Randomized Clinical Trial on the Efficacy and Safety of Preoperative Enema in the Prevention of Peritoneal Dialysis Catheter Dysfunction

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Introduction Current clinical practice guidelines do not universally recommend bowel preparation for peritoneal dialysis (PD) catheter insertion. This randomized controlled trial aimed to evaluate the efficacy and safety of preoperative enema in preventing PD catheter dysfunction. Methods In this prospective, single-center trial, 136 patients undergoing PD catheterization were randomly assigned to receive either preoperative enema within 24 hours (enema group, n=68) or no bowel preparation (control group, n=68). The primary endpoint was the incidence of catheter dysfunction requiring intervention within 3 months post-operation. Secondary outcomes encompassed the incidence of catheter dysfunction requiring intervention in six months, catheter event free survival time, the incidence of peritoneal dialysis-associated peritonitis, and other catheter complications. Results After excluding two patients (one with scrotal leakage and one with acute kidney injury), 134 participants completed the 6-month follow-up. Baseline characteristics showed no significant intergroup differences. The enema group demonstrated significantly lower incidence of catheter dysfunction requiring intervention at 3 months (10/68, 14.7%, unadjusted risk ratio (RR) 0.297, [95% confidence interval (CI) 0.129-0.682], p = 0.004; adjusted RR 0.299 [95% CI 0.121-0.737], p = 0.009). Kaplan-Meier analysis revealed longer catheter survival in the enema group versus controls (log-rank p = 0.0015). Only one control patient (1.5%) required surgical revision. There was no statistically significant difference between the two groups in terms of other infection and non-infection complications. Conclusion Preoperative enema significantly reduces early PD catheter dysfunction risk without increasing complication rates. These findings support incorporating bowel preparation into standard preoperative protocols for PD catheter placement.

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