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MPT involves subcutaneous burial of the distal part of the catheter at the time of implantation. Externalization takes place after a variable period of time when initiation of dialysis is deemed necessary. The technique might add several clinical advantages besides allowing timely access implantation. Since 2012 we have used the MPT as our standard method for peritoneal dialysis (PD) catheter insertion. We report our experience using this technique in a dialysis center in Argentine Patagonia.
We performed a retrospective review of all catheters inserted with MPT between 12 January 2012 and 30 April 2025. We reported peritonitis rate, catheter survival (Kaplan Meier), futile catheter placement, complications (primary disfunction, catheter damage, others), embedment duration and eGFR at embedment. We divide the observation into two periods: number I (catheters implanted between Jan 12,2012 and Dec 31,2017) and number II (catheters inserted between Jan 1, 2018 and Apr 30, 2025). With the Mann-Whitney test (MWT) we compared embedment duration and eGFR at embedment between both periods.
We inserted 73 catheters with MPT in 63 patients. The peritonitis rate was 0.28 epi/pts-year. The catheter survival rate at one year was 93.3% and 84.7% at two years. Complications: 4 primary disfunction (2 rescued, 2 not), 2 catheter puncture, 1 fibrin plug, 1 keloid entrapment. Six catheters were not used (4 ptes died, 1 pte regretted it and 1 pte remains out of dialysis) and 67 catheters were externalized (94% achieved primary function which increased to 97% after the rescue of 2 cases). The median embedment period of the externalized catheters was 127.9 days (SD:265;R21-1977). In the first period (I), we implanted 37 catheters (6 unused). The remaining 31 catheters were buried for an average of 158 days(Me:42;SD377). In the second period (II) we inserted 36 catheters (2 unused, 1 primary disfunction, 1 still buried). The other 34 were buried for an average of 50 days(Me:41.5;SD27.83). We implanted 49 catheters with eGFR of 10 ml/min or < and 24 catheters with GFR >10 ml/min (Me 14 ml/min, R 11-27 ml/min). In stage I, we made 22 implants with GFR of 10 ml/min or < and 15 implants with GFR >10 ml/min. In stage II, we made 27 implants with GFR of 10 ml/min or < and 9 implants with GFR > 10 ml/min. The MWT did not reach statistical significance in any of the cases.
The MPT offers good results but the PD team needs to become familiar with it to obtain the maximun benefit, avoiding futile implants and prolonged burials.
