The Underrated Role of Ultrasound in Peritoneal Dialysis

Basile, Antonio; Rahbari, Elnaz; Nicolò, Pierpaolo Di; Battaglia, Yuri; Campo, Irene; Fresilli, Daniele; Pacini, P.; Lucatelli, Pierleone; Barr, Richard G.; Cantisani, Vito; Zeiler, Matthias

doi:10.1002/jum.15710

Cited by 9 publications

(11 citation statements)

References 37 publications

(79 reference statements)

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“…However, owing to the unpleasant experience with catheter-related complications in renal graft recipients with catheters left in place, some authors declared to switch to a routine of removing them at the time of transplantation [ 3 , 27 ]. As the certainty of the available is very low, we believe that ultrasound examination should be considered in select uncertain cases [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Peritoneal dialysis catheter removal at the time or after kidney transplantation: a systematic review and meta-analysis

Zawistowski

Nowaczyk

Domagała

2022

Langenbecks Arch Surg

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Purpose An increasing number of patients treated with peritoneal dialysis eventually undergo kidney transplantation. Owing to opposing reports, we aimed to find evidence about the best time for peritoneal dialysis catheter removal in transplant patients. Methods We conducted a systematic review and random effects meta-analysis of non-randomized studies of intervention comparing patients with peritoneal dialysis catheters left in place or removed during kidney transplantation in regard to the need for dialysis and occurrence of catheter-related complications. We searched (last update on 8 December 2021) PubMed, Embase, Scopus, and Web of Science for eligible studies. ROBINS-I tool and funnel plot asymmetry analysis were used to assess the quality of included articles. Results Eight observational studies were evaluated. Five of them, which involved 338 patients, were included in a meta-analysis. All were at moderate to serious risk of bias. The odds of needing dialysis are more than twice as high for patients with peritoneal dialysis catheters left in situ (pooled odds ratio, 2.21; 95% confidence interval [CI], 1.03 to 4.73; I2 = 0%). No statistically significant difference was noted when adult and pediatric subgroups were compared (Q = 0.13, P = .720). More individuals with catheters left in place required dialysis (pooled prevalence, 20.9%; 95% CI, 13.6 to 30.7%; I2 = 59% vs. 12.4%; 95% CI, 5.6 to 25.2%; I2 = 0%) and experienced catheter-related infections. Conclusion Available evidence is scarce. Unless new data from a randomized controlled trial are available, the dilemma of peritoneal dialysis catheter removal cannot be solved. Trial registration PROSPERO Protocol ID: CRD42020207707. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Peritoneal dialysis catheter removal at the time or after kidney transplantation: a systematic review and meta-analysis

Zawistowski

Nowaczyk

Domagała

2022

Langenbecks Arch Surg

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“…Future improvements in catheter infection treatment may include point-of-care ultrasound assessment and monitoring of treatment response. 86 The incidence and prevalence of NTM catheter infection rate is increasing. 103 Given the persistent nature of the infection, ongoing prospective collection of data from registries should clarify the recommended treatment strategy.…”

Section: Future Researchmentioning

confidence: 99%

“…Additional information from colour Doppler and contrast-enhanced ultrasound might provide additional information of hypervascularity, indicative of an inflammatory process. 86,87…”

Section: Management Of Catheter-related Infectionsmentioning

confidence: 99%

ISPD Catheter-related Infection Recommendations: 2023 Update

Chow

Cho

et al. 2023

Perit Dial Int

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Peritoneal dialysis (PD) catheter-related infections are important risk factors for catheter loss and peritonitis. The 2023 updated recommendations have revised and clarified definitions and classifications of exit site infection and tunnel infection. A new target for the overall exit site infection rate should be no more than 0.40 episodes per year at risk. The recommendation about topical antibiotic cream or ointment to catheter exit site has been downgraded. New recommendations include clarified suggestion of exit site dressing cover and updated antibiotic treatment duration with emphasis on early clinical monitoring to ascertain duration of therapy. In addition to catheter removal and reinsertion, other catheter interventions including external cuff removal or shaving, and exit site relocation are suggested.

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“…Peritoneal catheter tunnel infection can be difficult to diagnose on physical examination. Therefore, if tunnel infection is suspected, ultrasonographic examination of the catheter tunnel is recommended 1,2 …”

Section: Figurementioning

confidence: 99%