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Figueiredo AE, Hurst H, Neumann JL, Chow JSF, Walker R, Woodhouse J, Punzalan S, Tomlins M, Cave K, Brunier G. Nursing management of catheter-related non-infectious complications of PD: Your questions answered. Perit Dial Int 2024:8968608241246449. [PMID: 38770907 DOI: 10.1177/08968608241246449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
A review from the last seven years (August 2016-July 2023) of questions posted to the International Society for Peritoneal Dialysis (ISPD) website "Questions about PD" by nurses and physicians from around the world revealed that 19 of the questions were associated with optimal approaches for preventing, assessing, and managing issues related to PD catheter non-infectious complications. Our review focused on responses to these questions whereby existing best practice recommendations were considered, if available, relevant literature was cited and differences in international practices discussed. We combined similar questions, revised both the original questions and responses for clarity, as well as updated the references to these questions. PD catheter non-infectious complications can often be prevented or, with early detection, the potential severity of the complication can be minimized. We suggest that the PD nurse is key to educating the patient on PD about PD catheter non-infectious complications, promptly recognize a specific complication and bring that complication to the attention of the Home Dialysis Team. The questions posted to the ISPD website highlight the need for more education and resources for PD nurses worldwide on the important topic of non-infectious complications related to PD catheters, thereby enabling us to prevent such complications as PD catheter malfunction, peri-catheter leakage and infusion or drain pain, as well as recognize and resolve these issues promptly when they do arise, thus allowing patients to extend their time on PD therapy and enhance their quality of life whilst on PD.
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Affiliation(s)
- Ana E Figueiredo
- Curso de Enfermagem, Escola de Ciência da Sáude e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Helen Hurst
- School of Health and Society, University of Salford, UK
| | | | | | - Rachael Walker
- University of Auckland, New Zealand and Hawke's Bay District Health Board, Hastings, New Zealand
| | - Jayne Woodhouse
- Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Melinda Tomlins
- John Hunter Hospital, Hunter New England Local Health District, NSW, Australia
| | - Katie Cave
- Peritoneal Dialysis Unit, Abbotsford Regional Hospital and Cancer Centre, Fraser Health, BC, Canada
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Gao X, Peng Z, Li E, Tian J. Modified minimally invasive laparoscopic peritoneal dialysis catheter insertion with internal fixation. Ren Fail 2023; 45:2162416. [PMID: 36633221 PMCID: PMC9848322 DOI: 10.1080/0886022x.2022.2162416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Laparoscopic technique is widely used in peritoneal dialysis (PD) catheter placement. We developed a modified minimally invasive laparoscopic PD catheter (PDC) insertion with internal fixation and evaluated the early results by observing the intraoperative and postoperative conditions of the novel technique with those of conventional open surgery. METHODS Retrospective research was performed on 59 patients who underwent PDC insertion from June 2019 to January 2022, including 23 patients who received open surgery and 36 patients who received modified minimally invasive laparoscopic surgery. Information such as preoperative conditions, operation time, incision length, incidence of intraoperative complications, time from operation to starting PD, time from operation to discharge, and incidence of catheter-related complications were collected and analyzed. RESULTS The incision length, intraoperative blood loss, catheter migration rates and the total incidence of complications 6 months after operation in the laparoscopic group were lower than those in the conventional group. There were no statistically significant differences between the two groups in operation time, time from operation to starting PD, time from operation to discharge and the incidence of catheter blockage, leakage, exit-site infection, peritoneal dialysis associated peritonitis and hernia. CONCLUSIONS Modified minimally invasive laparoscopic PDC insertion and internal fixation method achieved direct vision and reliable fixation of the catheter, significantly reduced incision length and blood loss. The incidence of catheter migration was significantly lower than that of open surgery. Our primary findings reveal that modified minimally invasive laparoscopic PDC insertion with internal fixation is safe, effective and beneficial for PD patients.
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Affiliation(s)
- Xingzhe Gao
- Department of organ transplantation, Qilu Hospital of Shandong University, Jinan, PR China
| | - Zhiguo Peng
- Department of organ transplantation, Qilu Hospital of Shandong University, Jinan, PR China
| | - Engang Li
- Department of organ transplantation, Qilu Hospital of Shandong University, Jinan, PR China
| | - Jun Tian
- Department of organ transplantation, Qilu Hospital of Shandong University, Jinan, PR China,CONTACT Jun Tian Department of organ transplantation, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, 250012, PR China
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Rivera AS, Vesga JI, Páez S, Astudillo K, Aldana A, Alba Y, Niño LE, Castillo JC, Sanabria M, Lindholm B, Rutherford P. Early outcomes of peritoneal dialysis in a middle-income country: A retrospective cohort study of a large dialysis network in Colombia. Perit Dial Int 2023; 43:467-474. [PMID: 37723995 DOI: 10.1177/08968608231198977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The first year of dialysis is critical given the significant risk for complications following dialysis initiation. We analysed complications during the first year among incident peritoneal dialysis (PD) patients. METHODS This retrospective cohort study comprised adult kidney failure patients starting PD in Baxter Renal Care Services in Colombia, receiving their first PD catheter between 1 January 2017 and 31 December 2020 and were followed up for up to 1 year. We analysed incidence, causes and factors associated with complications using logistic regression and transfer to haemodialysis (HD) using the Fine-Gray regression model. RESULTS Among 4743 patients receiving their first PD catheter: 4628 (97.6%) of catheter implantations were successful; 377 (7.9%) patients experienced early complications. The incidence rate of complications during the year was 0.51 events per patient-year (95% CI: 0.48-0.54). Age, obesity and urgent start were associated with higher probability of complications after catheter implantation. The cumulative incidence of transfer to HD within 1 year of PD initiation was 10.1% [95% CI: 9.2-11.1%]. The hazard function for transfer to HD showed an accelerating pattern during the first month followed by progressive decrease during the first year. CONCLUSIONS In this large population of incident PD patients, there is a high primary catheter placement success rate. Urgent start, age ≥65 years, obesity, centre size ≥150 PD patients and diabetes were risk factors associated with early complications. The follow-up of the cohort from day 1 of PD treatment showed that the risk for transfer to HD was higher during the first month.
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Affiliation(s)
| | | | - Sergio Páez
- Departamento de Estadística, Facultad de Ciencias, Universidad Nacional de Colombia, Bogotá, DC, Colombia
| | | | - Andrea Aldana
- Baxter Renal Care Services Colombia, Bogotá, DC, Colombia
| | - Yolima Alba
- Baxter Renal Care Services Colombia, Bogotá, DC, Colombia
| | - Luz E Niño
- Baxter Renal Care Services, Bucaramanga, Colombia
| | | | | | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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Zou HC, Gao MM, Chen YX, Xu CY, Tu WP, Qin XH. Analysis of the impact of peritoneal dialysis catheter tail-end design on catheter-related complications. Ther Apher Dial 2023; 27:937-948. [PMID: 37115023 DOI: 10.1111/1744-9987.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/26/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Evaluate the impact of peritoneal dialysis catheter (PDC) tail-end design variations on PDC-related complications. METHOD Effective data were extracted from databases. The literature was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions, and a meta-analysis was conducted. RESULTS Analysis revealed that the straight-tailed catheter was superior to the curled-tailed catheter in minimizing catheter displacement and complication-induced catheter removal (RR = 1.73, 95%CI:1.18-2.53, p = 0.005). In terms of complication-induced PDC removal, the straight-tailed catheter was superior to the curled-tailed catheter (RR = 1.55, 95%CI: 1.15-2.08, p = 0.004). CONCLUSION Curled-tail design of the catheter increased the risk of catheter displacement and complication-induced catheter removal, whereas the straight-tailed catheter was superior to the curled-tailed catheter in terms of reducing catheter displacement and complication-induced catheter removal. However, the analysis and comparison of factors such as leakage, peritonitis, exit-site infection, and tunnel infection did not reveal a statistically significant difference between the two designs.
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Affiliation(s)
- Hong-Chang Zou
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ming-Ming Gao
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan-Xia Chen
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cheng-Yun Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei-Ping Tu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiao-Hua Qin
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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5
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Cholerzyńska H, Zasada W, Michalak H, Miedziaszczyk M, Oko A, Idasiak-Piechocka I. Urgent Implantation of Peritoneal Dialysis Catheter in Chronic Kidney Disease and Acute Kidney Injury-A Review. J Clin Med 2023; 12:5079. [PMID: 37568481 PMCID: PMC10419992 DOI: 10.3390/jcm12155079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Acute kidney injury (AKI) and sudden exacerbation of chronic kidney disease (CKD) frequently necessitate urgent kidney replacement therapy (UKRT). Peritoneal dialysis (PD) is recognized as a viable modality for managing such patients. Urgent-start peritoneal dialysis (USPD) may be associated with an increased number of complications and is rarely utilized. This review examines recent literature investigating the clinical outcomes of USPD in CKD and AKI. Relevant research was identified through searches of the MEDLINE (PubMed), Scopus, Web of Science, and Google Scholar databases using MeSH terms and relevant keywords. Included studies focused on the emergency use of peritoneal dialysis in CKD or AKI and reported treatment outcomes. While no official recommendations exist for catheter implantation in USPD, the impact of the technique itself on outcomes was found to be less significant compared with the post-implantation factors. USPD represents a safe and effective treatment modality for AKI, although complications such as catheter malfunctions, leakage, and peritonitis were observed. Furthermore, USPD demonstrated efficacy in managing CKD, although it was associated with a higher incidence of complications compared to conventional-start peritoneal dialysis. Despite its cost-effectiveness, PD requires greater technical expertise from medical professionals. Close supervision and pre-planning for catheter insertion are essential for CKD patients. Whenever feasible, an urgent start should be avoided. Nevertheless, in emergency scenarios, USPD does remain a safe and efficient approach.
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Affiliation(s)
| | | | | | - Miłosz Miedziaszczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (H.C.); (W.Z.); (H.M.); (A.O.); (I.I.-P.)
