1
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Fotheringham J, Solis-Trapala I, Briggs V, Lambie M, McCullough K, Dunn L, Rawdin A, Hill H, Wailloo A, Davies S, Wilkie M. Catheter Event Rates in Medical Compared to Surgical Peritoneal Dialysis Catheter Insertion. Kidney Int Rep 2023; 8:2635-2645. [PMID: 38106573 PMCID: PMC10719604 DOI: 10.1016/j.ekir.2023.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction How patient, center, and insertion technique factors interact needs to be understood when designing peritoneal dialysis (PD) catheter insertion pathways. Methods We undertook a prospective cohort study in 44 UK centers enrolling participants planned for first catheter insertion. Sequences of regressions were used to describe the associations linking patient and dialysis unit-level characteristics with catheter insertion technique and their impact on the occurrence of catheter-related events in the first year (catheter-related infection, hospitalization, and removal). Factors associated with catheter events were incorporated into a multistate model comparing the rates of catheter events between medical and surgical insertion alongside treatment modality transitions and mortality. Results Of 784 first catheter insertions, 466 (59%) had a catheter event in the first year and 61.2% of transitions onto hemodialysis (HD) were immediately preceded by a catheter event. Catheter malfunction was less but infection was more common with surgical compared with medical insertions. Participants at centers with fewer late presenters and more new dialysis patients starting PD, had a lower probability of a catheter event. Adjusting for these factors, the hazard ratio for a catheter event following insertion (medical vs. surgical) was 0.70 (95% confidence interval [CI] 0.43 to 1.13), and once established on PD 0.77 (0.62 to 0.96). Conclusion Offering both medical and surgical techniques is associated with lower catheter event rates and keeps people on PD for longer.
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Affiliation(s)
- James Fotheringham
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ivonne Solis-Trapala
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Victoria Briggs
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Mark Lambie
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Keith McCullough
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Louese Dunn
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Andrew Rawdin
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Harry Hill
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Allan Wailloo
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon Davies
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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2
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Khan SF, Rosner MH. Optimizing peritoneal dialysis catheter placement. FRONTIERS IN NEPHROLOGY 2023; 3:1056574. [PMID: 37675363 PMCID: PMC10479565 DOI: 10.3389/fneph.2023.1056574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/22/2023] [Indexed: 09/08/2023]
Abstract
Long-term success of peritoneal dialysis as a kidney replacement therapy requires a well-functioning peritoneal dialysis catheter. With ongoing reductions in infectious complications, there is an increased emphasis on the impact of catheter-related and mechanical complications. There is currently a marked variation in the utilization of various types of catheters (double cuff vs single cuff, coiled tip vs straight tip), methods of catheter insertion (advanced laparoscopic, open surgical dissection, image guided percutaneous, blind percutaneous), timing of catheter insertion, location of catheter placement (pre-sternal v. abdominal) and peri-operative practices. Specialized approaches to catheter placement in clinical practice include use of extended catheters and embedded catheters. Marked variations in patient lifestyle preferences and comorbidities, specifically in high acuity patient populations (polycystic kidney disease, obesity, cirrhosis) necessitate individualized approaches to catheter placement and care. Current consensus guidelines recommend local procedural expertise, consideration of patient characteristics and appropriate resources to support catheter placement and long-term functioning. This review focuses on an overview of approaches to catheter placement with emphasis on a patient-centered approach.
