen W, Ye Q, Behera TR, He Q. Modified laparoscopic placement of peritoneal dialysis catheter with intra-abdominal fixation. Int Urol Nephrol 2017; 49:1481-1488. [PMID: 28455661 DOI: 10.1007/s11255-017-1593-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
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Wang Y, Zou Y, Chen X, Zhu J, Xiang C, Jia H, Ding G, Wang H. Identification of the appropriate fixation site to avoid peritoneal catheter migration based on a mechanical analysis. Ren Fail 2017; 39:400-405. [PMID: 28222614 PMCID: PMC6014350 DOI: 10.1080/0886022x.2017.1291433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: To conduct mechanical analysis on the relationship between abdominal wall fixation point and the displacement of catheter top, and establish the finite element model for the complex forces and conditions that the catheter wears in human abdominal cavity, in order to provide the scientific basis for optimizing the catheter position in abdominal wall fixation method. Methods: Using the PIPE59 finite elements to divide units, and taking the lower part of catheter, that is, below interior polyester cuff to simulate and compute the displacement formula. Results: The whole model includes a total of 1701 units. Periodic load was used to simulate the dynamic pressure that peritoneal dialysis catheter gets in abdominal cavity. The load direction was perpendicular to the catheter axis. We used pressure amplitude, duration and frequency as the boundary conditions, and adjusted the fixation point of the catheter lower part at the same time, thus calculating the extreme displacement value of the catheter top end with changing parameter conditions. We also did fitted regression on the results and obtained the displacement formula: y = 0.2 × 0.87x (y: the end displacement of peritoneal dialysis catheter, x: the distance between fixation point and the interior polyester cuff), R2: .982. Simulation the catheter maximal displacement on flat surface demonstrated that additional catheter fixation at the site of 9 cm or more below the internal cuff significantly restricted the catheter migration. Conclusions: The optimal position of fixation point in peritoneal dialysis is about 9 cm away from the interior polyester cuff.
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Affiliation(s)
- Yujuan Wang
- a Renal Department of Renmin Hospital , Wuhan University , Wuhan , PR China
| | - Yao Zou
- b School of Urban Construction, Wuhan University of Science and Technology , Wuhan , PR China
| | - Xinghua Chen
- a Renal Department of Renmin Hospital , Wuhan University , Wuhan , PR China
| | - Jili Zhu
- a Renal Department of Renmin Hospital , Wuhan University , Wuhan , PR China
| | - Cuizhi Xiang
- a Renal Department of Renmin Hospital , Wuhan University , Wuhan , PR China
| | - Houjun Jia
- c Division of General Surgery , First affiliated hospital of Chongqing Medical University , Chongqing , PR China
| | - Guohua Ding
- a Renal Department of Renmin Hospital , Wuhan University , Wuhan , PR China
| | - Huiming Wang
- a Renal Department of Renmin Hospital , Wuhan University , Wuhan , PR China
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Hauch AT, Lundberg PW, Paramesh AS. Laparoscopic techniques enable peritoneal dialysis in the difficult abdomen. JSLS 2016; 18:JSLS.2014.002334. [PMID: 25587214 PMCID: PMC4283101 DOI: 10.4293/jsls.2014.002334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Continuous ambulatory peritoneal dialysis has become an increasingly popular modality of renal replacement therapy. Laparoscopic placement of peritoneal dialysis catheters may help overcome previous barriers to peritoneal dialysis, such as previous abdominal surgical procedures or the presence of hernias, without incurring substantially greater risks. Methods: We performed a retrospective review of 120 consecutive patients who underwent attempted laparoscopic peritoneal dialysis catheter placement between July 2009 and June 2014 by a single surgeon. Patient and catheter characteristics and outcomes were compared between patients with and without complications, as well as between patients with a history of major abdominal surgery and those without such a history. Results: Laparoscopic peritoneal dialysis catheter placement was aborted in 4 patients because of an inability to safely achieve sufficient access to the abdominal cavity through dissection; these patients were excluded from subsequent analysis. The mean follow-up period was 18.8 ± 12.9 months. Fifty-five patients had a history of major abdominal surgery compared with 61 without such a history. No significant difference was observed with respect to age, race, sex, or body mass index between groups. Notably, more adjunctive procedures were required in patients with previous abdominal surgery, including adhesiolysis (60.0% vs 4.9%, P < .0001) and hernia repair (12.7% vs 1.6%, P = .026). Postoperative catheter complications were not significantly different between patients with and patients without a history of abdominal surgery (29.1% vs 32.8%, P = .667). Both unassisted (56.8% vs 65.0%, P = .397) and overall (72.7% vs 76.7%, P = .647) 1-year catheter survival rates were similar between patients with and patients without previous surgery, and the overall 1-year survival rate improved to 83.9% on exclusion of patients who stopped peritoneal dialysis for nonsurgical reasons. Conclusions: Laparoscopic peritoneal dialysis catheter placement offers a chance to establish peritoneal dialysis access in patients traditionally viewed as noncandidates for this modality. Despite the potential risks incurred because of additional procedures at the time of catheter placement in these complicated cases, these patients can achieve good long-term peritoneal dialysis access with an aggressive surgical approach.