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6
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Abderraman GM, Niang A, Mohamed T, Mahan JD, Luyckx VA. Understanding Similarities and Differences in CKD and Dialysis Care in Children and Adults. Semin Nephrol 2023; 43:151440. [PMID: 38016864 DOI: 10.1016/j.semnephrol.2023.151440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
In lower-income settings there is often a dearth of resources and nephrologists, especially pediatric nephrologists, and individual physicians often find themselves caring for patients with chronic kidney diseases and end-stage kidney failure across the age spectrum. The management of such patients in high-income settings is relatively protocolized and permits high-volume services to run efficiently. The basic principles of managing chronic kidney disease and providing dialysis are similar for adults and children, however, given the differences in body size, causes of kidney failure, nutrition, and growth between children and adults with kidney diseases, nephrologists must understand the relevance of these differences, and have an approach to providing quality and safe dialysis to each group. Prevention, early diagnosis, and early intervention with simple therapeutic and lifestyle interventions are achievable goals to manage symptoms, complications, and reduce progression, or avoid kidney failure in children and adults. These strategies currently are easier to implement in higher-resource settings with robust health systems. In many low-resource settings, kidney diseases are only first diagnosed at end stage, and resources to pay out of pocket for appropriate care are lacking. Many barriers therefore exist in these settings, where specialist nephrology personnel may be least accessible. To improve management of patients at all ages, we highlight differences and similarities, and provide practical guidance on the management of children and adults with chronic kidney disease and kidney failure. It is important that children are managed with a view to optimizing growth and well-being and maximizing future options (eg, maintaining vein health and optimizing cardiovascular risk), and that adults are managed with attention paid to quality of life and optimization of physical health.
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Affiliation(s)
- Guillaume Mahamat Abderraman
- Department of Nephrology-Dialysis, Renaissance University Hospital Center, University of N'Djamena, Chad, Africa.
| | - Abdou Niang
- Department of Nephrology-Dialysis, Dalal Diam University Hospital Center, Cheikh Anta Diop University of Dakar, Senegal, Africa
| | - Tahagod Mohamed
- Pediatric Nephrology, The Ohio State University College of Medicine, Columbus OH
| | - John D Mahan
- Pediatric Nephrology, The Ohio State University College of Medicine, Columbus OH; Nationwide Children's Hospital Center for Faculty Development, Columbus OH
| | - Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
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7
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Khan SF, Rosner MH. Optimizing peritoneal dialysis catheter placement. FRONTIERS IN NEPHROLOGY 2023; 3:1056574. [PMID: 37675363 PMCID: PMC10479565 DOI: 10.3389/fneph.2023.1056574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/22/2023] [Indexed: 09/08/2023]
Abstract
Long-term success of peritoneal dialysis as a kidney replacement therapy requires a well-functioning peritoneal dialysis catheter. With ongoing reductions in infectious complications, there is an increased emphasis on the impact of catheter-related and mechanical complications. There is currently a marked variation in the utilization of various types of catheters (double cuff vs single cuff, coiled tip vs straight tip), methods of catheter insertion (advanced laparoscopic, open surgical dissection, image guided percutaneous, blind percutaneous), timing of catheter insertion, location of catheter placement (pre-sternal v. abdominal) and peri-operative practices. Specialized approaches to catheter placement in clinical practice include use of extended catheters and embedded catheters. Marked variations in patient lifestyle preferences and comorbidities, specifically in high acuity patient populations (polycystic kidney disease, obesity, cirrhosis) necessitate individualized approaches to catheter placement and care. Current consensus guidelines recommend local procedural expertise, consideration of patient characteristics and appropriate resources to support catheter placement and long-term functioning. This review focuses on an overview of approaches to catheter placement with emphasis on a patient-centered approach.
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Affiliation(s)
- Sana F. Khan
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA, United States
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8
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Keshvari A, Meshkati Yazd SM, Keramati MR, Kamran H, Shahriarirad R, Mivefroshan A, Kiani F. Evaluation of the effectiveness of prophylactic omentopexy during laparoscopic insertion of peritoneal dialysis catheter: a case-control clinical trial. Int Urol Nephrol 2023:10.1007/s11255-023-03522-3. [PMID: 36828921 DOI: 10.1007/s11255-023-03522-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/17/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION The laparoscopic omentopexy has been described for the prevention of peritoneal dialysis catheter obstruction due to omental wrapping of the catheter. As there are some controversies and limited data regarding the outcomes of prophylactic omentopexy, we designed a study to evaluate the efficacy of prophylactic omentopexy in preventing catheter dysfunction in patients undergoing laparoscopic catheter placement. MATERIALS AND METHODS In this randomized clinical trial, patients with end-stage renal disease during 3 months were divided into two groups of peritoneal dialysis catheter implants with and without omentopexy and subsequently evaluated regarding postoperative features. RESULTS A total of 43 patients were evaluated, including 22 undergoing prophylactic omentopexies. There was no significant difference among the baseline features of the patients. There was also no significant difference regarding postoperative features, including peritonitis, leakage, reoperation, need for catheter removal, and mortality. CONCLUSION Prophylactic omentopexy did not cause any significant differences in complications. In addition, there was no benefit for decreasing postoperative outflow obstruction due to omental wrapping following peritoneal dialysis catheter insertion.
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Affiliation(s)
- Amir Keshvari
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Colorectal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Keramati
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Colorectal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Kamran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.,Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.,Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azam Mivefroshan
- Nephrology and Renal Transplant Research Center, Urmia University of Medical Science, Urmia, Iran
| | - Fakhroddin Kiani
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.
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Liu F, Zhang H, Wu H, Yang S, Liu J, Wang J. The Effects of Indobufen on Micro-Inflammation and Peritoneal Transport Function in Patients Undergoing Continuous Ambulate Peritoneal Dialysis: A Prospective Randomized Controlled Study. J Pharmacol Exp Ther 2023; 384:296-305. [PMID: 36357159 DOI: 10.1124/jpet.122.001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 10/20/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022] Open
Abstract
Indobufen possesses anticoagulant and antithrombotic effects that can improve micro-inflammation and renal function. This study aimed to examine whether indobufen could improve the microinflammatory state in patients on continuous ambulatory peritoneal dialysis (CAPD) and explore its therapeutic effects on peritoneal transport function. A total of 60 patients undergoing CAPD from October 2019 to October 2020 were selected and randomized to the control and indobufen groups. All patients received conventional treatments. Blood routine and the serum and peritoneal effusion levels of tumor necrosis factor-α (TNF-α), transforming growth factor-β1 (TGF-β1), cellular fibronectin (cFN), and vascular endothelial growth factor were determined before and after 6 months of treatment. The peritoneal equilibrium test (PET) was used to evaluate peritoneal transport function. There were no significant differences in PET results, microinflammatory state, and biochemical indices between the two groups before treatment (P > 0.05). After 6 months of treatment, platelet-to-lymphocyte ratio and serum and peritoneal effusion TNF-α levels in the indobufen group were decreased compared with the control group (P < 0.05). Serum and peritoneal effusion TGF-β1 and cFN levels in the indobufen group were reduced compared with the control group (P < 0.05). PET results in the indobufen group were decreased compared with baseline (P < 0.05). The difference in PET results between the two groups before and after treatment was statistically significant (P < 0.05). Indobufen could improve the peritoneal transport function in patients undergoing CAPD. The underlying mechanism might be related to the improvement of the microinflammatory state and peritoneal fibrosis. SIGNIFICANCE STATEMENT: Microinflammation and peritoneal fibrosis can lead to peritoneal failure in CAPD. Indobufen is a novel antiplatelet drug that can alleviate renal fibrosis and improve renal function in patients with diabetic nephropathy. Indobufen can improve the peritoneal transport function in patients undergoing CAPD. The mechanism of indobufen improving the peritoneal function might be related to the improvement of the microinflammatory state and peritoneal fibrosis.
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Affiliation(s)
- Fang Liu
- Department of Nephropathy (F.L., H.Z., S.Y., J.L., J.W.) and Department of Anesthesiology (H.W.), Third Xiangya Hospital of Central South University, Changsha, China, and Department of Nephropathy, Zhangjiajie City People's Hospital, Zhangjiajie, China (F.L.)
| | - Hao Zhang
- Department of Nephropathy (F.L., H.Z., S.Y., J.L., J.W.) and Department of Anesthesiology (H.W.), Third Xiangya Hospital of Central South University, Changsha, China, and Department of Nephropathy, Zhangjiajie City People's Hospital, Zhangjiajie, China (F.L.)
| | - Hong Wu
- Department of Nephropathy (F.L., H.Z., S.Y., J.L., J.W.) and Department of Anesthesiology (H.W.), Third Xiangya Hospital of Central South University, Changsha, China, and Department of Nephropathy, Zhangjiajie City People's Hospital, Zhangjiajie, China (F.L.)
| | - Shikun Yang
- Department of Nephropathy (F.L., H.Z., S.Y., J.L., J.W.) and Department of Anesthesiology (H.W.), Third Xiangya Hospital of Central South University, Changsha, China, and Department of Nephropathy, Zhangjiajie City People's Hospital, Zhangjiajie, China (F.L.)
| | - Jun Liu
- Department of Nephropathy (F.L., H.Z., S.Y., J.L., J.W.) and Department of Anesthesiology (H.W.), Third Xiangya Hospital of Central South University, Changsha, China, and Department of Nephropathy, Zhangjiajie City People's Hospital, Zhangjiajie, China (F.L.)
| | - Jianwen Wang
- Department of Nephropathy (F.L., H.Z., S.Y., J.L., J.W.) and Department of Anesthesiology (H.W.), Third Xiangya Hospital of Central South University, Changsha, China, and Department of Nephropathy, Zhangjiajie City People's Hospital, Zhangjiajie, China (F.L.)
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10
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Nekooeian M, Ezzatzadegan Jahromi S, Masjedi F, Sohooli M, Shekouhi R, Moaref A. The significance of volume overload in the development of pulmonary arterial hypertension in continuous ambulatory peritoneal dialysis patients. Ther Apher Dial 2022. [PMID: 36579477 DOI: 10.1111/1744-9987.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The underlying pathophysiology of pulmonary arterial hypertension (PAH) is multifactorial; however, the significance of chronic volume overload and its subsequent effects on cardiac function must be studied thoroughly. The main objective of this study was to determine the predictive parameters of PAH in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) using transthoracic echocardiography (TTE) and bioimpedance analysis (BIA). METHODS In this cross-sectional study, 43 eligible CAPD patients were chosen. The patients were examined by TTE and BIA before the morning dialysis session, and baseline patient characteristics, echocardiography, and BIA parameters were recorded. RESULTS Sixteen (37.2%) patients were diagnosed with PAH. Patients with PAH had significantly greater left atrial diameter (LAD), left ventricular mass index (LVMI), and higher grades of diastolic dysfunction (DDF). Systolic pulmonary artery pressure (sPAP) correlated with LAD (p < 0.001, r = 0.566), interventricular septal diameter (IVSD) (p = 0.004, r = 0.425), LVMI (p = 0.030, r = 0.323), and extracellular water/total body water (ECW/TBW) ratio (p = 0.002, r = 0.458). CONCLUSION Two volume status-related parameters including ECW/TBW ratio and inferior vena cava (IVC) expiratory diameter, and cardiac-related TTE findings such as LAD and DDF were predictors of sPAP in CAPD patients.