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Affiliation(s)
- Sana F. Khan
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA, United States
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3
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Briggs VR, Jacques RM, Fotheringham J, Maheswaran R, Campbell M, Wilkie ME. Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients. Cochrane Database Syst Rev 2023; 2:CD012478. [PMID: 36810986 PMCID: PMC9946371 DOI: 10.1002/14651858.cd012478.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Peritoneal dialysis (PD) relies on the optimal functionality of the flexible plastic PD catheter present within the peritoneal cavity to enable effective treatment. As a result of limited evidence, it is uncertain if the PD catheter's insertion method influences the rate of catheter dysfunction and, thus, the quality of dialysis therapy. Numerous variations of four basic techniques have been adopted in an attempt to improve and maintain PD catheter function. This review evaluates the association between PD catheter insertion technique and associated differences in PD catheter function and post-PD catheter insertion complications OBJECTIVES: Our aims were to 1) evaluate if a specific technique used for PD catheter insertion has lower rates of PD catheter dysfunction (early and late) and technique failure; and 2) examine if any of the available techniques results in a reduction in post-procedure complication rates including postoperative haemorrhage, exit-site infection and peritonitis. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 24 November 2022 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials (RCTs) examining adults and children undergoing PD catheter insertion. The studies examined any two PD catheter insertion techniques, including laparoscopic, open-surgical, percutaneous and peritoneoscopic insertion. Primary outcomes of interest were PD catheter function and technique survival. DATA COLLECTION AND ANALYSIS: Two authors independently performed data extraction and assessed the risk of bias for all included studies. Main outcomes in the Summary of Findings tables include primary outcomes - early PD catheter function, long-term PD catheter function, technique failure and postoperative complications. A random effects model was used to perform meta-analyses; risk ratios (RRs) were calculated for dichotomous outcomes, and mean differences (MD) were calculated for continuous outcomes, using 95% confidence intervals (CIs) for effect estimates. The certainty of the evidence was evaluated using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. MAIN RESULTS: Seventeen studies were included in this review. Nine studies were suitable for inclusion in quantitative meta-analysis (670 randomised participants). Five studies compared laparoscopic with open PD catheter insertion, and four studies compared a 'medical' insertion technique with open surgical PD catheter insertion: percutaneous (2) and peritoneoscopic (2). Random sequence generation was judged to be at low risk of bias in eight studies. Allocation concealment was reported poorly, with only five studies judged to be at low risk of selection bias. Performance bias was judged to be high risk in 10 studies. Attrition bias and reporting bias were judged to be low in 14 and 12 studies, respectively. Six studies compared laparoscopic PD catheter insertion with open surgical insertion. Five studies could be meta-analysed (394 participants). For our primary outcomes, data were either not reported in a format that could be meta-analysed (early PD catheter function, long-term catheter function) or not reported at all (technique failure). One death was reported in the laparoscopic group and none in the open surgical group. In low certainty evidence, laparoscopic PD catheter insertion may make little or no difference to the risk of peritonitis (4 studies, 288 participants: RR 0.97, 95% CI 0.63 to 1.48; I² = 7%), PD catheter removal (4 studies, 257 participants: RR 1.15, 95% CI 0.80 to 1.64; I² = 0%), and dialysate leakage (4 studies, 330 participants: RR 1.40, 95% CI 0.49 to 4.02; I² = 0%), but may reduce the risk of haemorrhage (2 studies, 167 participants: RR 1.68, 95% CI 0.28 to 10.31; I² = 33%) and catheter tip migration (4 studies, 333 participants: RR 0.43, 95% CI 0.20 to 0.92; I² = 12%). Four studies compared a medical insertion technique with open surgical insertion (276 participants). Technique failure was not reported, and no deaths were reported (2 studies, 64 participants). In low certainty evidence, medical insertion may make little or no difference to early PD catheter function (3 studies, 212 participants: RR 0.73, 95% CI 0.29 to 1.83; I² = 0%), while one study reported long-term PD function may improve with peritoneoscopic insertion (116 participants: RR 0.59, 95% CI 0.38 to 0.92). Peritoneoscopic catheter insertion may reduce the episodes of early peritonitis (2 studies, 177 participants: RR 0.21, 95% CI 0.06 to 0.71; I² = 0%) and dialysate leakage (2 studies, 177 participants: RR 0.13, 95% CI 0.02 to 0.71; I² = 0%). Medical insertion had uncertain effects on catheter tip migration (2 studies, 90 participants: RR 0.74, 95% CI 0.15 to 3.73; I² = 0%). Most of the studies examined were small and of poor quality, increasing the risk of imprecision. There was also a significant risk of bias therefore cautious interpretation of results is advised. AUTHORS' CONCLUSIONS The available studies show that the evidence needed to guide clinicians in developing their PD catheter insertion service is lacking. No PD catheter insertion technique had lower rates of PD catheter dysfunction. High-quality, evidence-based data are urgently required, utilising multi-centre RCTs or large cohort studies, in order to provide definitive guidance relating to PD catheter insertion modality.
