N SHAH1, A GOSWELL2, C CUESTA3, I KATZ3
1St George-Sutherland Basic Physician Training Network, Kogarah, Australia, 2St George Hospital, Kogarah, Australia, 3Department of Renal Medicine, St George Hospital, Kogarah, Australia
Background: Peritoneal dialysis (PD) is an effective home-based form of renal replacement therapy. Delays in insertion, higher costs, primary catheter failure, and patient choices are contributors to its under-use and lower rates of penetration
Aim: To describe and compare outcomes of percutaneous PD catheter insertion (PDCI) by a nephrologist compared with surgical insertion.
Methods: A retrospective study at St. George Tertiary Hospital, Sydney, using a prospectively-collected database over 8-years. The data analysed included195 PD catheters inserted using two techniques (72 percutaneous (PCDI), 123 surgical). Analysis included patient demographics, date of catheter insertion, and complications.
Results: Patients were well matched for age, and primary cause of renal failure. Those receiving PDCI had lower BMIs versus surgically inserted lines (p = 0.027). Time-to-insertion was significantly shorter with the PDCI (p = 0.0014). The over-all complication rate was similar (44% vs. 36%, p =0.24). Significant differences in the type of adverse outcomes were seen. Patients with surgically-inserted catheters experienced more exit site leaks (p = 0.026), and peritonitis (p =0.028). Nephrologist-inserted catheters had more technical complications. These included bowel puncture (p = 0.0085) or procedure cancelation due to inadequate preparation (p=0.0008). There were no differences in primary failure between the techniques (p = 0.436), and increasing BMI did not confer an increased risk of primary failure in either cohort (p= 0.601).
Conclusions: The study confirms the complementary roles of nephrologist and surgical insertion. With fewer delays to catheter insertion and similar absolute complication rates, a nephrologist-inserted PD catheter, using the percutaneous technique, is a good option to consider in the right patient in metropolitan areas. Especially in Australia where higher uptake of home based therapies is so important.
Nasir Shah is a basic physician trainee in the St George-Sutherland Basic Physician Training Network in Kogarah, NSW. Througout his academic and clinical career his research has focused on renal medicine. Currently, his clinical curiosity lies in the up-and-coming subspecialty of interventional nephrology. In particular, dialysis access, and the vascular biology underlying arterio-venous fistula maturation.