A multi-institutional, observational study of outcomes after catheter placement for peritoneal dialysis in Japan

Abstract

Background: This multi-institutional, observational study examined whether the outcomes after peritoneal dialysis (PD) catheter placement in Japan meet the audit criteria of the International Society for Peritoneal Dialysis (ISPD) guideline and identified factors affecting technique survival and perioperative complications. Methods: Adult patients who underwent first PD catheter placement for end-stage kidney disease between April 2019 and March 2021 were followed until PD withdrawal, kidney transplantation, transfer to other facilities, death, 1 year after PD start or March 2022, whichever came first. Primary outcomes were time to catheter patency failure and technique failure, and perioperative infectious complications within 30 days of catheter placement. Secondary outcomes were perioperative complications. Appropriate statistical analyses were performed to identify factors associated with the outcomes of interest. Results: Of the total 409 patients, 8 who underwent the embedded catheter technique did not have externalised catheters. Of the 401 remaining patients, catheter patency failure occurred in 25 (6.2%). Technical failure at 12 months after PD catheter placement calculated from cumulative incidence function was 15.3%. On Cox proportional hazards model analysis, serum albumin (hazard ratio (HR) 0.44; 95% confidence interval (CI) 0.27–0.70) and straight type catheter (HR 2.14; 95% CI 1.24–3.69) were the independent risk factors for technique failure. On logistic regression analysis, diabetes mellitus was the only independent risk factor for perioperative infectious complications (odds ratio 2.70, 95% CI 1.30–5.58). The occurrence rate of perioperative complications generally met the audit criteria of the ISPD guidelines. Conclusion: PD catheter placement in Japan was proven to be safe and appropriate.

The Association of Intra-Abdominal Adhesions with Peritoneal Dialysis Catheter-Related Complications

“…The prevalence of prior abdominal surgery in patients undergoing PD catheter insertion ranges from 22% to 59% in previous studies compared with 30% in this study. [13][14][15][16][19][20][21] Most of these studies do not report the prevalence of adhesions but rather the use of adhesiolysis, which ranges from 1% to 31% (mean 19%) compared with 11% in this study. Crabtree found that the number of prior surgeries and women were at higher risk for adhesiolysis.…”

Multi-institutional audit of outcomes after peritoneal dialysis catheter placement in Japan: What are the takeaways?

“…2,3 Published in this issue of Peritoneal Dialysis International is the first multi-centre study of outcomes after PD catheter placement in Japan, contrasting their results to the audit criteria suggested in the guidelines for PD access by the International Society for Peritoneal Dialysis (ISPD). 4,5 The study was comprised of 49 collaborating institutions performing 409 catheter placements by nephrologists (69.2%) and surgeons (30.8%) using laparotomy (87.8%) and laparoscopy (12.2%). Although the authors used the term catheter patency failure, the outcome was based upon the ISPD definition of probability of catheter survival at 12 months following placement where the catheter has not been removed, replaced or required some type of intervention (surgical or radiological) because of flow restriction or irremediable drain pain.…”