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Affiliation(s)
- Mohammad Nekooeian
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrokh Ezzatzadegan Jahromi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Internal Medicine, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Fatemeh Masjedi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Sohooli
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Shekouhi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Moaref
- Department of Cardiology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.,Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
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11
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Li Z, Fang Z, Ding H, Sun J, Li Y, Liu J, Yu Y, Zhang J. Success rates and safety of a modified percutaneous PD catheter placement technique: Ultrasound-guided percutaneous placement of peritoneal dialysis catheters using a multifunctional bladder paracentesis trocar. Medicine (Baltimore) 2022; 101:e29694. [PMID: 35945766 PMCID: PMC9351854 DOI: 10.1097/md.0000000000029694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We modified the blind Seldinger technique by incorporating ultrasound guidance and the use of a multifunctional bladder paracentesis trocar for PD catheter (PDC) placement, which can be easily performed by a nephrologist and is a feasible technique. To compare success rates and safety of our modified percutaneous PD catheter placement technique to open surgery. METHODS Two hundred and twelve stage-5 chronic kidney disease(CKD) patients receiving PD therapy from June 2016 to June 2019 were included, 105 patients treated by ultrasound-guided percutaneous placement of peritoneal dialysis catheters using a multifunctional bladder paracentesis trocar (Group A) and 107 patients receiving open surgical placement (Group B). Outcomes of patients via either catheter placement technique were retrospectively compared. The clinical success rate as defined by proper catheter drainage within 4 weeks after placement, complication rates (both technical complications and infections), and 1-year catheter survival were compared. RESULTS There was no significant difference in sex ratio, age, or previous abdominal surgery history between groups (P > .05). Both surgical time and incision length were significantly shorter in Group A than in Group B (P < .05). Clinical success rate was also higher inGroup A (P < .05). Moreover, Group A demonstrated lower overall complication rates (P < .05) and lower incidence rates of early peritonitis, initial drainage disorder, and peritubular leakage (all P < .05). One-year catheter survival was also higher in Group A (P < .05). CONCLUSION Percutaneous placement of PD catheters using our modified technique demonstrates superior success rates and safety compared to open surgery. In addition, our modified technique can be a better alternative to traditional Seldinger percutaneous catheterization for its higher success rate and safety, more accurate positioning.
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Affiliation(s)
- Zhen Li
- Department of Nephrology, The people’s hospital of Banan District, ChongQing, China
| | - Zheng Fang
- Department of Radiology, The people’s hospital of Banan District, ChongQing, China
| | - HongYun Ding
- Department of Nephrology, YongChuan Hospital of ChongQing medical university, ChongQing, China
| | - JiYe Sun
- Department of Nephrology, The people’s hospital of Banan District, ChongQing, China
| | - Yi Li
- Department of Nephrology, The people’s hospital of Banan District, ChongQing, China
| | - Jie Liu
- Department of Nephrology, The people’s hospital of Banan District, ChongQing, China
| | - YunLu Yu
- Department of Nephrology, The people’s hospital of Banan District, ChongQing, China
| | - JianBin Zhang
- Department of Nephrology, The people’s hospital of Banan District, ChongQing, China
- *Correspondence: JianBin Zhang, MD, Department of nephrology, The people’s hospital of Banan District, 659 YuNan Road, Bannan district, ChongQing, 401320 China (e-mail: )
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12
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Shi CX, Li ZX, Sun HT, Sun WQ, Ji Y, Jia SJ. Bladder perforation injury after percutaneous peritoneal dialysis catheterization: A case report. World J Clin Cases 2022; 10:7054-7059. [PMID: 36051131 PMCID: PMC9297435 DOI: 10.12998/wjcc.v10.i20.7054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/02/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Insertion of a catheter into the bladder is a rare complication of peritoneal dialysis (PD), and is mainly related to surgical injury. This paper reports a case of bladder perforation that was caused by percutaneous PD catheterization.
CASE SUMMARY A 64-year-old man underwent percutaneous PD catheterization for end-stage renal disease. On the second day after the operation, urgent urination and gross hematuria occurred. Urinalysis showed the presence of red and white blood cells. Empirical anti-infective treatment was given. On the third day after the operation, urgent urination occurred during PD perfusion. Ultrasound showed that the PD catheter was located in the bladder, and subsequent computed tomography (CT) showed that the PD catheter moved through the anterior wall into the bladder. The PD catheter was withdrawn from the bladder and catheterization was retained. Repeat CT on the fourth day after the operation showed that the PD catheter was removed from the bladder, but there was poor catheter function. The PD catheter was removed and the patient was changed to hemodialysis. CT cystography showed that the bladder healed well and the patient was discharged 14 d after the operation.
CONCLUSION Bladder perforation injury should be considered and treated timeously in case of bladder irritation during and after percutaneous PD catheterization. The use of Doppler ultrasound and other related technologies may reduce the incidence of such complications.
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Affiliation(s)
- Chun-Xia Shi
- Department of Nephrology, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Zhong-Xin Li
- Department of Nephrology, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Hai-Tao Sun
- Department of General Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Wu-Qing Sun
- Department of General Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Yu Ji
- Department of General Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China
| | - Shu-Jing Jia
- Department of Medicine, Beijing Shuangqiao Hospital, Beijing 100121, China
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13
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Jha V, Abrahams AC, Al-Hwiesh A, Brown EA, Cullis B, Dor FJMF, Mendu M, Ponce D, Divino-Filho JC. Peritoneal catheter insertion: combating barriers through policy change. Clin Kidney J 2022; 15:2177-2185. [PMID: 36381371 PMCID: PMC9384046 DOI: 10.1093/ckj/sfac136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 12/02/2022] Open
Abstract
Barriers to accessing home dialysis became a matter of life and death for many patients with kidney failure during the coronavirus disease 2019 (COVID-19) pandemic. Peritoneal dialysis (PD) is the more commonly used home therapy option. This article provides a comprehensive analysis of PD catheter insertion procedures as performed around the world today, barriers impacting timely access to the procedure, the impact of COVID-19 and a roadmap of potential policy solutions. To substantiate the analysis, the article includes a survey of institutions across the world, with questions designed to get a sense of the regulatory frameworks, barriers to conducting the procedure and impacts of the pandemic on capability and outcomes. Based on our research, we found that improving patient selection processes, determining and implementing correct insertion techniques, creating multidisciplinary teams, providing appropriate training and sharing decision making among stakeholders will improve access to PD catheter insertion and facilitate greater uptake of home dialysis. Additionally, on a policy level, we recommend efforts to improve the awareness and feasibility of PD among patients and the healthcare workforce, enhance and promulgate training for clinicians—both surgical and medical—to insert PD catheters and fund personnel, pathways and physical facilities for PD catheter insertion.
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Affiliation(s)
- Vivekanand Jha
- George Institute for Global Health India, New Delhi, India; School of Public Health, Imperial College, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Alferso C Abrahams
- Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Abdullah Al-Hwiesh
- Department of Internal Medicine, Nephrology Division, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Brett Cullis
- Renal and Intensive Care Unit, Hilton Life Hospital, South Africa
- Department of Child Health, University of Cape Town, South Africa
| | - Frank J M F Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Mallika Mendu
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - José Carolino Divino-Filho
- Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Latin America Chapter- Diálisis Domiciliaria (LAC-DD)
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14
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Oza-Gajera BP, Abdel-Aal AK, Almehmi A. Complications of Percutaneous Peritoneal Dialysis Catheter. Semin Intervent Radiol 2022; 39:40-46. [PMID: 35210731 PMCID: PMC8856778 DOI: 10.1055/s-0041-1741484] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A functional peritoneal dialysis (PD) catheter is the cornerstone for the success of renal replacement therapy. This success is largely dependent on adhering to best practices during catheter insertion, which starts with a comprehensive preoperative evaluation that helps in determining the catheter configuration type and both entry and exit sites. Additionally, following the best practice guidelines during PD catheter insertion minimizes undesirable complications and provides a durable functional access for dialysis. However, adverse complications are still encountered despite abiding with these clinical guidelines. These complications are categorized into mechanical and infectious groups. The description and management of these adverse events are discussed in detail in this article with particular attention to the technical pitfalls that can occur during catheter insertion. Avoiding these pitfalls can minimize PD catheter complications and potentially improve clinical outcomes.
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Affiliation(s)
| | - Ahmed K. Abdel-Aal
- Department of Interventional Radiology, University of Texas at Houston, Houston, Texas
| | - Ammar Almehmi
- Department of Radiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama,Address for correspondence Ammar Almehmi, MD 619 19th Street South, Birmingham, AL 35249
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15
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Granata A, Rahbari E, Di Nicolò P, Battaglia Y, Campo I, Fresilli D, Pacini P, Lucatelli P, Barr RG, Cantisani V, Zeiler M. The Underrated Role of Ultrasound in Peritoneal Dialysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:301-310. [PMID: 33780019 DOI: 10.1002/jum.15710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 06/12/2023]
Abstract
Ultrasound is very effective in performing procedures and assessment of complications in peritoneal dialysis. The ultrasound examination can be applied for preoperative assessment, during the peritoneal catheter placement, for the detection and monitoring of infection, as well as for the evaluation of the catheter malfunction. Despite being not only a cost- and time-saving technique but also a bedside procedure, ultrasonography remains an underrated clinical tool in the field of peritoneal dialysis. This publication wants to explain and reinforce the clinical utility of US in PD and to expand the diagnostic equipment for the clinician.
