Medical Peritoneal Dialysis Catheter Insertion Can Increase Peritoneal Dialysis (PD) Patient Population: A Single-Centre Study

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Background: Peritoneal dialysis (PD) can offer improvement in quality of life and treatment costs compared to hemodialysis. Access to PD is often limited by cather insertion facilities. PD catheters can be inserted surgically (laparoscopic or open, both typically under general anaesthesia) or medically (percutaneous, under local anaesthesia). We examined the benefits of introducing a medical PD catheter service in a tertiary renal unit in addition to a surgical service which was already available. Methods: Safety data (incidence of peritonitis within 90 days and of catheter malpositioning) were reviewed in the electronic health record from July 2017-June 2019 (surgical insertions alone) and July 2019-June 2021 (medical and surgical insertions). PD prevalence was tracked over 6 years. Results: From June 2017-July 2019 there were 44 surgical catheter insertions compared to 63 (33 medical, 30 surgical) from July 2019-June 2021: a 43% increase in incident PD patients. There was no significant difference in early peritonitis (14% in surgical vs 15% in medical, P=0.77) or malposition (7% in surgical vs 9% in medical, p=0.70). Prevalent PD patients fell by 15% from 2016-2019 but grew by 79% in the 3 years after introduction of medical catheter insertions. Conclusions: Introducing percutaneous PD catheter insertion by nephrologists was associated with an increase in PD patients with no increase in complications. Contraindications to medical insertion include significant obesity or previous major abdominal surgery. A hybrid medical/surgical service allowed most patients to be offered PD while avoiding general anaesthesia and minimising operating theatre usage. A limitation in this study is the groups arenot matched for complication risk: technically challenging patients will tend to be offered surgical insertion. Nevertheless, we demonstrated that introduction of medical PD catheter insertion can grow the PD population without an increase in complications.

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