Introduction:
Peritoneal dialysis (PD) is a vital home-based renal replacement therapy, particularly important in resource-limited settings. This study aims to evaluate PD program under the Pradhan Mantri National Dialysis Program (PMNDP) at the Department of Nephrology, Medical College Hospital & North Bengal Medical College Hospital. The focus is on the efficacy of different catheter insertion methods in these two centres, in a prospective observational study conducted from January to July 2024.
Methods:
Study Site: Department of Nephrology, Medical College Hospital & North Bengal Medical College Hospital, WestBengal
Study Period: January to July 2024
Prospective observational study evaluating PD catheter insertion methods under support of PMNDP
Participants: 20 patients (12 males, 8 females)
Native Kidney Disease: DM (7), CGN (6), Alport (1), Unknown (6)
Baseline Characteristics:
Residual renal output: Mean 800 ml
Average BP medications: 4
No prior abdominal surgery
PD-first policy: 16 patients
Access crisis: 4 patients
Catheter Insertion Methods:
Blind Verres needle insertion: 6
Dissection with pull-apart sheath: 10
Stylet-based insertion without pull-apart sheath: 4
Results:
Primary success rate: CAPD initiation was successful in 75% of cases (15/20) after two weeks of catheterization.
Complications requiring repeat primary reinsertion:
Migration: 1 patient
Omental wrap: 1 patient
Outflow failure: 2 patients
Shifting to hemodialysis (HD): 1 patient
6-month follow-up of 5 patients showed:
Kt/V: Average 1.7
Creatinine clearance (CrCl): 85 ml/min
The results of the chi-square test comparing the three catheter insertion methods are as follows:
Chi-square value (χ²): 1.69
Degrees of freedom (df): 2
p-value: 0.43
Interpretation:
With a p-value of 0.43, which is greater than 0.05, the test indicates that there is no statistically significant difference in the success rates among the three catheter insertion methods (Verres needle, dissection with pull-apart sheath, and stylet-based insertion).
This suggests that the choice of insertion method did not significantly impact the likelihood of successful CAPD initiation in this study
Conclusions:
Promising initial success of various catheter insertion methods by nephrologist for PD program under PMNDP
Limitations:
Lack of varying size catheters and pull-apart sheaths
Need for robust long-term outcome data
Adherence to hand hygiene to prevent peritonitis
Supply challenges for remotely located patients
Government support benefits:
Major interest among economically disadvantaged
Continuation of schooling and farming with ongoing RRT
No Conflict of interest
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.