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Affiliation(s)
- Antonio Granata
- Nephrology and Dialysis Unit, "Cannizzaro" Hospital, Catania, Italy
| | - Elnaz Rahbari
- Nephrology and Dialysis Unit, "Cannizzaro" Hospital, Catania, Italy
| | - Pierpaolo Di Nicolò
- Nephrology and Dialysis Unit, "Santa Maria della Scaletta" Hospital, Imola, Italy
| | - Yuri Battaglia
- Nephrology and Dialysis Unit, "St. Anna" University Hospital, Ferrara, Italy
| | - Irene Campo
- Department of Radiology, "Civile di Conegliano" Hospital, Conegliano, Italy
| | - Daniele Fresilli
- Department of Radiology, "Sapienza" University of Rome, Rome, Italy
| | - Patrizia Pacini
- Department of Radiology, "Sapienza" University of Rome, Rome, Italy
| | | | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA
- Southwoods Imaging, Youngstown, Ohio, USA
| | - Vito Cantisani
- Department of Radiology, "Sapienza" University of Rome, Rome, Italy
| | - Matthias Zeiler
- Nephrology and Dialysis Unit, "Carlo Urbani" Hospital, Jesi, Italy
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16
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Foley catheter used for peritoneal dialysis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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Fissell RB, Schlundt D, Cavanaugh KL, Mueller C, Umeukeje EM, Nair D, Wild M, Chariwala S, Guide A, Stewart T, Wallston K. A Cross-sectional Study of Fixed and Growth Mindset in Adult Peritoneal Dialysis Patients. J Patient Exp 2021; 8:23743735211055289. [PMID: 34820508 PMCID: PMC8606950 DOI: 10.1177/23743735211055289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Increasing home dialysis prevalence is an international priority. Many patients start peritoneal dialysis, then transition to hemodialysis after complications. New strategies are needed to support modality persistence. Health mindset refers to individual belief about capacity to change to improve health. Mindset was measured in a cross-section of 101 adult peritoneal dialysis patients from April 2019 to June 2020. The Health Mindset Scale was administered to characterize the continuum of fixed vs. growth mindset with respect to health. Health literacy and health self-efficacy were also assessed. Participants were 43% female, 32% African American, and 42% diabetic. Health mindset scores were skewed toward growth (range 3-18), with average (SD) 12.83 (4.2). Growth mindset was strongly associated with health self-efficacy. Adults receiving peritoneal dialysis report health mindset variation. Growth mindset and health self-efficacy correlation suggests measurement of similar constructs, demonstrating convergent validity. The Health Mindset Scale may identify individuals who could benefit from targeted interventions to improve mindset, and foster peritoneal dialysis modality persistence.
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Affiliation(s)
- Rachel B Fissell
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Kerri L Cavanaugh
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Ebele M Umeukeje
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Devika Nair
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marcus Wild
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Saqib Chariwala
- New York Institute of Technology College of Osteopathic Medicine, New York, USA
| | - Andrew Guide
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth Wallston
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
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18
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Zhang D, Li R, He J, Peng Y, Liu H, Liu X, Lu F. The "Half-Perc" technique using a simple modified metal trocar for peritoneal dialysis catheter placement: results of a 3-year follow-up of 280 patients and a literature review. Int Urol Nephrol 2021; 54:1741-1749. [PMID: 34813024 DOI: 10.1007/s11255-021-03028-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE There is an ongoing debate about the ideal technique for peritoneal dialysis (PD) catheter insertion in patients with end-stage renal disease (ESRD). A half-percutaneous ("Half-Perc") technique shares some of the advantages of both percutaneous technique and traditional open surgery. This retrospective study aimed to evaluate the clinical feasibility, safety, and effects of the "Half-Perc" technique for PD catheter placement, and to compare the clinical outcomes of the "Half-Perc" technique with various imaging-assisted percutaneous techniques from the current literature. METHODS We included 280 consecutive patients with ESRD who underwent the "Half-Perc" insertion of the first PD catheter between September 2016 and September 2019. We recorded baseline characteristics, operative parameters, catheter-related complications, catheter survival, and the reason behind PD cessation. RESULTS We included 174 men and 106 women, with a mean age of 50.4 years (range, 11-85 years). The mean operative time was 28.8 min (range, 15-38 min) and technical success rate was observed in 278 patients (99.3%). There were 28 episodes (10%) of mechanical complications with initial catheters occurring during the follow-up. Catheter malfunctions were the most common mechanical complication and were observed in 15 patients. Peritonitis was the most frequent catheter-related complication, with 32 episodes of peritonitis observed in 29 (10.4%) patients. After a mean follow-up period of 15.4 months (range, 2-36 months), 235 patients (83.9%) survived with their initial PD catheter by the end of the study. Of the 280 patients analyzed, 35 patients (12.5%) ceased PD at some stage during follow-up. The most common reason for PD cessation was kidney transplantation (18 patients (6.4%)), followed by death (9 patients (3.2%)) and switch to hemodialysis (HD) (7 patients (2.5%)), and recovery of renal failure (1 patient (0.4%)). CONCLUSION The "Half-Perc" technique, including a modified metal trocar, is a simple, safe, and effective method for PD catheter placement that can be used for patients with ESRD.
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Affiliation(s)
- Difei Zhang
- The Second Clinical College of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, China
| | - Rongrong Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510405, China
| | - Jingwen He
- The Second Clinical College of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510405, China
| | - Yu Peng
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, China.
| | - Hui Liu
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, China
| | - Xusheng Liu
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, China
| | - Fuhua Lu
- The Second Clinical College of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510405, China. .,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, China.
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19
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Zhao L, Yang J, Bai M, Dong F, Sun S, Xu G. Risk Factors and Management of Catheter Malfunction During Urgent-Start Peritoneal Dialysis. Front Med (Lausanne) 2021; 8:741312. [PMID: 34790676 PMCID: PMC8591039 DOI: 10.3389/fmed.2021.741312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Catheter malfunction is a common complication of peritoneal dialysis (PD). This study aimed to retrospectively analyze the risk factors and management of catheter malfunction in urgent-start PD. Methods: Patients who underwent urgent-start PD were divided into catheter-malfunction and control groups. Baseline demographic and laboratory data of the two groups were compared, and the risk factors for catheter malfunction were analyzed. Primary outcome measure was catheter survival, and the secondary outcomes were surgical complications and malfunction treatment. Results: Total of 700 patients was analyzed, among whom 143 (20.4%) experienced catheter malfunctions, specifically catheter migration (96, 67.1%), omental wrapping (36, 25.2%), and migration plus omental wrapping (11, 7.7%). Catheter survival time in the malfunction group (202.5 ± 479.4 days) was significantly shorter than that in the control group (1295.3 ± 637.0 days) (P < 0.001). Multivariate analysis revealed higher body mass index [hazard ratio (HR), 1.061; 95% confidence intervals (CI), 1.010–1.115; P = 0.018], lower surgeon count (HR, 1.083; 95% CI, 1.032–1.136; P = 0.001), and higher serum potassium (HR, 1.231; 95% CI, 1.041–1.494; P = 0.036) as independent risk factors for catheter malfunction, while older age (HR, 0.976, 95% CI, 0.962–0.991; P = 0.002) and colonic dialysis (HR, 0.384; 95% CI, 0.254–0.581; P < 0.001) as protective factors. Further subgroup analysis revealed a shorter catheter survival time in patients with younger age ( ≤ 40 years), higher serum potassium levels (≥5 mmol/L), while a longer catheter survival time in patients with colonic dialysis. PD tube and subcutaneous tunnel preservation was successful in 41 out of 44 patients with omental wrapping. All patients had good post-incision prognoses. Conclusions: Urgent-start PD is safe and effective for unplanned PD patients. Adequate pre-operative colonic dialysis and serum potassium level control are conducive in preventing catheter malfunction. Conservative treatment is effective in managing catheter migration alone, while preservation of the PD tube and the subcutaneous tunnel is effective for omental wrapping.
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Affiliation(s)
- Lijuan Zhao
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China
| | - Jun Yang
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China
| | - Ming Bai
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China
| | - Fanfan Dong
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China
| | - Shiren Sun
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China
| | - Guoshuang Xu
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China
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20
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Chang HH, Chang CH, Hsiao CY, Kao SY, Chen JY, Chen TH, Tsai PJ. Diabetes Is the Most Critical Risk Factor of Adverse Complications After Peritoneal Dialysis Catheter Placement. Front Med (Lausanne) 2021; 8:719345. [PMID: 34778285 PMCID: PMC8578184 DOI: 10.3389/fmed.2021.719345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Peritoneal dialysis (PD) is a kind of renal replacement therapy for end-stage renal disease (ESRD). While PD has many advantages, various complications may arise. Methods: This retrospective study analyzed the complications of ESRD patients who received PD catheter implantation in a single medical center within 15 years. Results: This study collected 707 patients. In the first 14 days after PD implantation, 54 patients experienced bleeding complications, while 47 patients experienced wound infection. Among all complications, catheter-related infections were the most common complication 14 days after PD implantation (incidence: 38.8%). A total of 323 patients experienced PD catheter removal, of which 162 patients were due to infection, while 96 were intentional due to kidney transplantation. Excluding those whose catheters were removed due to transplantation, the median survival of the PD catheter was 4.1 years; among them, patients without diabetes mellitus (DM) were 7.4 years and patients with DM were 2.5 years (p < 0.001). Further, 50% probability of surviving was beyond 3.5 years in DM patients with HbA1CC < 7 and 1.6 years in DM patients with HbA1C <7 (p ≥ 0.001). Conclusions: Catheter-related infections were the most common complications following PD catheter implantation. DM, especially with HbA1C ≥7, significantly impacted on the catheter-related infection and the survival probability of the PD catheter.
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Affiliation(s)
- Hsiao-Huang Chang
- Division of Cardiovascular Surgery, Department of Surgery, Veterans General Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Chen-Yuan Hsiao
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Yi Kao
- Ten-Chan General Hospital Zhongli, Taoyuan, Taiwan
| | - Jinn-Yang Chen
- Division of Nephrology, Department of Medicine, Veterans General Hospital, Taipei, Taiwan
| | - Tien-Hua Chen
- School of Medicine, Institute of Anatomy and Cell Biology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Surgery, Trauma Center, Veterans General Hospital, Taipei, Taiwan.,Division of General Surgery, Department of Surgery, Veterans General Hospital, Taipei, Taiwan
| | - Pei-Jiun Tsai
- School of Medicine, Institute of Anatomy and Cell Biology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Surgery, Trauma Center, Veterans General Hospital, Taipei, Taiwan.,Department of Critical Care Medicine, Veterans General Hospital, Taipei, Taiwan
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21
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S2231 Transcolonic Placement of Peritoneal Dialysis Catheter: A Delayed Cause of Bacterial Peritonitis. Am J Gastroenterol 2021. [DOI: 10.14309/01.ajg.0000782456.97435.2a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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22
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Dogra PM, Nair RK, Sood V, Datt B, Katyal A, Jairam A, Hooda A, Mendonca S, Mukherjee D, Chauhan P, Murari T. Pneumoperitoneum needle vs. introducer needle: Comparison of complications and short-term outcomes in percutaneously inserted peritoneal dialysis catheters in naïve abdomens. Ther Apher Dial 2021; 26:212-219. [PMID: 33998155 DOI: 10.1111/1744-9987.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
Percutaneous peritoneal dialysis catheter (PDC) insertion for continuous ambulatory peritoneal dialysis (CAPD) entails a higher risk of complications such as bowel injury, vascular injury, and catheter migration compared to the surgical insertions. We conducted a comparative analysis of two techniques of peritoneal entry for PDC insertion by Seldinger technique. We performed a retrospective review of 426 percutaneously inserted PDCs in nonobese naïve abdomens for CAPD at two tertiary care teaching hospitals in India over 6 years. Comparison of various mechanical complications, and short-term catheter survival was done between use of introducer needle (Group "I") and spring-loaded pneumoperitoneum (Veress) needle (Group "V"). Group "I" to "V" patient ratio was 277:149. Group "I" had heavier patients (p = 0.03) whereas "V" group had a dominance of diabetes (p = 0.009) and prior hemodialysis patients (p = 0.03). At 3 months, the odds of mechanical complications (OR = 0.27, p = 0.004), PDC migration (OR = 0.18, p = 0.02), and omental wrapping (OR = 0.13, p = 0.04) were less in "V" group. No bowel injury occurred with Veress needle use. At 6 months, "V" group had higher odds of event-free sustained PDC tip position (OR = 0.39, p = 0.003), and catheter survival (p = 0.03), and the cumulative events were lesser too (p = 0.002). Refractory peritonitis and deaths with functioning catheter were comparable between both the groups. In this first-of-its-kind study, spring-loaded Veress pneumoperitoneum needle use was safer, entrusted sustained PDC tip position in pelvis, and had a better catheter survival compared to use of introducer needle for peritoneal entry in percutaneously inserted PDCs. These findings should be confirmed by a randomized controlled study.