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Affiliation(s)
- Victoria R Briggs
- Department of Nephrology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Richard M Jacques
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - James Fotheringham
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ravi Maheswaran
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Martin E Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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4
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Shi CX, Li ZX, Sun HT, Sun WQ, Ji Y, Jia SJ. Bladder perforation injury after percutaneous peritoneal dialysis catheterization: A case report. World J Clin Cases 2022; 10:7054-7059. [PMID: 36051131 PMCID: PMC9297435 DOI: 10.12998/wjcc.v10.i20.7054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/02/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Insertion of a catheter into the bladder is a rare complication of peritoneal dialysis (PD), and is mainly related to surgical injury. This paper reports a case of bladder perforation that was caused by percutaneous PD catheterization.
CASE SUMMARY A 64-year-old man underwent percutaneous PD catheterization for end-stage renal disease. On the second day after the operation, urgent urination and gross hematuria occurred. Urinalysis showed the presence of red and white blood cells. Empirical anti-infective treatment was given. On the third day after the operation, urgent urination occurred during PD perfusion. Ultrasound showed that the PD catheter was located in the bladder, and subsequent computed tomography (CT) showed that the PD catheter moved through the anterior wall into the bladder. The PD catheter was withdrawn from the bladder and catheterization was retained. Repeat CT on the fourth day after the operation showed that the PD catheter was removed from the bladder, but there was poor catheter function. The PD catheter was removed and the patient was changed to hemodialysis. CT cystography showed that the bladder healed well and the patient was discharged 14 d after the operation.
CONCLUSION Bladder perforation injury should be considered and treated timeously in case of bladder irritation during and after percutaneous PD catheterization. The use of Doppler ultrasound and other related technologies may reduce the incidence of such complications.
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Affiliation(s)
- Chun-Xia Shi
- Department of Nephrology, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Zhong-Xin Li
- Department of Nephrology, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Hai-Tao Sun
- Department of General Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Wu-Qing Sun
- Department of General Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Yu Ji
- Department of General Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Shu-Jing Jia
- Department of Medicine, Beijing Shuangqiao Hospital, Beijing 100121, China
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5
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Omental Procedures During Peritoneal Dialysis Insertion: A Systematic Review and Meta-Analysis. World J Surg 2022; 46:1183-1195. [PMID: 35076821 DOI: 10.1007/s00268-021-06413-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Peritoneal dialysis (PD) is an option for ultrafiltration for patients with end-stage renal disease. Once placed, PD catheters may malfunction often due to omental wrapping. Omental procedures such as omentectomy and omentopexy may reduce this risk. This investigation aims to perform a systematic review and meta-analysis of the literature on the role of omental procedures on PD catheter insertions. METHODS Following protocol registration on PROSPERO (CRD42020218950), a systematic review was performed in accordance with the Cochrane Collaboration. A literature search was performed in February 2021 across Medline, EMBASE, Scopus, and Cochrane Library. Records with patients who underwent PD catheter insertion with and without omental manipulation were included. The records underwent screening, full-text review, and data extraction. Study qualities were assessed using RoBINS-I and RoB2. Effect estimates were extracted as risk ratios and corresponding 95% confidence intervals (CI) were pooled using inverse variance method with random-effect model. RESULTS Of 510 records identified, 15 studies were included in the meta-analysis (1 RCT, 2 prospective, 12 retrospective). With omental procedures, there was decreased the likelihood of failure requiring removal of PD catheter (RR 0.47, 95% CI 0.38, 0.58) and PD catheter obstruction (RR 0.23, 95% CI 0.14, 0.39); there was no difference in likelihood of catheter malposition or migration (RR 0.87, 95% CI 0.23, 3.29) or peritonitis (RR 0.74, 95% CI 0.40, 1.35). CONCLUSION Based on the current low to moderate quality of evidence, omental manipulation at the time of PD catheter insertion confers benefits of decreased obstruction and failure requiring removal.
