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Kidney Week

Abstract: PO1276

Image-Guided Percutaneous Peritoneal Dialysis Catheters: Greater Than the Sum of Their Parts

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Mutneja, Anubha, Washington University in Saint Louis, Saint Louis, Missouri, United States
  • Arora, Shilpa, Rush University Medical Center, Chicago, Illinois, United States
  • O Brien, Frank J., Washington University in Saint Louis, Saint Louis, Missouri, United States
  • Coyne, Daniel W., Washington University in Saint Louis, Saint Louis, Missouri, United States
  • Picus, Daniel, Washington University in Saint Louis, Saint Louis, Missouri, United States
Background

Peritoneal Dialysis (PD) is a favored treatment modality for patients with end stage kidney disease. PD initiation depends on adequate and timely insertion of PD catheter. Most centers rely on laparoscopic insertion of PD catheters for PD initiation. Small studies indicate that image guided percutaneous (IGP) PD catheter insertion by interventional radiology (IR) may be non-inferior to laparoscopic catheters. However, there are limited data to compare IGP PD catheters to those inserted with laparoscopic technique. Hence, there are no definitive evidence based recommendations to support which technique may be superior. We conducted a retrospective analysis to compare complication rates and catheter survival in laparoscopic versus IGP PD catheter insertions.

Methods

Patients who underwent laparoscopic or IGP PD catheter placement from Jan 2014 to Aug 2019 were included in the analysis. IGP catheter placement employed both fluoroscopic and ultrasound guidance. Primary outcome was rate of mechanical complications. Secondary outcome was death and transplant censored complication free catheter survival at 1 year.

Results

244 PD catheters were placed at our institution during the study time period - 56 by laparoscopic surgical technique and 188 by IGP technique. Baseline characters including age, gender, race and BMI were similar in both groups. Surgical group consisted of 60% of patients with prior abdominal surgery as compared to 24% in the IR group OR 4.62 (2.35 – 9.09), P <0.0001. Mechanical complication rates were higher in the surgical group 29.6 % (18.0 – 43.6) versus 13.4 % (8.9 – 19.2) in the IR group (p 0.02). Death and transplant censored complication free catheter survival rate at one year was 87.8% (79.6 – 93.5) in the IR group and 73.3% (54.1 – 87.7) in the surgical group, P 0.063. In the surgical group, patients with higher BMI (> 35) had higher rate of complications 83.3% versus 22.9% in the low BMI (<35) group, OR 16.82 (1.77 – 159.58) P 0.014. In the IR group, catheter complication rates were not different in high versus low BMI groups, 5.0% vs 14.6% respectively, OR 0.31 (0.04- 2.4) P 0.26.

Conclusion

Our findings suggest IGP PD catheter is an effective option for PD initiation even in patients with high BMI and offers several advantages including ease of placement and lower recovery time.