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Affiliation(s)
| | - Ranjith K Nair
- Department of Nephrology, Army Hospital (R&R), New Delhi, India
| | - Vivek Sood
- Department of Nephrology, Army Hospital (R&R), New Delhi, India
| | - Bhaskar Datt
- Department of Nephrology, Army Hospital (R&R), New Delhi, India
| | - Amit Katyal
- Department of Nephrology, Army Hospital (R&R), New Delhi, India
| | | | - Ashok Hooda
- Department of Nephrology, Army Hospital (R&R), New Delhi, India
| | - Satish Mendonca
- Department of Nephrology, Army Hospital (R&R), New Delhi, India
| | | | | | - Tomala Murari
- Department of Nephrology, Military Hospital, Jalandhar, India
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23
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Ma Y, Liu S, Yang M, Zou Y, Xue D, Wang Y, Xie X, Chen H, Liu Y. Establishment of a prediction model for early and mid-term complications for patients undergoing catheter insertion for peritoneal dialysis. J Int Med Res 2021; 49:3000605211004524. [PMID: 33853434 PMCID: PMC8059045 DOI: 10.1177/03000605211004524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To investigate the factors involved in early and mid-term complications after catheter insertion for peritoneal dialysis and to establish prediction models. Methods A total of 158 patients with peritoneal dialysis in the Department of Nephrology of our hospital were retrospectively analyzed. General information, laboratory indices, early complications (within 1 month after the operation), mid-term complications (1–6 months after the operation), and other relevant data were recorded. Multivariate logistic regression analysis was performed to establish a prediction model of complications and generate a nomogram. Receiver operating characteristic (ROC) curve analysis was used to evaluate the efficacy of the model. Results Among the patients, 48 (30.8%) had early complications, which were mainly catheter-related complications, and 29 (18.4%) had mid-term complications, which were mainly abdominal infection and catheter migration. We constructed a prediction model for early complications (area under the curve = 0.697, 95% confidence interval: 0.609–0.785) and mid-term complications (area under the curve = 0.730, 95% confidence interval: 0.622–0.839). The sensitivity was 0.750 and 0.607, and the specificity was 0.589 and 0.765, respectively. Conclusions Our prediction model has clinical significance for risk assessment of early and mid-term complications and prevention of complications after catheterization for peritoneal dialysis.
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Affiliation(s)
- Yibo Ma
- Department of Ultrasound, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Shuiqing Liu
- Department of Ultrasound, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Min Yang
- Department of Nephrology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yun Zou
- Department of Nephrology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Dong Xue
- Department of Urology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yufeng Wang
- Department of Ultrasound, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiao Xie
- Department of Ultrasound, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Hui Chen
- Department of Ultrasound, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yanping Liu
- Department of Ultrasound, the Third Affiliated Hospital of Soochow University, Changzhou, China
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Ma Y, Liu S, Yang M, Zou Y, Xue D, Liu Y, Wang Y, Xie X, Chen H. Association between different peritoneal dialysis catheter placement methods and short-term postoperative complications. BMC Nephrol 2021; 22:151. [PMID: 33902497 PMCID: PMC8074448 DOI: 10.1186/s12882-021-02340-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 04/08/2021] [Indexed: 02/08/2023] Open
Abstract
Background Considering that current peritoneal dialysis has its own shortcomings, In this study, the Seldinger technique was modified to explore the relationship between different catheter placement methods of peritoneal dialysis and short-term postoperative complications. Methods We retrospectively analyzed the data of 157 patients who received peritoneal dialysis in the Department of Nephrology of our hospital from January 2017 to December 2019. According to different catheter placement methods, the patients were divided into three groups: 111 cases of open surgery technique, 23 cases of Seldinger technique, and 23 cases of modified Seldinger technique (ultrasound-guided Veress needle puncture). The general data, laboratory indexes, and abdominal infection and catheter-related complications within one month postoperatively were collected. Results There were 48 (31.0 %) cases of complications in 157 patients within one month postoperatively, which were mainly catheter-related complications (45 cases, 29.0 %). The incidence of catheter tip peritoneal drift (catheter migration) in the three groups was 27.3 %, 39.1 %, and 9.1 %, respectively, with no significant difference between groups (P = 0.069). Univariate logistic regression analysis showed that the systolic blood pressure, history of abdominal and pelvic surgery, creatinine, and modified Seldinger technique were possible impact factors of catheter migration (P < 0.10). After fully adjusting for confounding factors, Compared with the open surgery group, the modified Seldinger method group significantly reduced the risk of catheter migration with an OR of 0.161 (95 % confidence interval: 0.027–0.961, P = 0.045); However, the difference between the Seldinger method group and the open surgery group was not significant, with an OR of 1.061 (95 % confidence interval: 0.308–3.649, P = 0.926). Curve fitting showed that the average incidence of catheter migration in the three groups was 27.3 % (95% CI: 15.9-42.7 %), 28.5 % (95% CI: 10.7-56.9 %), and 5.7 % (95% CI: 1.0-27.0 %); the modified Seldinger method has the lowest average incidence of catheter migration. Conclusions Modified Seldinger technique can significantly reduce catheter-related short-term complications after peritoneal dialysis, and it is especially effective in reducing the incidence of catheter migration. Modified Seldinger technique is a safe and feasible method for the placement of a peritoneal dialysis catheter.
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Affiliation(s)
- Yibo Ma
- Department of Ultrasound, the Third Affiliated Hospital of Soochow University, 213003, Changzhou, China
| | - Shuiqing Liu
- Department of Ultrasound, the Third Affiliated Hospital of Soochow University, 213003, Changzhou, China
| | - Min Yang
- Department of Nephrology, the Third Affiliated Hospital of Soochow University, 213003, Changzhou, China
| | - Yun Zou
- Department of Nephrology, the Third Affiliated Hospital of Soochow University, 213003, Changzhou, China
| | - Dong Xue
- Department of Urology, the Third Affiliated Hospital of Soochow University, 213003, Changzhou, China
| | - Yanping Liu
- Department of Ultrasound, the Third Affiliated Hospital of Soochow University, 213003, Changzhou, China
| | - Yufeng Wang
- Department of Ultrasound, the Third Affiliated Hospital of Soochow University, 213003, Changzhou, China
| | - Xiao Xie
- Department of Ultrasound, the Third Affiliated Hospital of Soochow University, 213003, Changzhou, China.
| | - Hui Chen
- Department of Ultrasound, the Third Affiliated Hospital of Soochow University, 213003, Changzhou, China.
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Dogra PM, Nair RK, Katyal A, Shanmugraj G, Hooda AK, Jairam A, Mendonca S, Chauhan PS. Peritoneal Dialysis Catheter Insertion by Nephrologist Using Minilaparotomy: Do Survival and Complications Vary in Obese? Indian J Nephrol 2021; 31:124-129. [PMID: 34267433 PMCID: PMC8240946 DOI: 10.4103/ijn.ijn_341_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/27/2020] [Accepted: 09/26/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction: Peritoneal dialysis catheter (PDC) placement for chronic kidney disease (CKD) amongst overweight and obese patients is difficult owing to deeper operating field. Literature being discordant on survival and complications in this patient subset, we attempted to analyse this research question in Indian population. Materials and Methods: We retrospectively analysed PDC inserted by nephrologist using surgical minilaparotomy for survivals and complications amongst 'overweight and obese' cohort ('O') at two tertiary care government hospitals in India, and compared results with normo-weight cohort ('N'), with 12−36 months follow-up. Results: 245 PDCs were inserted by surgical minilaparotomy and 'N' to 'O' ratio was 169:76. 'O' group were more rural residing (P = 0.003) and post-abdominal surgery (P = 0.008) patients. The 1, 2, and 3-year death censored catheter survival rate was 98.6%, 95.8%, and 88.2% respectively in 'O' group, and 97.6%, 94.5% and 91.8% in 'N' group respectively (P = 0.52). Patient survival (P = 0.63), mechanical complications (P = 0.09) and infective complications (P = 0.93) were comparable despite technically challenging surgery in 'O' group. Refractory peritonitis related PDC removal was comparable (P = 0.54). Prior haemodialysis or catheter related blood stream infections or diabetes were non-contributory to results. Conclusions: Catheter survival and patient survival amongst obese and overweight CAPD patients was non-inferior to normal weight patients. Mechanical, and infective complications were comparable despite technically challenging abdominal terrain in 'O' group. The overall CAPD performance was good amongst obese and overweight.
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Affiliation(s)
| | - Ranjith K Nair
- Department of Nephrology, Command Hospital, Kolkata, West Bengal, India
| | - Amit Katyal
- Department of Nephrology, Command Hospital, Kolkata, West Bengal, India
| | - G Shanmugraj
- Department of Nephrology, Command Hospital, Kolkata, West Bengal, India
| | - Ashok K Hooda
- Department of Nephrology, Command Hospital, Kolkata, West Bengal, India
| | - Anantharam Jairam
- Department of Nephrology, Command Hospital, Kolkata, West Bengal, India
| | - Satish Mendonca
- Department of Nephrology, Command Hospital, Kolkata, West Bengal, India
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Ogawa K, Maruyama Y, Matsuo N, Tanno Y, Ohkido I, Hirano K, Ikeda M, Yokoo T. The efficacy and safety of a novel method of peritoneal dialysis catheter insertion from the McBurney point. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00307-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Catheter dysfunction, especially omental wrapping, is a serious complication of peritoneal dialysis (PD). Although catheter implantation at a lower site was reported to prevent omental wrapping, this method could induce insufficient drainage of the PD solution and cause pain or a persistent desire to defecate, when the intraperitoneal catheter is of insufficient length or when its tip is in direct contact with the pelvic floor, respectively. The aim of this study was to assess the efficacy and safety of a novel PD catheter insertion method of approaching from the McBurney point, from the outer side of the abdomen.
