Percutaneous insertion of peritoneal dialysis catheter is a safe and effective technique irrespective of BMI

Abstract

Background: A large body mass index (BMI) has been considered as a relative contraindication for percutaneous catheter insertion, although this technique has many advantages. Up to now, there are few studies on peritoneal catheter placement and obesity. The aim of this study was to determine whether patients with large BMI can also choose the percutaneous technique for peritoneal dialysis catheter insertion. Methods: One hundred eighty seven consecutive patients underwent peritoneal catheter insertions in the Chinese PLA General Hospital between January 1, 2015 and December 31, 2016, with 178 eligible cases being included in the analysis. Two groups were created based on the catheter insertion techniques, the percutaneous group (group P) and the surgical group (group S). Subgroups were created according to BMI > 28 or ≤ 28. The outcomes included catheter related complications and catheter survival. Results: Total infectious complication rates were significantly lower in group P than in group S. There were no significant differences in peritonitis rate between group P and group S (1.20% vs. 3.16% with P = 0.71 in early stage, and 4.82% vs. 11.58% with P = 0.11 in late stage). All other measured complications were similar between the two groups. Though the one-year infection-free catheter survival in group P was 7.5% higher than group S, the difference was not significant. The one-year dysfunction-free catheter survival, one-year dysfunction-and-infectionfree catheter survival, and overall catheter survival were similar between the two groups. Subgroup analyses showed a superior one-year infection-free catheter survival of percutaneous technique in patients with BMI > 28, which was confirmed by Kaplan-Meier analysis. Conclusions: Despite the challenges that may be encountered with patients who have a large BMI, the percutaneous technique seems to be a safe and effective approach to placing a peritoneal dialysis catheter.

Association between different peritoneal dialysis catheter placement methods and short‐term postoperative complications

“…However, compared with the traditional open surgical method, whether Seldinger’s method can reduce postoperative complications is still controversial [ 14 , 25 ]. A meta-analysis of different catheter placement methods in peritoneal dialysis (PD) by Xie et al [ 16 ] showed that the one-year dysfunction-free catheter survival, one-year dysfunction-and-infection-free catheter survival, and overall catheter survival were similar between the traditional open surgery method and Seldinger technique. Lee et al showed that compared with open surgery method, Seldinger technique could reduce catheter-related complications [ 26 , 27 ].…”

“…Also, Seldinger technique has the advantages of less traumatic, less intraoperative pain, and less economic burden, and the operation technique is easy for nephrologists to master. However, whether it can reduce postoperative complications than traditional open surgery methods remain controversial [ 16 ]. At present, there are few relevant studies.…”

Peritoneal dialysis catheter insertion by nephrologist using minilaparotomy: Do survival and complications vary in obese?

“…Though percutaneous technique has been used for obese patients, elaborate studies are absent. [ 16 ] Our PDC insertion practice conformed to those formulated under the best practices for PDC insertion, getting updated over time. [ 2 17 18 ]…”

“…In a retrospective study of 178 PDC insertions by Xie et al ., subgroup analyses of BMI >28 kg/m 2 showed a superior one-year infection-free catheter survival of percutaneous technique compared to surgical minilaparotomy[ 16 ] though the overall catheter survival was comparable across BMI groups. Our study too demonstrated that PDC survival and infection rates were comparable across BMI groups.…”

Establishment of a prediction model for early and mid-term complications for patients undergoing catheter insertion for peritoneal dialysis

“…Peritoneal dialysis has become the preferred alternative treatment for end-stage renal disease because of its advantages, including low cost, simple technique, protection of residual renal function, minimal effect on normal work, and stable hemodynamics. 1 Studies have shown that the 5-year survival rate is not significantly different between peritoneal dialysis and hemodialysis. 2 Although peritoneal dialysis is a safe and effective alternative treatment for renal disease, 3 it may still cause a series of complications.…”