Kidney Week

Abstract: PO1283

Spontaneous Peritoneal Dialysis Catheter Expulsion: Our Experience

Session Information

• Peritoneal Dialysis - 1
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Report

• 703 Dialysis: Peritoneal Dialysis

Authors

• Lopez Melero, Eva, Hospital Ramon y Cajal, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Eva Lopez Melero,

• Sosa Barrios, Haridian, Hospital Ramon y Cajal, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Haridian Sosa Barrios,

• Burguera, Victor, Hospital Ramon y Cajal, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Victor Burguera,

• Ortego, Sofia, Hospital Ramon y Cajal, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Sofia Ortego,

• Álvarez nadal, Marta, Hospital Ramon y Cajal, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Marta Álvarez nadal,

• Fernandez-Lucas, Milagros, Hospital Ramon y Cajal, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Milagros Fernandez-Lucas,

• Rivera, Maite, Hospital Ramon y Cajal, Hospital Universitario Ramon y Cajal, Madrid, Madrid, Spain

Maite Rivera,

Introduction

Mechanical complications of PD are a significant cause of technique failure. Amongst them, complete expulsion of the peritoneal catheter (PC) is rare.

Case Description

CASE1: 62-year-old woman with chronic kidney disease (CKD) secondary to unknown glomerulonephritis. PD was started after a failed transplant. She had two episodes of exit site infection (ESI) secondary to Corynebacterium spp, recovered. In 2001 she presented with pericatheter leak, solved after transient switch to hemodialysis for 2 months. In 2002 she was admitted with complete spontaneous PC extrusion (straight Tenckhoff PC 2 cuffs). She had no signs of ESI and denied using any topical medication. A contralateral PC was inserted with no complications.

CASE2: 61-year-old woman with CKD due to anti-glomerular basement membrane disease. She received induction treatment with high-dose steroid therapy, with no response, so a straight Tenckhoff PC (2 cuffs) was placed and she started PD. 2 months later she presented a spontaneous PC expulsion with evidence of ESI with Candida parapsylosis that was adequately treated. After infection resolved, a contralateral PC was placed with no complications.

CASE3: 68-year-old woman with CKD secondary to type 2 cardiorenal syndrome. She started on PD because of diuretic-resistant heart failure (straight Tenckhoff PC, 2 cuffs). She presented Pseudomonas aeruginosa relapsing peritonitis in 4 occasions, requiring taudolidine-urokinase PD catheter lock with good outcome. In 2018 she had an episode of ESI, again by Pseudomonas aeruginosa solved after a course of topical antibiotics as well as external cuff shaving. In 2019 she developed again ESI with Pseudomonas areuginosa, and despite topic treatment as per antibiogram exit site cultures remained positive. One month later she presented a spontaneous expulsion of the PC. A contralateral PC was placed without further infectious complications.

Discussion

We present an atypical complication in PD. Triggers for PC extrusion in our cases appear to be related to peritoneal leak in the first case, and to ESI in the remaining two cases. Steroids are likely disrupting exit site healing and fibrosis formation around the cuff, contributing to this infrequent complication.
These risk factors should be identified and kept in mind to prevent the catheter extrusion.