Double purse-string around the inner cuff of the peritoneal catheter: A novel technique for an immediate initiation of continuous peritoneal dialysis

Scalamogna, Antonio; Nardelli, Luca

doi:10.1177/0391398819891735

Cited by 13 publications

(10 citation statements)

References 34 publications

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“…Our overall peritonitis rate was far below the threshold of 0.4 episode/patient-year proposed by the ISPD recommendations 8 . This overall good rate might be associated with the early start of in-hospital PD training (mainly the day after the catheter insertion) that patients received in our center 9,12 .…”

Section: Discussionmentioning

confidence: 91%

“…In every patient a straight double-cuffed Tenckhoff catheter was placed with a modi ed double purse string technique around the inner-cuff either in semi-surgical or surgical procedure, as described elsewhere 9,10 . The creation of the subcutaneous part was achieved by using a piercing tunneller in a direction able to minimize shear forces with the super cial cuff located at least 4 cm from the exit of the skin 11 .…”

Section: Clinical Managementmentioning

confidence: 99%

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Peritoneal Dialysis Related Peritonitis: Insights From a Long-Term Analysis of an Italian Center

Nardelli,

Scalamogna,

Ponzano

et al. 2023

Preprint

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Background Peritonitis is a common and severe complication of peritoneal dialysis (PD). For comparative analysis standardized definitions as well as measurements and outcomes are crucial. However, most PD-related peritonitis studies have been using heterogenous definitions and variable methods to measure outcomes. The ISPD 2022 guidelines have revised and clarified numerous definitions and proposed new peritonitis categories and outcomes. Methods Between 1st January 2009 and 31st May 2023, 267 patients who started PD at our institution were included in the study. All PD-related peritonitis episodes that occurred in our unit during the study period were collected. The new definitions and outcomes of ISPD 2022 recommendations were employed. Results The overall peritonitis rate was 0.25 episode/patient year. Patient cumulative probability of remaining peritonitis-free at one year was 84.2%. The medical cure and refractory peritonitis rates were equal to 70.3 and 22.4%, respectively. Culture-negative peritonitis accounted for 25.6% of all specimens. The rates of peritonitis associated death, HD transfer, catheter removal and hospitalization were 6.8%, 18.3%, 18.7% and 64.4%, respectively. Relapsing, repeat, recurrent and enteric peritonitis accounted for 7.8%, 6.8%, 4.1% and 2.7% of all episodes, respectively. Catheter insertion, catheter related and pre-PD peritonitis were 4.2, 2.1 and 0.5%. Conclusions The implementation of PD-related peritonitis reports using standardized definitions and outcome measurements is of paramount importance to enhance clinical practice and to allow comparative studies.

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Section: Discussionmentioning

confidence: 91%

Section: Clinical Managementmentioning

confidence: 99%

Peritoneal Dialysis Related Peritonitis: Insights From a Long-Term Analysis of an Italian Center

Nardelli,

Scalamogna,

Ponzano

et al. 2023

Preprint

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“…The high incidence of technique failure has been recognized as a critical factor in the relatively poor PD retention rates worldwide [ 40 ]. The technique survival rate with a BI < 24 h was 95% according to a report from Korea with a 1 month follow-up period [ 20 ] and was 97.8%, according to another report from Italy with a 3 month follow-up period [ 21 ]. Povlsen et al.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a break-in period of less than 24 hours for urgent start peritoneal dialysis: a multicenter study

