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The success rate of peritoneal dialysis catheter (PDC) insertion varies among different techniques and operators. Traditionally, surgeons have inserted Tenkchoff catheters. Tenckhoff catether placement with percutaneous technique has become a viable skill in interventional nephology PD access programs, and the use of ultrasound and fluoroscope have been important tools day-by-day, making a more safe procedure.
OBJECTIVE: To determine complications rates related with of the PDC insertion by interventional nephrology group (ING) and by surgery group (SG) during the first 30 days after insertion.
Cross sectional study spawning data from 2018-2022 in Interventional Nephrology Service of 2 third level centers in Mexico. PDC insertion was performed with 3 different techniques: mini lap, percutaneous non-ultrasound guided (PNUSG) and percutaneous ultrasound-guided (PUSG) with no use of fluoroscope (unavailable in our centers). The evaluated complications related with procedure were: peritonitis, tunnelitis, bowel perforation and mechanical dysfunction requiring catheter replacement. U-Mann-Whitney-Wilcoxon test was used for continuous variables and Pearson's Chi-Square for categorical variables.
265 patients undewent PDC placement were analyzed. 61.5% were placed by nephrologists The most performed technique by ING was PUSG (47%) with a modified technique with and adequate visualization of abdominal wall vessels and peritoneal space, and in SG was mini lap (78%). In interesting point is that in ING 15% were obese patients and 25% had history of abdominal surgery, and these were no correlated with mechanical dysfunction, even though was the main complication in both groups (17%), and the main cause for need replacement in ING. The rates for peritonitis and tunnelitis in ING were 3.1 % and 1.2%, respectively and in SG were 8.8% and 5.9%, respectively, and was the main cause for need replacement in this group. Catheter break-in time were <12 hours in 88% in ING and >48 hours in 78% in SG. There was no correlation between the different PDC insertion techniques and complications OR 0.6, 0.61 and 0.8 (mini lap, PUSG and PNUSG, 95% CI).
Nephrolgist-iniciated peritoneal dialysis are associated with better success rate and shorter catheter break-in time, infections continue being the main complication in SG. Obesity and history of abdominal surgeries were not correlated with complications, and should not be considered a contraindication to perform percutaneus technique. Even though if we do not have a fluoroscope available in our centers, PUSG is the most safe technique, as long as, we have special attention in adequate visualization of abdomnal wall vessels and peritoneal space with US. We need to select carefully the group of patients that benefit of PDC by SG. Visual abstract below.