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Affiliation(s)
- Adam T Hauch
- Department of General Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Peter W Lundberg
- Department of General Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Anil S Paramesh
- Department of General Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Bircan HY, Kulah E. Effects of a Novel Peritoneal Dialysis: The Open Versus Laparoscopic Preperitoneal Tunneling Technique. Ther Apher Dial 2015; 20:66-72. [DOI: 10.1111/1744-9987.12377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | - Eyyup Kulah
- Baskent University; Department of Nephrology; Istanbul Turkey
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Abstract
Acute genital edema (AGE) is an infrequent but disruptive complication in patients on continuous ambulatory peritoneal dialysis. It is a common manifestation of dialysate leakage caused by inguinal, umbilical, femoral, or incisional hernias; peritoneal tears; leaks around the dialysis catheter; trauma; fluid overload; and malignancy. The evaluation of AGE begins with a history and physical exam. However, the physical exam in these patients is often indeterminate. Several diagnostic measures exist to evaluate and guide management of AGE occurring during continuous ambulatory peritoneal dialysis but little agreement exists on an optimum method. We have conducted a review of the literature on the evaluation and management of AGE and present a summary of the data. CT peritoneography and peritoneal scintigraphy have been used extensively to evaluate AGE although no comparative studies exist. MRI peritoneography has also been described. CT peritoneography offers more anatomical detail but may not be as sensitive as peritoneal scintigraphy in detecting a peritoneal fluid leak as the cause for AGE. CT is also more costly and subjects the patient to more radiation. MRI is a noncontrast study without radiation risk, but has not been studied to the same degree. If testing is equivocal or bilateral hernias are suspected, diagnostic laparoscopy is helpful and can be combined with hernia repair. Whether the etiology is a leak or tear, low-volume peritoneal dialysis (PD) or cessation of PD for two to four weeks will allow closure. However, hernias almost always require operative repair with mesh usually without disrupting PD.
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Affiliation(s)
- Juaquito Jorge
- Department of Surgery, Lincoln Medical and Mental Health Center, Bronx, New York
| | - Stephen P. Haggerty
- Department of Surgery, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, Illinois
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The Survival and Complication Rates of Laparoscopic Versus Open Catheter Placement in Peritoneal Dialysis Patients. Surg Laparosc Endosc Percutan Tech 2015; 25:440-3. [DOI: 10.1097/sle.0000000000000188] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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49
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Cox TC, Blair LJ, Huntington CR, Prasad T, Kercher KW, Heniford BT, Augenstein VA. Laparoscopic versus open peritoneal dialysis catheter placement. Surg Endosc 2015; 30:899-905. [DOI: 10.1007/s00464-015-4297-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/29/2015] [Indexed: 01/30/2023]
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50
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Cullis B, Abdelraheem M, Abrahams G, Balbi A, Cruz DN, Frishberg Y, Koch V, McCulloch M, Numanoglu A, Nourse P, Pecoits-Filho R, Ponce D, Warady B, Yeates K, Finkelstein FO. Peritoneal dialysis for acute kidney injury. Perit Dial Int 2015; 34:494-517. [PMID: 25074995 DOI: 10.3747/pdi.2013.00222] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Brett Cullis
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USARenal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, U
| | - Mohamed Abdelraheem
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Georgi Abrahams
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Andre Balbi
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Dinna N Cruz
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Yaacov Frishberg
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Vera Koch
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Mignon McCulloch
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Alp Numanoglu
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Peter Nourse
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Roberto Pecoits-Filho
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Daniela Ponce
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Bradley Warady
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Karen Yeates
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
| | - Fredric O Finkelstein
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa; Renal and Intensive Care Units, Royal Devon and Exeter Hospital, Exeter, United Kingdom; Pediatric Nephrology Unit, Soba University Hospital, University of Khartoum, Sudan; Pondicherry Institute of Medical Sciences and Madras Medical Mission, Chennai, India; Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil; Division of Nephrology-Hypertension, University of California, San Diego, USA; Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Pediatric Nephrology Unit, Instituto da Criança of the Hospital das Clinicas of the University of Sao Paulo Medical School, Sao Paulo, Brazil; Pediatric Nephrology Department, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil; Division of Pediatric Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, USA; Division of Nephrology, Queen's University, Kingston, Canada; and Yale University, New Haven, USA
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