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6
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Sugita K, Suzuki N, Nogaki F, Washida N, Urano T. [An 89-year-old man who underwent percutaneous peritoneal dialysis catheter placement and had peritoneal dialysis introduced]. Nihon Ronen Igakkai Zasshi 2021; 58:303-308. [PMID: 34039808 DOI: 10.3143/geriatrics.58.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The number of elderly patients requiring dialysis is continuously increasing. In Japan, many patients undergo hemodialysis; however, it has been associated with huge stress-mainly on the cardiovascular system-and requires frequent hospital visits. Conversely, peritoneal dialysis is much less invasive with a much lower frequency of hospital visits than that of hemodialysis; therefore, it is suitable for elderly patients. In addition, peritoneal dialysis, which originally had a high affinity for home care, has become more useful for elderly patients with renal failure thanks to the recent introduction of a cloud-based remote monitoring system at home. We performed percutaneous placement of a peritoneal dialysis catheter to reduce physical invasiveness and initiate peritoneal dialysis. The Barthel Index before hospitalization was 0 but increased to 65 at discharge. Further technology advancements in peritoneal dialysis are expected in the future. The cloud-based remote monitoring system is also expected to maintain or increase activities of daily living and the quality of life in elderly patients with renal failure with decreased activities of daily living.
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Affiliation(s)
- Kazuya Sugita
- Division of Nephrology, Shimada Municipal Hospital.,Division of Nephrology, School of Medicine, International University of Health and Welfare.,Department of Geriatric Medicine, School of Medicine, International University of Health and Welfare
| | | | | | - Naoki Washida
- Division of Nephrology, School of Medicine, International University of Health and Welfare
| | - Tomohiko Urano
- Department of Geriatric Medicine, School of Medicine, International University of Health and Welfare
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7
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Kim JH, Kim MJ, Ye BM, Kim JH, Kim MJ, Kim S, Kim IY, Kim HJ, Han M, Rhee H, Song SH, Seong EY, Lee SB, Lee DW. Percutaneous peritoneal dialysis catheter implantation with no break-in period: A viable option for patients requiring unplanned urgent-start peritoneal dialysis. Kidney Res Clin Pract 2020; 39:365-372. [PMID: 32759467 PMCID: PMC7530356 DOI: 10.23876/j.krcp.20.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/04/2022] Open
Abstract
Background Urgent-start peritoneal dialysis (PD) is applied to patients who need PD within two weeks but are able to wait for more than 48 hours before starting PD. To evaluate the usefulness of percutaneous PD catheter insertion in urgent-start PD, we reviewed the clinical outcomes of percutaneous catheter insertion with immediate start PD and surgical insertion with longer break-in time in Pusan National University Hospital. Methods This study included 177 patients who underwent urgent-start PD. Based on the PD catheter insertion techniques, the patients with urgent-start PD were divided into percutaneous (n = 103) and surgical (n = 74) groups. For the percutaneous group, a modified Seldinger percutaneous catheter insertion with immediate initiation of continuous ambulatory PD was performed by nephrologists. Results The percutaneous group showed higher serum urea nitrogen, creatinine, and lower serum albumin compared with the surgical group (P < 0.05). Ninety-day infectious and mechanical complications showed no significant differences between the two groups. Ninety-day peritonitis in the percutaneous group was 9.7% compared to 5.4% in the surgical group (P = not significant [NS]). Major leakage was 3.9% in the percutaneous group compared to 1.4% in the surgical group (P = NS). Overall infectious and mechanical complication-free survival was not significantly different between the two groups. The percutaneous group and surgical group showed no statistical difference with respect to catheter survival over the entire observation period (P = NS). Conclusion This study suggests that urgent-start PD can be applied safely with percutaneous catheter insertion by nephrologists with no break-in period.