Wen

Yang

Sun³

et al. 2022

Renal Failure

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Purpose Urgent start peritoneal dialysis (USPD) is an effective therapeutic method for end-stage renal disease (ESRD). However, whether it is safe to initiate peritoneal dialysis (PD) within 24 h unclear. We examined the short-term outcomes of a break-in period (BI) of 24 h for patients undergoing USPD. Methods This real-world, multicenter, retrospective cohort study evaluated USPD patients from five centers from January 2013 to August 2020. Patients were divided into BI ≤ 24 h or BI > 24 h groups. The Primary outcomes included incidence of mechanical and infectious complications. The secondary outcome was technique failure. Moreover, we presented a subgroup analysis for patients who did not receive temporary hemodialysis (HD). Results A total of 871 USPD patients were included: 470 in the BI ≤ 24 h and 401 in the BI > 24 h groups. Mechanical and infectious complications did not differ between the two groups across the follow-up timepoints (2 weeks, 1 month, 3 months, and 6 months) ( p > 0.05). Multiple logistic regression analysis revealed that BI ≤ 24 h was not an independent risk factor for mechanical complications, catheter migration, or infectious complications ( p > 0.05). A BI ≤ 24 h was not an independent significant risk factor for technique failure by multivariate Cox regression analysis ( p > 0.05). The subgroup analysis of patients who did not receive temporary HD returned the same results. Conclusion Initiating PD within 24 h of catheter insertion was not associated with increased mechanical complications, infectious complications, or technique failures.

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Section: Methodsmentioning

confidence: 99%

“…After obtaining informed consent for catheter insertion, double-cuffed Tenckhoff catheter was placed by an interventional nephrologist according to semi-surgical or surgical procedure described thoroughly elsewhere. [22][23][24] Incremental CAPD was defined as the start of PD with less than four exchanges per day, 7 days a week and a peritoneal weekly Kt/V < 1.7 per week, but a total weekly Kt/V ! 1.7 per week.…”

Section: Capd Dose Prescriptionmentioning

confidence: 99%

Relationship between number of daily exchanges at CAPD start with clinical outcomes

Nardelli,

Scalamogna,

Cicero

et al. 2023

Perit Dial Int

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Background: Peritoneal dialysis (PD) continues to be demanding for patients affected by kidney failure. In kidney failure patients with residual kidney function, the employment of incremental PD, a less onerous dialytic prescription, could translate into a decrease burden on both health systems and patients. Methods: Between 1st January 2009 and 31st December 2021, 182 patients who started continuous ambulatory peritoneal dialysis (CAPD) at our institution were included in the study. The CAPD population was divided into three groups according to the initial number of daily CAPD exchanges prescribed: one or two (50 patients, CAPD-1/2 group), three (97 patients, CAPD-3 group) and four (35 patients, CAPD-4 group), respectively. Results: Multivariate analysis showed a difference in term of peritonitis free survival in CAPD-1/2 in comparison to CAPD-3 (hazard ratio (HR): 2.20, p = 0.014) and CAPD-4 (HR: 2.98, p < 0.01). A tendency towards a lower hospitalisation rate (CAPD-3 and CAPD-4 vs. CAPD-1/2, p = 0.11 and 0.13, respectively) and decreased mortality (CAPD-3 and CAPD-4 vs. CAPD-1/2, p = 0.13 and 0.22, respectively) in patients who started PD with less than three daily exchanges was detected. No discrepancy of the difference of the mean values between baseline and 24 months residual kidney function was observed among the three groups ( p = 0.33). Conclusions: One- or two-exchange CAPD start was associated with a lower risk of peritonitis in comparison to three- or four-exchange start. Furthermore, an initial PD prescription with less than three exchanges may be associated with an advantage in term of hospitalisation rate and patient survival.

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Double purse-string around the inner cuff of the peritoneal catheter: A novel technique for an immediate initiation of continuous peritoneal dialysis

Cited by 13 publications

References 34 publications

Peritoneal Dialysis Related Peritonitis: Insights From a Long-Term Analysis of an Italian Center

Peritoneal Dialysis Related Peritonitis: Insights From a Long-Term Analysis of an Italian Center

Feasibility of a break-in period of less than 24 hours for urgent start peritoneal dialysis: a multicenter study

Relationship between number of daily exchanges at CAPD start with clinical outcomes

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