Introduction:
Peritoneal dialysis (PD) is increasingly recognized as a significant modality for renal replacement therapy, with around 19% of new dialysis patients in Malaysia opting for it in 2022. PD treatment been effective in preserving residual renal function , lower cost of therapy and better quality of life as a home based therapy. Proper patient evaluation, meticulous surgical placement, and vigilant post-insertion care are essential to address issues such as infections, catheter malposition, and blockages, ultimately enhancing the effectiveness and longevity of the PD catheter. A multicentric study in Netherlands revealed that peritoneal dialysis (PD) catheter dysfunction was a primary reason for early dropout from PD. By reviewing catheter performance and identifying key variables affecting their longevity, the study seeks to improve catheter management strategies and enhance patient outcomes in PD.
Methods:
We performed a retrospective cohort study on ESKD patients who had PD catheter insertion by nephrology team of Hospital Sultanah Nur Zahirah,Terengganu, Malaysia from January 2018 to December 2022. The inclusion criteria was ESKD patients more than 18 years old who had undergone PD catheter insertion at our facility however we excluded patients with incomplete or missing data. Study population undergone PD catheter insertion using minor surgical dissection under local anesthesia and sedation using modified non-peritoneoscopic technique.
Results:
The study included 326 patients who met the criteria. Among this cohort, 52.8% were female. The most common comorbidities observed were hypertension in 82.2% of the patients, diabetes mellitus in 68.7%, and ischemic heart disease in 23.6%. in our study, 98.2% of the patients underwent peritoneal dialysis catheter insertion for long-term peritoneal dialysis, while the remaining 1.8% had the catheter placed for interim PD while awaiting hemodialysis vascular access. Routine post-procedure abdominal X-rays revealed that 309 (94.8%) of the PD catheters were correctly positioned at pelvic cavity, while 17 (5.2%) were noted to be malpositioned. Among the 17 malpositioned catheters, 47% required removal. Overall, 40.8% of the PD catheters were removed, with a mean survival of 14.5 months among them. Of the removed catheters, 18.8% had a lifespan exceeding 24 months. The most common reasons for removal included infections such as peritonitis (47.4%), tunnel infection (9%), and exit site infection (4.5%). Mechanical issues were responsible for 23.3% of the removals, while 3.8% were due to conversion to hemodialysis. The overall mortality rate in the study population was 19.9%. The cause of the mortality otherwise not specified.
Conclusions:
Our study revealed that diabetes and hypertension are the primary contributors to end-stage kidney disease (ESKD) within the local population. Additionally, the modified non-peritoneoscopic surgical technique demonstrated notable effectiveness, as evidenced by the high rate of correctly positioned catheters confirmed through postoperative imaging. Proper catheter placement is essential, as early misplacement can lead to increased risks of dysfunction and removal. Catheter-related infections have been a significant challenge in our peritoneal dialysis (PD) program, as our study indicates. Further research into patient demographics including socioeconomic factors, education levels, and understanding of the PD program which could be beneficial in reducing infection rates and improving PD effectiveness. Empowering nephrology team on PD catheter placement should be prioritized, as it promotes continuity of care and positively impacts the efficacy of PD as a renal replacement therapy.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.