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For patients requiring renal replacement therapy (RRT), peritoneal dialysis (PD) is an alternative to maintain an optimal quality of life. The long-term success of PD depends mainly on the use of a safe, functional, and durable peritoneal catheter.
The aim of this study is to describe the results of a training program for peritoneal catheter insertion aimed at nephrologists in dialysis centers in South America.
Longitudinal, retrospective study conducted in four countries: Colombia, Chile, Ecuador and Bolivia. Patients who underwent PC insertion between January 2022 and May 2023 were included. The procedure was performed by nephrologists participating in a specific training program. The baseline characteristics of the subjects, information related to the procedure, catheter function follow-up and complications in the first, third and sixth month after catheter insertion were collected and analyzed from the clinical records.
121 subjects who underwent peritoneal catheter insertion were included, with a median age of 59 years (range 18 to 94), 51% (n=62) women. Arterial hypertension (83.47% n=101) and diabetes mellitus (56.20% n=68) were the most frequent clinical history of the study subjects. These pathologies were the primary cause of renal disease in 33.06% (n=40) and 47.93% (n=58) of the subjects, respectively.
Of the total, 44.63% of individuals were overweight or obese (n=54 with BMI ≥25), and 14.04% (n=16) had previous abdominal surgery. Before starting the procedure, all patients had to have their bladder emptied and receive a prophylactic dose of antibiotics. Implant insertion was performed with local anesthesia in 85.12% (n=103), sedoanalgesia (lidocaine/midazolam) in 14.88% (n=18).
The modified Seldinger technique with 2 cm left lateral incision, horizontal to the umbilicus, was performed in 83.19% (n=94). Catheter implantation was successful in 95.04% (n=115) of the procedures. Causes of non-success included the impossibility of reaching the peritoneal cavity, adhesions, pain and inadequate preparation of the patient. Elective PD was performed in 66.67% (n=80) of the subjects, while 29.17% (n=35) required emergency peritoneal dialysis.
In the first two weeks after the procedure, complications occurred in 5.78% (n=7/121) subjects with 10 events, including catheter tip migration (n=2), flow failure (n=2), one case of bleeding requiring transfusion and one surgical site infection. The proportion of subjects who had complications was 2.59% (3/116 subjects, 3 events), 3.64% (4/110 subjects, 4 events) and 8.65% (9/104 subjects, 11 events) at the first, third and sixth months of follow-up, with no significant differences between procedures performed with mentoring or those without supervision (Table 1). During the follow-up, 9 subjects required catheter repositioning for surgery. Catheter permeability was maintained in 99.14% (n=115), 95.45% (n=105) and 95.19% (n=99) of subjects, respectively at the first, third and sixth month of follow-up. Persistence on peritoneal dialysis was recorded in 97.41% (n=113) in the first month, 97.27.46% (n=107) in the third month and 93.27% (n=97) in the sixth month post-peritoneal catheter implantation (Figure 1).
Optimal peritoneal access can be ensured by implementing educational programs that provide the necessary tools for appropriate implant placement, successful peritoneal catheter maintenance, and a low rate of PD complications.