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Affiliation(s)
- Joo Hui Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Min Jeong Kim
- Department of Internal Medicine, Gimhae Bokum Hospital, Gimhae, Republic of Korea
| | - Byung-Min Ye
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - June Hyun Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Min Jeong Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Seorin Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Il Young Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Pusan National University Hospital, Busan, Republic of Korea
| | - Miyeun Han
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Pusan National University Hospital, Busan, Republic of Korea
| | - Harin Rhee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Pusan National University Hospital, Busan, Republic of Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Pusan National University Hospital, Busan, Republic of Korea
| | - Eun Young Seong
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo Bong Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dong Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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8
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Abstract
Patients receiving peritoneal dialysis (PD) encounter an increased risk for infection, bleeding, and PD fluid leakage after abdominal surgery. These complications may affect the future use of PD. Appropriate patient preparation may mitigate complications. Certain complications or procedures allow patients to remain on PD while others require transition to hemodialysis. We review the etiology and management of infection, bleeding, and PD fluid leakage associated with abdominal surgery as well as the relationship of specific abdominal procedures to continuing PD.
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Affiliation(s)
- Susie Q Lew
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC, USA
| | - Ashté Collins
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC, USA
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9
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Oliver MJ, Perl J, McQuillan R, Blake PG, Jain AK, McCormick B, Yang R, Pirkle JL, Fissell RB, Golper TA, Shen JI, Hu SL, Pellegrino B, Liebman SE, Krishna VN, Ravani P, Clarke A, Quinn RR. Quantifying the risk of insertion-related peritoneal dialysis catheter complications following laparoscopic placement: Results from the North American PD Catheter Registry. Perit Dial Int 2020; 40:185-192. [PMID: 32063191 DOI: 10.1177/0896860819893813] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is a more cost-effective therapy to treat kidney failure than in-center hemodialysis, but successful therapy requires a functioning PD catheter that causes minimal complications. In 2015, the North American Chapter of the International Society for Peritoneal Dialysis established the North American PD Catheter Registry to improve practices and patient outcomes following PD catheter insertion. AIMS The objective of this study is to propose a methodology for defining insertion-related complications that lead to significant adverse events and report the risk of these complications among patients undergoing laparoscopic PD catheter insertion. METHODS Patients undergoing laparoscopic PD catheter insertion were enrolled at 14 participating centers in Canada and the United States and followed using a Web-based registry. Insertion-related complications were defined as flow restriction, exit-site leak, or abdominal pain at any point during follow-up. We also included infections or bleeding within 30 days of insertion, and any immediate postoperative complications. Adverse events were categorized as PD never starting or termination of PD therapy, delay in the start of PD therapy or interruption of PD therapy, an emergency department visit or hospitalization, or need for invasive procedures. Cause-specific cumulative incidence functions were used to estimate risk. RESULTS Five hundred patients underwent laparoscopic PD catheter insertion between 10 November 2015 and 24 July 2018. The cumulative risk of insertion-related complications 6 months from the date of insertion that led to an adverse event was 24%. The risk of flow restriction, exit-site leak, and pain at 6 months was 10.2%, 5.7%, and 5.3%, respectively. PD was never started or terminated in 6.4% of patients due to an insertion-related complication. Leaks and flow restrictions were most likely to delay or interrupt PD therapy. Flow restrictions were the primary cause of invasive procedures. Fifty percent of the complications occurred before the start of PD therapy. CONCLUSIONS Insertion-related complications leading to significant adverse events following laparoscopic placement of PD catheters are common. Many complications occur before the start of PD. Insertion-related complications are an important area of focus for future research and quality improvement efforts.