Methods
This retrospective study included 23 patients with end-stage renal disease who were started on PD from January 2017 to July 2018 at Ashikaga Red Cross Hospital, Tochigi, Japan. Among them, 16 patients underwent a PD catheter insertion using a conventional method, whereas 7 patients underwent a novel method of approaching from the McBurney point. Infectious and mechanical complications were evaluated until August 2020.
Results
There were 18 men and 5 women, with a mean age of 63.1 ± 13.6 years. All patients were followed up postoperatively for a mean duration of 27.2 ± 13.4 months. No patient experienced omental wrapping, insufficient drainage of the PD solution, and pain or persistent desire to defecate in both groups. Both the incidence of infectious and mechanical complications (times per patient-year) were not statistically different between patients undergoing a conventional and a novel PD catheter insertion (0.18 vs. 0.24; p = 0.79 and 0.03 vs. 0.16; p = 0.16, respectively).
Conclusions
This novel method of PD catheter insertion from the McBurney point was safe, caused less discomfort, and was effective in preventing catheter dysfunction.
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27
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Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis. J Nephrol 2020; 34:1681-1696. [PMID: 33197001 DOI: 10.1007/s40620-020-00896-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/28/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND No consensus currently exists regarding the optimal approach for peritoneal dialysis catheter placement. We aimed to compare the outcomes of percutaneous and surgical peritoneal dialysis catheter placement. METHODS A systematic review of the literature was performed using the MEDLINE, Cochrane Library, and Scopus databases (end-of-search date: August 29th, 2020). We included studies comparing percutaneous (blind, under fluoroscopic/ultrasound guidance, and "half-perc") and surgical peritoneal dialysis catheter placement (open and laparoscopic) in terms of their infectious complications (peritonitis, tunnel/exit-site infections), mechanical complications (leakage, inflow/outflow obstruction, migration, hemorrhage, hernia, bowel perforation) and long-term outcomes (malfunction, removal, replacement, surgery required, and mortality). RESULTS Thirty-four studies were identified, including thirty-two observational studies (twenty-six retrospective and six prospective) and two randomized controlled trials. Percutaneous placement was associated with significantly lower rates of tunnel/exit-site infection [relative risk (RR) 0.72, 95% confidence interval (CI) 0.56-0.91], catheter migration (RR 0.68, 95% CI 0.49, 0.95), and catheter removal (RR 0.73, 95% CI 0.60-0.88). The 2-week and 4-week rates of early tunnel/exit-site infection were also lower in the percutaneous group (RR 0.45, 95% CI 0.22-0.93 and RR 0.41, 95% CI 0.27-0.63, respectively). No statistically significant difference was observed regarding other outcomes, including catheter survival and mechanical complications. CONCLUSION Overall, the quality of published literature on the field of peritoneal dialysis catheter placement is poor, with a small percentage of studies being randomized clinical trials. Percutaneous peritoneal dialysis catheter placement is a safe procedure and may result in fewer complications, such as tunnel/exit-site infections, and catheter migration, compared to surgical placement. PROTOCOL REGISTRATION PROSPERO CRD42020154951.
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Morris CS. Interventional Radiology Placement and Management of Tunneled Peritoneal Dialysis Catheters: A Pictorial Review. Radiographics 2020; 40:1789-1806. [DOI: 10.1148/rg.2020200063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Christopher S. Morris
- From the Department of Radiology, Larner College of Medicine, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401
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Li J, Guo W, Zhao W, Wang X, Hu W, Zhou J, Xu S, Lei H. Ultrasound-Guided Unilateral Transversus Abdominis Plane Combined with Rectus Sheath Block versus Subarachnoid Anesthesia in Patients Undergoing Peritoneal Dialysis Catheter Surgery: A Randomized Prospective Controlled Trial. J Pain Res 2020; 13:2279-2287. [PMID: 32982391 PMCID: PMC7500835 DOI: 10.2147/jpr.s264255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022] Open
Abstract
Background Peritoneal dialysis catheter placement can be performed under general anesthesia, local anesthesia or subarachnoid anesthesia (SA). Recently, studies have reported the successful placement of peritoneal dialysis catheters using a transversus abdominis plane (TAP) block and rectus sheath (RS) block. This study compared the TAP + RS block with SA for patients undergoing peritoneal dialysis catheter placement. Methods Sixty patients were randomly divided into two groups, with 30 receiving unilateral ultrasound-guided TAP + RS block anesthesia and 30 receiving SA. The demographic characteristics, anesthesia efficacy, indicators related to anesthesia or operation, hemodynamic index, postoperative pain numeric rating score (NRS), postoperative recovery indicators, complications related to anesthesia or surgery, and dosage of sedative or analgesic medication were analyzed. Results Anesthesia operation time was significantly shorter in the TAP + RS block group than in the SA group (P<0.001), while there was no significant difference in success rates (TAP + RS 93.33% [95% confidence interval, 95% CI, 83.9–102.8%] vs SA 100.00% [95% CI, 100–100%], P=0.472). Two patients in the TAP + RS group needed extra analgesia, although the dermatome pinprick sensation test gave negative results for all patients. Patients who received the TAP + RS block expressed significantly less pain on movement or at rest at 4 h and 8 h postoperative. Fewer patients needed rescue analgesia with tramadol in the postoperative period in the TAP + RS block group than in the SA group (P<0.05). The intraoperative MAP was more stable (P<0.05) in the TAP + RS group compared to the SA group. Conclusion The TAP + RS block is a safe, effective method for use as the principal anesthesia technique in PD catheter placement. Compared to SA, it has the advantages of less influence on hemodynamics and a better postoperative analgesic effect.
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Affiliation(s)
- Ji Li
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wenjing Guo
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wei Zhao
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xiang Wang
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wenmin Hu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Jie Zhou
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shiyuan Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Hongyi Lei
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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30
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Zang Z, Qiu X, Yang L, Wang X, Li Z. Different techniques for peritoneal dialysis catheter implantation: A systematic review and network meta-analysis. Perit Dial Int 2020; 41:522-532. [PMID: 32914705 DOI: 10.1177/0896860820953720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The current consensus recommended the peritoneal dialysis catheter (PDC) techniques based on the patients' anesthesia situation and previous abdominal surgery. However, the research comparing of all the existing PDC techniques is lacking. The objective was to compare the efficacy and safety of PDC techniques by network meta-analysis (NMA). A systematic review of databases was conducted to identify eligible studies. NMA was used to estimate the ranking for endpoints. Our NMA included 41 studies (9 randomized controlled trials (RCTs) and 32 observational trials) and enrolled 3902 patients, comparing three techniques: the laparoscopic catheterization (LC), open surgery catheterization (OSC), and percutaneous catheterization (PC). NMA in RCTs showed OSC had the highest incidence of catheter mechanical dysfunction, PC and LC were very similar, but this result had no statistical difference. NMA in observational studies showed that LC had the highest 1-year catheter survival but without statistical difference (LC vs. OSC: odds ratio (OR) 1.75, 95% credible intervals (CrIs) 0.90-3.40; PC vs. OSC: OR 1.55, 95% CrIs 0.80-2.97; PC vs. LC: OR 0.88, 95% CrIs 0.54-1.44). OSC had the lowest incidence for bleeding. The complications of leakage, peritonitis, and exit/tunnel infection were inconclusive due to the inconsistent results between RCTs and observational studies. Our NMA revealed LC may have the best 1-year catheter survival. PC and LC might be efficacious in lowering the mechanical dysfunction. OSC had the lowest incidence for bleeding. More RCTs with larger scale and higher quality are needed in order to obtain more credible evidence.
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Affiliation(s)
- Zhiyun Zang
- Department of Nephrology, Institute of Nephrology, West China Hospital, 12530Sichuan University, Chengdu, China.,*These authors contributed equally to this work
| | - Xiao Qiu
- Department of Nephrology, Institute of Nephrology, West China Hospital, 12530Sichuan University, Chengdu, China.,*These authors contributed equally to this work
| | - Lichuan Yang
- Department of Nephrology, Institute of Nephrology, West China Hospital, 12530Sichuan University, Chengdu, China.,*These authors contributed equally to this work
| | - Xin Wang
- Department of Nephrology, Institute of Nephrology, West China Hospital, 12530Sichuan University, Chengdu, China
| | - Zi Li
- Department of Nephrology, Institute of Nephrology, West China Hospital, 12530Sichuan University, Chengdu, China
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Harris DCH, Davies SJ, Finkelstein FO, Jha V, Donner JA, Abraham G, Bello AK, Caskey FJ, Garcia GG, Harden P, Hemmelgarn B, Johnson DW, Levin NW, Luyckx VA, Martin DE, McCulloch MI, Moosa MR, O'Connell PJ, Okpechi IG, Pecoits Filho R, Shah KD, Sola L, Swanepoel C, Tonelli M, Twahir A, van Biesen W, Varghese C, Yang CW, Zuniga C. Increasing access to integrated ESKD care as part of universal health coverage. Kidney Int 2020; 95:S1-S33. [PMID: 30904051 DOI: 10.1016/j.kint.2018.12.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/28/2018] [Indexed: 12/17/2022]
Abstract
The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle-income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide.
