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Various techniques for peritoneal dialysis catheter insertion have been described, involving both general surgery and interventional nephrology. At our center, we have utilized the following techniques over the past two years: insertion by general surgery and three techniques by interventional nephrology—catheter insertion with a stylet, catheter insertion with unguided ultrasound kit, and catheter insertion with ultrasound-guided kit.
Retrospective, single-center cohort study that included 167 acutely hospitalized patients with a need for urgent start dialysis at a secondary-level center in Mexico City. Patients were categorized by the technique used for peritoneal catheter insertion. Variables were expressed as mean ± standard deviation, median (interquartile range), or number of subjects (%). Comparison of means between the four groups was performed using ANOVA; Kruskal-Wallis, or chi-squared tests, respectively.
A total of 168 acutely hospitalized patients requiring urgent start dialysis were included. The frequency of Tenckhoff catheter insertion techniques was as follows: general surgery insertion 17.37%, nephrology insertion with stylet 47.9%, unguided ultrasound kit 11.98%, and ultrasound-guided kit 22.75%. The mean age of the patients was 54.59 ± 13.85 years, 41.9% were female, and the mean body mass index (BMI) was 26.21 ± 4.86 kg/m2; 25.8% had a history of abdominal surgery.
Bivariate analysis by chi-squared test showed a higher frequency of cathehter recolocation (p=0.016), disfunction (p=0.002), higher frequency of catheter leaks (p=0.027), and a higher frequency of peritonitis events (p=0.006) in the general surgery group. There was no statistically significant difference in migration, perforation, tunnelitis, or hemorrhage among the four groups.
Nephrology-performed catheter insertion techniques for peritoneal dialysis showed a lower frequency of catheter disfunction, catheter relocations, peritonitis, and catheter leaks compared to general surgery. Due to the methodology of the present study, it cannot be conclusively determined that there is superiority. However, the results suggest that nephrology catheter insertion techniques may not be inferior in terms of safety and efficacy compared to the surgical technique.