E TAN1, S GODDARD1
1Regional Renal Unit, Waikato Hospital, Hamilton, New Zealand
Aim: To describe a case series of Peritoneal Dialysis Catheter (PDC) Insertions (PDCI)s for recurrent Ascites Drainage (AD)
Background: Interventional nephrologists insert 60 PDCs annually (50%) in Waikato Renal Unit. Expanding the scope of practice involved inserting PDCs for non-dialysis reasons: AD. These patients’ outcomes were analysed.
Methods: Data was retrospectively collected for patients with PDCIs for ascites (2013-2017) and included age at insertion, gender, frequency of prior paracentesis, initial renal function, initial albumin levels and ascites diagnosis. Major endpoints analysed: complications (including PDC malfunction and infection: peritonitis/exit-site infection), catheter survival and mortality. All insertions were physician-led, using modified Fluoroscopic Seldinger technique.
Results: 5 patients were identified and all required at least fortnightly paracentesis. All reported immediate symptom-relief from AD post-PDCI. Patient demographics: mean age (55.35±6.49years), male/female ratio (2:3), mean creatinine (118.80±41.52umol/L), mean eGFR (64.40±15.76ml/min) and mean Albumin (22.80±3.12g/L). The underlying diagnoses were malignancy (melanoma, pancreatic and breast) and heart failure (ischaemic heart disease and amyloidosis). Complications: none were catheter-related (malfunction or infectious), 1 patient developed acute kidney injury and 2 patients developed symptomatic hypotension at home. Catheter and patient survival: both 41.60±20.76days (range 1-104 days). 3 patients died within 3 weeks. All died with PDCs in situ.
Conclusions: PDCs (inserted quickly and safely by physicians) is a viable solution to problematic ascites, avoiding repeated paracentesis. Most patients were medically and nutritionally poorly by the referral/insertion time, possibly resulting in the above complications and short survival.
Discussion: Patients with ascites may benefit from earlier referrals for PDCIs. One patient (not included here) even died 2 days before the planned PDCI. Local guidelines for PDCIs for AD are called for; covering referral criteria and pre/post-insertion management.