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Affiliation(s)
- David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | | | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India; University of Oxford, Oxford, UK
| | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Georgi Abraham
- Nephrology Division, Madras Medical Mission Hospital, Pondicherry Institute of Medical Sciences, Chennai, India
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J Caskey
- UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, UK; Population Health Sciences, University of Bristol, Bristol, UK; The Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Guillermo Garcia Garcia
- Servicio de Nefrologia, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital 278, Guadalajara, JAL, Mexico
| | - Paul Harden
- Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Brenda Hemmelgarn
- Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia; Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Australia
| | - Nathan W Levin
- Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Valerie A Luyckx
- Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland; Lecturer, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mignon I McCulloch
- Paediatric Intensive and Critical Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Mohammed Rafique Moosa
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Philip J O'Connell
- Renal Unit, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Roberto Pecoits Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | | | - Laura Sola
- Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Charles Swanepoel
- Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ahmed Twahir
- Parklands Kidney Centre, Nairobi, Kenya; Department of Medicine, The Aga Khan University Hospital, Nairobi, Kenya
| | - Wim van Biesen
- Nephrology Department, Ghent University Hospital, Ghent, Belgium
| | | | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Carlos Zuniga
- School of Medicine, Catholic University of Santisima Concepción, Concepcion, Chile
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Rajora N, Shastri S, Pirwani G, Saxena R. How To Build a Successful Urgent-Start Peritoneal Dialysis Program. ACTA ACUST UNITED AC 2020; 1:1165-1177. [DOI: 10.34067/kid.0002392020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022]
Abstract
In-center hemodialysis (HD) remains the predominant dialysis therapy in patients with ESKD. Many patients with ESKD present in late stage, requiring urgent dialysis initiation, and the majority start HD with central venous catheters (CVCs), which are associated with poor outcomes and high cost of care. Peritoneal dialysis (PD) catheters can be safely placed in such patients with late-presenting ESKD, obviating the need for CVCs. PD can begin almost immediately in the recumbent position, using low fill volumes. Such PD initiations, commencing within 2 weeks of the catheter placement, are termed urgent-start PD (USPD). Most patients with an intact peritoneal cavity and stable home situation are eligible for USPD. Although there is a small risk of PD catheter–related mechanical complications, most can be managed conservatively. Moreover, overall outcomes of USPD are comparable to those with planned PD initiations, in contrast to the high rate of catheter-related infections and bacteremia associated with urgent-start HD. The ongoing coronavirus disease 2019 pandemic has further exposed the vulnerability of patients with ESKD getting in-center HD. PD can mitigate the risk of infection by reducing environmental exposure to the virus. Thus, USPD is a safe and cost-effective option for unplanned dialysis initiation in patients with late-presenting ESKD. To develop a successful USPD program, a strong infrastructure with clear pathways is essential. Coordination of care between nephrologists, surgeons or interventionalists, and hospital and PD center staff is imperative so that patient education, home visits, PD catheter placements, and urgent PD initiations are accomplished expeditiously. Implementation of urgent-start PD will help to increase PD use, reduce cost, and improve patient outcomes, and will be a step forward in fostering the goal set by the Advancing American Kidney Health initiative.
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Kang SH, Park JW, Cho KH, Do JY. Comparison of peritoneal dialysis catheter insertion techniques by nephrologists: Surgical vs blind methods. Semin Dial 2020; 34:31-37. [PMID: 32705710 DOI: 10.1111/sdi.12904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The aim of the present study was to perform a comparative analysis of peritoneal dialysis catheter (PDC) insertion between blind and surgical methods by nephrologists. PATIENTS AND METHODS The present study enrolled 249 peritoneal dialysis patients who received first-time PDC insertion. All PDC insertions were performed using either the blind or surgical method. In our hospital during the study period, two of three nephrologists performed the blind method routinely in all eligible patients (blind group), and one of three nephrologists performed the surgical method in all eligible patients (surgical group). Catheter outcomes, including infectious or mechanical complications, functional parameters, and catheter survival, were evaluated. RESULTS The numbers of patients underwent surgical or blind methods were 105 and 144, respectively. The use of systemic analgesics in the surgical group was higher than that in the blind group. The operation time was longer in the blind group than in the surgical group. The D0 level and peritoneal Kt/V were similar between the two groups. There was no significant difference in infectious and mechanical complications between the two groups. The catheter survival and intervention-free survival were similar between the two groups (P = .995 for catheter survival and P = .723 for intervention-free survival). CONCLUSION Our study shows that catheter outcomes are similar between blind and surgical insertion techniques performed by nephrologists. These findings reveal that patients without previous major abdominal surgery would be suitable to receive any one of the two methods according to the operator-friendly technique.
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Affiliation(s)
- Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jong Won Park
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Kyu Hyang Cho
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
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Zhang D, Peng Y, Zheng T, Liu H, Wu J, Li Z, Su J, Xu Y, Hu X, Chen G, Hou H, Zhang L, Wu L, Liu X, Lu F. An analysis of the "Half-Perc" versus open surgical placement method for a peritoneal dialysis catheter: a non-inferiority cohort study. BMC Nephrol 2020; 21:288. [PMID: 32689969 PMCID: PMC7370485 DOI: 10.1186/s12882-020-01936-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 07/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background Most end-stage renal disease (ESRD) patients undergo open surgical techniques for peritoneal dialysis (PD) catheter placement. An alternative method to PD catheter implantation is the half-percutaneous (“Half-Perc”) technique based on a modified trocar that is performed by a nephrologist. The single-center, retrospective, observational, cohort study presented here aimed to compare the effects of the “Half-Perc” technique with the traditional open surgery on peritoneal catheter insertion. Methods From January 2015 to January 2018, 240 ESRD patients who received initial PD catheter placement were divided into two groups based on the “Half-Perc” technique or open surgery. All patients were followed up for 365 days or until loss of initial PD catheter or death. Prism 5 software was used to analyze baseline characteristics, operation-related parameters, mechanical complications and clinical outcomes. Results The “Half-Perc” technique showed shorter operation time, shorter incision length, lower postoperative pain scores and quick initiation of the PD program compared to the open surgery. After the 365-day follow-up, the “Half-Perc” group showed a higher rate of catheter dysfunction (4% versus 0.9%) that was corrected by conservative treatment in most patients and a lower rate of peritonitis (4% versus 9.6%) but mechanical complications and clinical outcomes did not differ between the two groups. There was also no significant difference based on overall patient mortality or catheter removal. One-year initial catheter survival and true catheter survival were not statistically different between the groups. Conclusion The “Half-Perc” placement of the PD catheter using a modified metal trocar appears to be a non-inferior alternative method and carries minimal invasiveness and risk compared to open surgical placement.
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Affiliation(s)
- Difei Zhang
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Yu Peng
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Tingting Zheng
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Hui Liu
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Jianfeng Wu
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Zewen Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Jingxu Su
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Yuan Xu
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Xiaoxuan Hu
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Guowei Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Haijing Hou
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - La Zhang
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Liwen Wu
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Xusheng Liu
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China
| | - Fuhua Lu
- The Second Clinical College of Guangzhou University of Chinese Medicine, No.111 Dade Road, Guangzhou, 510405, China. .,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, No.111 Dade Road, Guangzhou, 510120, China.
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Watchful waiting is an appropriate option for peritoneal dialysis candidates with an asymptomatic ventral hernia. Hernia 2020; 25:709-715. [PMID: 32556634 DOI: 10.1007/s10029-020-02248-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/08/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Expert consensus recommends that all ventral hernias be repaired prior to, or concomitantly with, peritoneal dialysis (PD) catheter insertion. We examined the clinical outcomes of patients undergoing initial PD catheter insertion, with asymptomatic ventral hernias that were not repaired and rather managed using a watchful waiting approach. METHODS A single-center, retrospective review of patients undergoing PD catheter insertion from 2005-2019 was performed. Patients who did not undergo repair of a pre-existing ventral hernia at the time of their initial PD catheter insertion were included. The primary endpoint was ventral hernia repair following PD catheter insertion. RESULTS Forty-one patients were included. Most patients presented with an umbilical hernia (78%). Six patients (15%) underwent ventral hernia repair at a median postoperative interval of 12 months [IQR 8-16], due to abdominal discomfort and hernia enlargement (n = 2) and incarceration (n = 2). Two patients remained asymptomatic, yet underwent ventral hernia repair at the time of renal transplantation. The cumulative incidence of ventral hernia repair within 12 and 24 months of PD catheter insertion was 13% and 21%, respectively. CONCLUSION Watchful waiting may be an acceptable option for select patients with asymptomatic ventral hernias at the time of initial PD catheter placement. These findings highlight the need to better identify factors associated with asymptomatic ventral hernias that do not warrant concomitant repair to aid surgeons in the decision-making process.
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Shao Q, Xia Y, Zhang Q, Zhang M. Intestinal fistula accompanied by recurrent peritonitis associated with peritoneal dialysis: a case report. BMC Gastroenterol 2020; 20:157. [PMID: 32448191 PMCID: PMC7245831 DOI: 10.1186/s12876-020-01303-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/11/2020] [Indexed: 11/13/2022] Open
Abstract
Background Intestinal perforation from peritoneal dialysis is rare, but the resulting complications are serious. Some patients do not necessarily have symptoms, and it can be difficult to differentiate their condition from PD-related (peritoneal dialysis-related) peritonitis, which may lead to misdiagnosis. Here we report a peritoneal dialysis patient with intestinal fistula associated with recurrent peritonitis. Case presentation A 44-year-old man had been treated for more than 6 years with peritoneal dialysis for chronic kidney disease stage-V. Abdominal computed tomography and electronic colonoscopy revealed an appendiceal fossa with adjacent fistula. The peritoneal dialysis catheter was removed, and the patient recovered with no recurrence of complications. Conclusion We report a case of a rare complication of peritoneal dialysis. The intestinal fistula in this patient was mainly caused by recurrent peritonitis and removal of the catheter could control the peritonitis.
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Affiliation(s)
- Qiuyuan Shao
- Department of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, 210008, China.
| | - Yangyang Xia
- Department of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, 210008, China
| | - Qingyan Zhang
- Department of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, 210008, China
| | - Miao Zhang
- Department of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, 210008, China
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Abstract
The cost and health burden of ESRD continues to increase globally. Total Medicare expenditure on dialysis has increased from 229 million USD in 1973 to 35.4 billion USD in 2016. Dialysis access can represent almost a tenth of these costs. Central venous catheters have been recognized as a significant factor driving costs and mortality in this population. Home dialysis, which includes peritoneal dialysis and home hemodialysis, is an effective way of reducing costs related to renal replacement therapy, reducing central venous catheter usage and in many cases improving the clinical and psychosocial aspects of patients' health. Addressing access-related issues for peritoneal dialysis, urgent-start peritoneal dialysis and home hemodialysis can have impact on the success of home dialysis. This article reviews issues related to dialysis access for home therapies.