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Affiliation(s)
- Matthew J Oliver
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeff Perl
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rory McQuillan
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter G Blake
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Arsh K Jain
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Brendan McCormick
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Yang
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - James L Pirkle
- Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rachel B Fissell
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas A Golper
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jenny I Shen
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Susie L Hu
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Scott E Liebman
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Vinay N Krishna
- Division of Nephrology, Department of Medicine, the University of Alabama at Birmingham, AL, USA
| | - Pietro Ravani
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alix Clarke
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert R Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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10
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Crabtree JH, Burchette RJ. Peritoneal Dialysis Access and Start Practices that Affect Dialysate Leak and Technique Failure: Acts of Commission and Omission. Perit Dial Int 2020; 37:358-361. [DOI: 10.3747/pdi.2017.00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- John H. Crabtree
- Division of Nephrology and Hypertension Harbor-UCLA Medical Center Torrance, CA, USA
| | - Raoul J. Burchette
- Research and Evaluation Department Kaiser Permanente Southern California Pasadena, CA, USA
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11
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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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12
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Vernier I, Fabre E, Dratwa M, Verger C. Peritoneal catheter infections : data from the French language peritoneal dialysis registry (RDPLF), risk factors. BULLETIN DE LA DIALYSE À DOMICILE 2019. [DOI: 10.25796/bdd.v2i3.21383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Peritoneal catheter infections : data from the French language peritoneal dialysis registry (RDPLF), risk factors
The French Language Peritoneal Dialysis Registry (RDPLF) record since 1997 all data dealing with peritoneal catheter insertion and follow up.
The aim of this study is to analyze catheter infections on 10801 catheters in 144 centres from January 1, 1997 and December 31, 2018.
Infections are more common in the first month and 50% occur before the tenth month. The risk of infection increases in case of wall hematoma, initial fluid leakage, and obesity. It decreases with the use of prophylactic antibiotics at the time of catheter insertion, with experienced operator, if the first dressing is delayed for 7 days, and with mupirocin as exit-site prophylaxis.
During last two decades the percentage of Staphylococcus aureus infections has decreased, whereas the proportion of Pseudomonas, Corynebacterium and other Gram + cocci increased.
The incidence of catheter infections is low compared to literature data: it decreased to 0.16 episodes per year for the 2013-2017 period.
Adherence to ISPD guidelines: preoperative antibioprophylaxis is the most followed guideline (70.7% of catheter implantations in 2018). Local antibioprophylaxis concerns only 15.6% of catheters, and remains concentrated in a few centres ; mupirocin is the most frequently used agent. Screening for nasal carriage of S. aureus is performed in only 42% of cases.
The catheter section of the RDPLF has allowed the follow-up of clinical practices incidence of infections and ecology for 21 years, both at the national and center level Our study confirms a wide variability in clinical practices, compared to ISPD guidelines.
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Lanot A, Bechade C, Verger C, Fabre E, Vernier I, Lobbedez T. Clusters of Practice in Peritoneal Dialysis in France: Data from the Catheter Section of the RDPLF. Perit Dial Int 2017; 38:89-97. [PMID: 29162681 DOI: 10.3747/pdi.2017.00135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 09/03/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peritonitis is a major cause of peritoneal dialysis (PD) failure. Recommendations for the prevention of peritonitis are available, but wide variations exist in the peritonitis rate among countries and PD units. The objective of this study was to describe the different pattern of practices in France. METHODS This was a retrospective, multicenter study based on data from the French Language Peritoneal Dialysis Registry. Center practices were described and mapped. Clusters of practices were sought in a hierarchical analysis and centers belonging to the same clusters of practices were mapped. RESULTS Data from 2,770 catheters placed in 64 centers in France between 1 February 2012 and 31 December 2016 were considered. A median of 34 (ranging from 5 to 133) catheters was reported in each center. Twenty-eight (43.8%) centers routinely administered a prophylactic antibiotic prior to catheter placement, and 8 (12.5%) centers applied a local prophylactic antibiotic at the exit site, as recommended by International guidelines. The presence of a PD nurse specialized in PD or PD referent nephrologist was not associated with better adherence to guidelines. Practices were heterogeneous across centers. We identified 5 clusters of centers according to practice. Geographical proximity was not associated with homogeneity in practices. CONCLUSION Peritoneal dialysis practices are heterogeneous in France, even those that are subject to International guidelines. Studies to identify associations between center-specific practices and PD patient outcomes remain mandatory. Efforts should be made to standardize the PD standards of care in France.
