American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Does Catheter Insertion by Nephrologists Improve Peritoneal Dialysis Utilization? A Multicenter Analysis

Abstract

In contrast to hemodialysis (HD), peritoneal dialysis (PD) remains an underutilized form of renal replacement therapy in the United States. Although a variety of factors have been deemed responsible, timely insertion of a PD catheter may also be a contributory factor. We conducted a multicenter analysis to examine whether the establishment of a program for PD catheter insertion by nephrologists has a positive impact on the growth in the number of patients using PD. Data for catheter insertion performed by nephrologists were collected from three centers. Any change in the prevalent PD population at each respective center was compared to the number of PD patients during the period having the traditional surgical approach. Nephrologists at the three centers used the peritoneoscopic technique and performed catheter insertion under local anesthesia. In center 1, the PD population remained stable at between 38 and 45 patients (approximately 16% of the total end-stage renal disease [ESRD] population) from 1993 to 2001. Nephrologists initiated a program for PD catheter insertion in 2001. The number of PD patients has increased to 101 (32% of the ESRD population). In center 2, the PD population remained stable at between 70 and 78 patients (approximately 17%) between 1988 and 1990. Catheter insertion by interventional nephrologists began in 1991. The number of PD patients has increased to 125 (22%). In center 3, the PD population remained at 20-30 patients (approximately 18%) between 1988 and 1991. Catheter placement by nephrologists was initiated in 1991. The number of PD patients increased to 97 (27%). Catheter insertion by interventional nephrologists was suspended in 2001. The number of PD patients has gradually declined to 25 (6%). This study suggests that catheter insertion by the nephrologist can have a positive impact on the utilization of PD.

Overcoming the Underutilisation of Peritoneal Dialysis

“…The inclusion of interventional nephrologist catheter placement in the integrated care approach to dialysis start has resulted in a relatively large PD penetration of 44.8% in one of the reports [ 32 ]. Another study reported an increase in the prevalence of PD from the relative share of 16–18% to 22–32% [ 33 ]. Catheter implantation by nephrologists compared to surgical or radiological services was associated with higher rates of successfully finalised peritoneal dialysis utilisation in patients undergoing elective PD catheter insertion [ 34 ].…”

Modified Peritoneal Dialysis Catheter Insertion: Comparison with a Conventional Method

“… 1 2 3 4 The availability of timely PD catheter insertion, low rate of complication related with procedure and the low rate of catheter failure with effort of nephrologists are important requisites that will increase the utility of PD and reduce patient morbidity. 1 5 6 The blind percutaneous PD catheter insertion by nephrologists shows similar outcome to catheter insertion performed by surgeons, and it is advantageous in that it can timely initiate dialysis therapy and does not require an operating room. 5 6 7 8 9 10 11 12…”

“… 1 5 6 The blind percutaneous PD catheter insertion by nephrologists shows similar outcome to catheter insertion performed by surgeons, and it is advantageous in that it can timely initiate dialysis therapy and does not require an operating room. 5 6 7 8 9 10 11 12…”

The Choice of Peritoneal Dialysis Catheter Implantation Technique by Nephrologists

“…In fact, the success of PD access procedures performed by nephrologists using various techniques has been well documented [8–12]. Catheter insertion by nephrologists has been shown to improve PD utilization and increase the PD population growth rate in other parts of the world [9, 11, 13, 14]. …”

“…Although peritoneoscopic implantation of PDC provides direct visualization, the introduction of the peritoneoscope still involves blind insertion through the abdominal wall. Therefore, bowel perforation remains a potential serious complication [13]. Pneumoperitoneum and pneumomediastinum are the rare complications caused by the air insufflation.…”