CLINICAL OUTCOMES AND COMPLICATIONS OF CATHETER REPLACEMENT BY SURGICAL METHOD BY NEPHROLOGISTS FOR MALFUNCTIONING PERITONEAL DIALYSIS CATHETERS

Introduction:

Technique failure in continuous ambulatory peritoneal dialysis (CAPD) patients due to malfunctioning CAPD catheters is a common issue affecting upto 20% of patients. The catheter revision or replacement surgery is usually done by surgeons. We present our experience of surgically replaced PDCs by nephrologists in this subset of patients.

Methods:

We retrospectively evaluated technique survival, clinical outcome and complications in 68 consequent patients with catheter malfunction who underwent either catheter replacement via old-laparotomy incision (O-group) or a neo-laparotomy incision (N-group). Primary outcome measure was overall catheter survival at 6-month and 1-year. Secondary outcome measures were technique survival at 6-month and 1-year, complications and death at 1-year and length of hospital stay. Overall catheter survival was defined as continuation of PD without any catheter intervention. For the technical survival analysis, event free continuation of PD was taken. Death, transfer to hemodialysis, and kidney transplantation were considered as events for technical survival, while loss to follow-up, transfer to other centers, and recovery of renal function were considered as censoring observations.

Results:

Of the total of 68 patients, 49 patients were in N-group with male: female ratio as 2.5:1 whereas 19 were in O-group with male: female ratio as 2.16:1. The mean patient age was 50.2 ± 14.13 years and 48.31 ± 13.35 years in N and O groups respectively. The previous PDC duration before mechanical failure was 24.81 ± 10.72 months and 23.36 ± 9.69 months in N- and O-groups respectively whereas the time gap between the PDC explantation and PDC reinsertion was 2.21 ± 0.56 months in N-group and 2.36 ± 0.49 months in O-group.  The catheter survival of the whole cohort was 72.05% at 6-months and 44.11% at 1-year whereas technical survival was 84.5% and 61.2% at 6-month and 1-year respectively. On comparing both groups, the overall catheter survival in N-group was 77.6% at 6-month and 57.1% at 1-year and in O-group it was 57.9% and 10.5% at 6-month and 1-year respectively (log rank test, p=0.001). (Fig-1)

The technique survival was 84.4% and 70.03% at 6-month and 1-year respectively in N-group and 84.6% and 22.2% respectively in O-group (log rank test, p=0.004). (Fig-2)

Early peritonitis occurred in seven patients (all responded to first line antimicrobial therapy) and eight patients had PDC migration within 3 months, requiring laparoscopic omentectomy and PDC repositioning whereas none had bleeding/hematoma. There were nine deaths in N-group and seven in O-group by 1-year (p=0.22). The length of hospital stay was comparative between groups.

Conclusions:

PDC reinsertion by nephrologists after mechanical failure is an excellent option, thereby reducing dependence on surgical colleagues. PDC reinsertion through a neo-laparotomy incision should be preferred and complications like PDC migration and early peritonitis should be promptly managed. The overall outcomes of PDC reinsertion by nephrologists after mechanical CAPD failure is encouraging. 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.