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Affiliation(s)
- Antoine Lanot
- Néphrologie, CUMR, CHU de Caen, Caen, France.,Université Normandie, Unicaen, UFR de médecine, Caen, France
| | | | | | | | - Isabelle Vernier
- RDPLF, Pontoise, France.,Néphrologie, Polyclinique le Languedoc, Narbonne, France
| | - Thierry Lobbedez
- Néphrologie, CUMR, CHU de Caen, Caen, France .,Université Normandie, Unicaen, UFR de médecine, Caen, France.,RDPLF, Pontoise, France
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14
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Abstract
Chronic kidney disease (CKD) is defined by persistent urine abnormalities, structural abnormalities or impaired excretory renal function suggestive of a loss of functional nephrons. The majority of patients with CKD are at risk of accelerated cardiovascular disease and death. For those who progress to end-stage renal disease, the limited accessibility to renal replacement therapy is a problem in many parts of the world. Risk factors for the development and progression of CKD include low nephron number at birth, nephron loss due to increasing age and acute or chronic kidney injuries caused by toxic exposures or diseases (for example, obesity and type 2 diabetes mellitus). The management of patients with CKD is focused on early detection or prevention, treatment of the underlying cause (if possible) to curb progression and attention to secondary processes that contribute to ongoing nephron loss. Blood pressure control, inhibition of the renin-angiotensin system and disease-specific interventions are the cornerstones of therapy. CKD complications such as anaemia, metabolic acidosis and secondary hyperparathyroidism affect cardiovascular health and quality of life, and require diagnosis and treatment.
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15
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Peritoneal dialysis catheter placement as a mode of renal replacement therapy: Long-term results from a tertiary academic institution. Surgery 2017; 162:1112-1120. [PMID: 28867046 DOI: 10.1016/j.surg.2017.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/12/2017] [Accepted: 07/24/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Peritoneal dialysis as a mode of renal replacement therapy still has not been embraced widely as an alternative to hemodialysis. Furthermore, there is marked variability in peritoneal dialysis catheter insertion techniques and perioperative management within the United States. After the publication of best-demonstrated practices for peritoneal dialysis catheter placement, the utilization of peritoneal dialysis has increased significantly at our institution. We detail the long-term success of peritoneal dialysis catheter placement after the adoption of best-demonstrated practices. METHODS Retrospective chart review was performed on all patients who underwent laparoscopic peritoneal dialysis catheter placement using the best-demonstrated practice technique from January 2005 through December 2015. Preoperative patient demographic information, intraoperative variables, 30-day morbidity and mortality, and long-term catheter durability outcomes were investigated. RESULTS A total of 457 patients met inclusion criteria. Four (0.9%) patients experienced an immediate postoperative complication requiring return to the operating room. There were no perioperative mortalities. A total of 298 (65.2%) patients were available for long-term follow-up; 221 (74.2%) patients are still alive, 76 (25.6%) patients are still undergoing peritoneal dialysis, 63 (21.1%) patients transitioned from peritoneal dialysis to hemodialysis, and 88 (29.5%) patients have undergone kidney transplantation. Based on Kaplan-Meier survival plots, 30% of patients will transition from peritoneal dialysis to hemodialysis after 5.5 years of peritoneal dialysis and the median time from commencing peritoneal dialysis to kidney transplantation is 5.6 years. CONCLUSION Based on our institutional data, the adoption of best-demonstrated practices should provide long-term and reliable access to the peritoneal cavity. We recommend the adoption of these techniques to facilitate long-term peritoneal dialysis catheter survival.
