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Peritoneal dialysis (PD) is an effective renal replacement therapy (RRT), and the success of starting this therapy depends on the insertion and functionality of the catheter. Traditionally, insertion has been surgical. Recently, percutaneous catheter insertion techniques have been implemented, which include ultrasound-guided and non-ultrasound-guided puncture, with the use of a peritoneoscope or fluoroscopy. All of these new procedures have shown greater benefits and fewer complications.
A retrospective, multicenter cohort study that included 298 hospitalized patients requiring the urgent start of RRT from 2019 to 2023. Peritoneal catheter inserition was performed using two techniques, surgical and percutaneous.
63.42% were placed by Nephrology, and 36.58% by general surgery. There was no difference in the demographic variables of both groups (age, sex, body mass index, previous abdominal surgeries, and comorbidities). The success rate in implantation was similar in both groups, as well as functionality during hospitalization. Only in the bivariate analysis by chi-squared (χ2) test, a higher frequency of infectious complications, peritonitis (p=0.010), and tunnelitis (p=0.029), was found in the surgical technique group.
The percutaneous catheter insertion technique shows a similar success rate to the surgical technique in immediate functionality. However, the surgical technique is associated with lower medium-term survival, mainly due to the greater presence of infectious complications (peritonitis and tunnelitis). Percutaneous insertion should be considered the technique of choice in peritoneal catheter placement, so training should be essential in Nephrology training centers.