Kidney Res Clin Pract.  2020 Sep;39(3):365-372. 10.23876/j.krcp.20.006.

Percutaneous peritoneal dialysis catheter implantation with no break-in period: a viable option for patients requiring unplanned urgent-start peritoneal dialysis

Affiliations
  • 1Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
  • 2Division of Nephrology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
  • 3Division of Nephrology, Pusan National University Hospital, Busan, Republic of Korea
  • 4Department of Internal Medicine, Gimhae Bokum Hospital, Gimhae, Republic of Korea

Abstract

Background
Urgent-start peritoneal dialysis (PD) is applied to patients who need PD within two weeks but are able to wait for more than 48 hours before starting PD. To evaluate the usefulness of percutaneous PD catheter insertion in urgent-start PD, we reviewed the clinical outcomes of percutaneous catheter insertion with immediate start PD and surgical insertion with longer break-in time in Pusan National University Hospital.
Methods
This study included 177 patients who underwent urgent-start PD. Based on the PD catheter insertion techniques, the patients with urgent-start PD were divided into percutaneous (n = 103) and surgical (n = 74) groups. For the percutaneous group, a modified Seldinger percutaneous catheter insertion with immediate initiation of continuous ambulatory PD was performed by nephrologists.
Results
The percutaneous group showed higher serum urea nitrogen, creatinine, and lower serum albumin compared with the surgical group (P < 0.05). Ninety-day infectious and mechanical complications showed no significant differences between the two groups. Ninety-day peritonitis in the percutaneous group was 9.7% compared to 5.4% in the surgical group (P = not significant [NS]). Major leakage was 3.9% in the percutaneous group compared to 1.4% in the surgical group (P = NS). Overall infectious and mechanical complication-free survival was not significantly different between the two groups. The percutaneous group and surgical group showed no statistical difference with respect to catheter survival over the entire observation period (P = NS).
Conclusion
This study suggests that urgent-start PD can be applied safely with percutaneous catheter insertion by nephrologists with no break-in period.

Keyword

Catheters; Complications; Peritoneal dialysis; Urgent-start
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