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Schreiber MJ. Changing Landscape for Peritoneal Dialysis: Optimizing Utilization. Semin Dial 2017; 30:149-157. [PMID: 28144977 DOI: 10.1111/sdi.12576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The future growth of peritoneal dialysis (PD) will be directly linked to the shift in US healthcare to a value-based payment model due to PD's lower yearly cost, early survival advantage over in-center hemodialysis, and improved quality of life for patients treating their kidney disease in the home. Under this model, nephrology practices will need an increased focus on managing the transition from chronic kidney disease to end-stage renal disease (ESRD), providing patient education with the aim of accomplishing modality selection and access placement ahead of dialysis initiation. Physicians must expand their knowledge base in home therapies and work toward increased technique survival through implementation of specific practice initiatives that highlight PD catheter placement success, preservation of residual renal function, consideration of incremental PD, and competence in urgent start PD. Avoidance of both early and late PD technique failures is also critical to PD program growth. Large dialysis organizations must continue to measure and improve quality metrics for PD, expand their focus beyond the sole provision of PD to holistic patient care, and initiate programs to reduce PD hospitalization rates and encourage physicians to consider the benefits of PD as an initial modality for appropriate patients. New and innovative strategies are needed to address the main reasons for PD technique failure, improve the connectivity of the patient in the home, leverage home biometric data to improve overall outcomes, and develop PD cycler devices that lower patient treatment burden and reduce both treatment fatigue and treatment-dependent complications.
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Affiliation(s)
- Martin J Schreiber
- Clinical Affairs, Home Modalities, DaVita Kidney Care, DaVita Inc, Denver, Colorado
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17
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Briggs VR, Jacques RM, Fotheringham J, Andras A, Campbell M, Wilkie ME. Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients. Hippokratia 2017. [DOI: 10.1002/14651858.cd012478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Victoria R Briggs
- Calderdale and Huddersfield NHS Foundation Trust; Department of Nephrology; Acre Street Lindley Huddersfield UK HD3 3EA
| | - Richard M Jacques
- University of Sheffield; School of Health and Related Research; 30 Regent Street Sheffield South Yorkshire UK S1 4DA
| | - James Fotheringham
- Sheffield Kidney Institute; Department of Nephrology; Herries Road Sheffield South Yorkshire UK S5 7AU
| | - Alina Andras
- Keele University, Guy Hilton Research Centre; Institute for Science and Technology in Medicine; Thornburrow Drive Hartshill Stoke-on-Trent UK ST4 7QB
| | - Michael Campbell
- University of Sheffield; School of Health and Related Research; 30 Regent Street Sheffield South Yorkshire UK S1 4DA
| | - Martin E Wilkie
- Sheffield Teaching Hospitals NHS; Sheffield Kidney Institute; Herries Road Sheffield South Yorkshire UK S5 7AU
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18
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Markel TA, West KW. Management of Peritoneal Dialysis Catheters That Erode Into Bowel: Two Pediatric Case Reports and a Review of the Literature. Perit Dial Int 2016; 36:680-684. [PMID: 27903851 DOI: 10.3747/pdi.2016.00029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Erosion of peritoneal dialysis (PD) catheters into the intestine is a rare complication of PD. Herein, we convey the first reports of 2 pediatric patients undergoing PD who were found to have the catheter eroding into their intestines. They were treated minimally with catheter removal and antibiotics. Definitive repair of the intestinal injury was not performed. These are the first pediatric patients reported with PD catheter erosion. Perforating injuries may be self-limiting, and therefore a more minimal approach may be considered in certain patient populations who do not express overt signs of peritonitis or illness.
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Affiliation(s)
- Troy A Markel
- Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children at Indiana University Health and The Indiana University School of Medicine, Indianapolis, IN, USA
| | - Karen W West
- Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children at Indiana University Health and The Indiana University School of Medicine, Indianapolis, IN, USA
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