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Abstract: FR-PO533

Percutaneous vs. Surgical Catheter Placement in Subjects With ESKD Referred Late to Start of Peritoneal Dialysis

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Author

  • Chavez, Hugo Enrique, Instituto Mexicano del Seguro Social, Jalisco, Guadalajara, Mexico
Background

In developing countries, end-stage kidney disease (ESKD) patients are often referred late for renal replacement treatment. In this context requiring immediate treatment, it is unknown whether percutaneous peritoneal dialysis (PD) catheter placement is feasible and safe compared to surgical insertion. Aims: To compare clinical outcomes of percutaneous vs surgical catheter placement in a cohort of ESKD patients with need to initiate as soon as possible dialysis and referred for PD initiation.

Methods

Prospective cohort study performed at the General Regional Hospital IMSS 180, a tertiary reference center for PD care in Jalisco, Mexico (2018-2020). Subjects were selected for percutaneous catheter placement unless there was a contraindication in which case surgical insertion was performed. The goal was a short break-in period to achieve PD initiation as soon as possible.

Results

A total of 261 subjects underwent percutaneous (n=102, 39%) or surgical (n=159, 61%) catheter placement. Patients who underwent percutaneous insertion were younger (39 [IQR 28-58] vs 54 [IQR 35-64] years), had more males (75% vs 50%), had a higher burden of uremic symptoms (54% vs 27%), lower eGFR (4.5 [IQR 3-6] vs 6 [IQR 4-7.5] mL/min/1.73m2), and higher frequency of serum K>6 mmol/L (22% vs 6%), all with a P<0.001. Subjects in percutaneous group had less waiting time between admission and catheter placement (6 [IQR 3-9] vs 11 [IQR 9-15] days), less time of break-in waiting period (1 [1-1] vs 2 [2-3] days) and shorter length of stay (13 [10-19] vs 18 [14-23], days, Fig 1). Nevertheless, percutaneous procedure was associated with a higher number of complications (48% vs 20%, P<0.001), including catheter dysfunction requiring surgery repair and/or exchange (29% vs 11%, P<0.001). Mortality during 3 year of follow-up was similar between percutaneous (23%) and surgical (24%) groups (log-rank=0.76, 95% CI: 0.46-1.26).

Conclusion

Compared to SX catheter insertion, percutaneous catheter placement in patients with need to initiate as soon as possible dialysis, significantly decreases waiting time between admission and catheter placement, break-in period, and the length of stay. Although the need for catheter exchange was more frequent with percutaneous technique, percutaneous placement allowed PD start in the majority of late-referred patients with advanced uremia.

Funding

  • Clinical Revenue Support