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Luo C, Huang X, Liu T, Liu H. Research on Inner Gas Inflation Improvements in Double-layer Gas-assisted Extrusion of Micro-tubes. Polymers (Basel) 2020; 12:polym12040899. [PMID: 32294994 PMCID: PMC7240425 DOI: 10.3390/polym12040899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/31/2020] [Accepted: 04/10/2020] [Indexed: 11/28/2022] Open
Abstract
Micro-tubes have small diameters and thin wall thicknesses. When using double-layer gas-assisted extrusion (DGAE) technology to process micro-tubes, due to the influence of flow resistance, airflow from the inner gas-assisted layer cannot flow into the atmosphere through the lumen. Over time, it will inflate or even fracture the micro-tubes intermittently and periodically. To solve this problem, a new double-layer micro-tube gas-assisted extrusion die was designed in this study. Its mandrel has an independent airway leading to the lumen of the extrudate, with which the gas flow into the lumen of the extrudate can be regulated by employing forced exhaust. Using the new die, we carried out extrusion experiments and numerical calculations. The results show a significant positive correlation between micro-tube deformation and gas flow rate in the lumen of a micro-tube. Without considering the refrigerant distortion of the microtube, the flow rate of forced exhaust should be set equal to that of the gas from the inner gas-assisted layer flow into the micro-tube lumen. By doing this, the problem of the micro-tube being inflated can be eliminated without causing other problems.
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Affiliation(s)
- Cheng Luo
- College of Mechanical and Electrical Engineering, Nanchang University, Nanchang 330031, China; (C.L.); (T.L.)
| | - Xingyuan Huang
- College of Mechanical and Electrical Engineering, Nanchang University, Nanchang 330031, China; (C.L.); (T.L.)
- Correspondence:
| | - Tongke Liu
- College of Mechanical and Electrical Engineering, Nanchang University, Nanchang 330031, China; (C.L.); (T.L.)
| | - Hesheng Liu
- School of Chemical Biology and Materials Science, East China University of Technology, Nanchang 330031, China;
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Abstract
Patients receiving peritoneal dialysis (PD) encounter an increased risk for infection, bleeding, and PD fluid leakage after abdominal surgery. These complications may affect the future use of PD. Appropriate patient preparation may mitigate complications. Certain complications or procedures allow patients to remain on PD while others require transition to hemodialysis. We review the etiology and management of infection, bleeding, and PD fluid leakage associated with abdominal surgery as well as the relationship of specific abdominal procedures to continuing PD.
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Affiliation(s)
- Susie Q Lew
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC, USA
| | - Ashté Collins
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC, USA
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Li Z, Ding H, Liu X, Zhang J. Ultrasound-guided percutaneous peritoneal dialysis catheter insertion using multifunctional bladder paracentesis trocar: A modified percutaneous PD catheter placement technique. Semin Dial 2020; 33:133-139. [PMID: 32160357 PMCID: PMC7187385 DOI: 10.1111/sdi.12862] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background To evaluate the efficacy and safety of ultrasound‐guided percutaneous peritoneal dialysis catheter insertion using multifunctional bladder paracentesis trocar. Methods A retrospective review of 103 ESRD patients receiving percutaneous PD catheter insertion using a multifunctional bladder paracentesis trocar under ultrasound guidance at a single center between May 2016 and May 2018. Mechanical complications and catheter survival were evaluated over a 12‐month follow‐up. Result Catheterization using this technique required only 10‐30 minutes from the beginning of local anesthesia to the end of skin suture at the puncture site (mean 18 ± 7 minutes) and an incision length of 2‐4 cm. Moreover, only four of 103 cases required catheter removal due to poor drainage within one month after surgery, with a success rate of 96.19%. Among failures, omentum wrapping was cause in two cases, catheter displacement in one case, and protein clot blockage in one case, while there were no instances of organ injury, severe hemorrhage, peritubular leakage, hernia, peritonitis, or exit infection within one month of PD catheter insertion. Catheter survival at 1 year was 92.2%. Conclusion Percutaneous PD catheter insertion using a multifunctional bladder paracentesis trocar and ultrasound guidance is a feasible technique for ESRD patients.
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Affiliation(s)
- Zhen Li
- Department of nephrology, YongChuan Hospital, ChongQing, China
| | - Hongyun Ding
- Department of nephrology, YongChuan Hospital, ChongQing, China
| | - Xue Liu
- Department of Medical Ultrasonics, YongChuan Hospital, ChongQing Medical University, ChongQing, China
| | - Jianbin Zhang
- Department of nephrology, YongChuan Hospital, ChongQing, China
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Sola L, Levin NW, Johnson DW, Pecoits-Filho R, Aljubori HM, Chen Y, Claus S, Collins A, Cullis B, Feehally J, Harden PN, Hassan MH, Ibhais F, Kalantar-Zadeh K, Levin A, Saleh A, Schneditz D, Tchokhonelidze I, Turan Kazancioglu R, Twahir A, Walker R, Were AJ, Yu X, Finkelstein FO. Development of a framework for minimum and optimal safety and quality standards for hemodialysis and peritoneal dialysis. Kidney Int Suppl (2011) 2020; 10:e55-e62. [PMID: 32149009 PMCID: PMC7031684 DOI: 10.1016/j.kisu.2019.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/14/2019] [Accepted: 11/26/2019] [Indexed: 12/11/2022] Open
Abstract
Substantial heterogeneity in practice patterns around the world has resulted in wide variations in the quality and type of dialysis care delivered. This is particularly so in countries without universal standards of care and governmental (or other organizational) oversight. Most high-income countries have developed such oversight based on documentation of adherence to standardized, evidence-based guidelines. Many low- and lower-middle-income countries have no or only limited organized oversight systems to ensure that care is safe and effective. The implementation and oversight of basic standards of care requires sufficient infrastructure and appropriate workforce and financial resources to support the basic levels of care and safety practices. It is important to understand how these standards then can be reasonably adapted and applied in low- and lower-middle-income countries.
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Affiliation(s)
- Laura Sola
- Dialysis Unit, Centro Asistencial del Sindicato Médico del Uruguay Institución de Asistencia Médica Privada de Profesionales Sin Fines de lucro, Montevideo, Uruguay
| | - Nathan W. Levin
- Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - David W. Johnson
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Roberto Pecoits-Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Harith M. Aljubori
- Nephrology Department, Alqassimi Hospital, Sharjah, United Arab Emirates
| | - Yuqing Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Key Lab of Renal Disease, Ministry of Health of China, Beijing, China
- Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Stefaan Claus
- Nephrology Division, Ghent University Hospital, Ghent, Belgium
| | - Allan Collins
- NxStage Medical, Inc., Lawrence, Massachusetts, USA
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Brett Cullis
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa
| | | | - Paul N. Harden
- Oxford Kidney Unit, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK
| | - Mohamed H. Hassan
- Division of Nephrology, Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Fuad Ibhais
- Yatta Governmental Hospital, Yatta, Palestine
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California, USA
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdulkarim Saleh
- Department of Nephrology Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Daneil Schneditz
- Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Irma Tchokhonelidze
- Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
| | | | - Ahmed Twahir
- Parklands Kidney Centre, Nairobi, Kenya
- Department of Medicine, The Aga Khan University Hospital, Nairobi, Kenya
| | - Robert Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Anthony J.O. Were
- Renal Unit, Kenyatta National Hospital, Nairobi, Kenya
- School of Medicine, Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
- East African Kidney Institute, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Xueqing Yu
- Division of Nephrology, Guangdong Provincial People’s School of Medicine, South China University of Technology, Guangzhou, China
- Key Laboratory of Nephrology, Ministry of Health, Guangzhou, Guangdong, China
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A half-percutaneous technique for peritoneal dialysis catheter implantation using a modified trocar: a report of 84 cases. Int Urol Nephrol 2019; 51:1451-1457. [PMID: 31119517 DOI: 10.1007/s11255-019-02159-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Peritoneal dialysis (PD) catheter implantation is necessary for patients with end-stage renal disease (ESRD) to maintain continuous ambulatory PD (CAPD). In this study, we aimed to introduce a half-percutaneous technique based on a modified trocar device for the placement of a PD catheter and to evaluate the safety and efficacy of this technique and its associated short-term postoperative outcomes. METHODS Eighty-four ESRD patients who underwent PD catheter implantation with the half-percutaneous technique were recruited retrospectively between September 2016 and October 2017 from the Guangdong Provincial Hospital of Chinese Medicine. All catheter implantation procedures were performed by the same three nephrologists. The surgical protocol was described in detail, and the general intraoperative parameters and short-term complications were evaluated. RESULTS All ESRD patients underwent successful PD catheterization with our novel technique. Neither conversion from this method to traditional open surgery nor major intraoperative complications were observed. The mean operative time was 20.8 ± 4.5 min, and the incision length was 2.28 ± 0.53 cm. The operative cost was CN ¥ 1762.45 (US $261), and the length of hospital stay was 7.5 ± 0.58 days. One patient (1.19%) showed leakage, and one patient (1.19%) experienced bleeding 2 weeks after the surgery. Catheter dysfunction due to catheter tip migration occurred in nine patients (10.7%) 2 weeks after the procedure, and the placement of the catheter was corrected with conservative treatment. No visceral injuries or PD-related infections were observed up to 4 weeks after the catheters were implanted. CONCLUSIONS This half-percutaneous technique for PD catheter implantation appears to be a safe, effective and feasible procedure. This technique has the advantages of reduced surgical trauma, a shorter operative time and faster postsurgical recovery. In particular, this novel technique is easy for nephrologists to perform and therefore may help to promote and popularize PD treatment.
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Li Y, Zhu Y, Liang Z, Zheng X, Zhang H, Zhu W. A simple modified open peritoneal dialysis catheter insertion procedure reduces the need for secondary surgery. Int Urol Nephrol 2019; 51:729-736. [PMID: 30830653 DOI: 10.1007/s11255-019-02101-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/08/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this retrospective study was to assess the efficacy of a modified peritoneal dialysis catheter insertion technique for reducing the incidence of mechanical complications. METHODS We conducted a retrospective analysis of clinical data of 346 patients undergoing peritoneal dialysis catheter insertion at our peritoneal dialysis center. The traditional procedure was performed in 157 patients (group A) and the modified procedure in 189 patients (group B). The double-polyester-cuff straight Tenckhoff catheter was used in all patients. RESULTS At the end of 1 year, tunnel inflammation was more common in group A (21 patients after 0.011 patient-months follow-up versus 10 patients in group B after 0.007 patient-months of follow-up; p = 0.009). Technical survival rate of the catheter was significantly higher in group B (97.35% in group B vs. 89.81% in group A; p = 0.005). All-cause mortality was not significantly different between the two groups (4.5% in group A vs. 3.2% in group B; p = 0.532). Postoperative mechanical complications were also higher in group A (32 patients [20.4%] in group A vs. 3 patients [1.6%] in group B; p < 0.001). The incidences of complications such as hernia, dialysis fluid leakage, hemorrhage, incision infection, and prolapse of the polyester cuff were similar in the two groups. CONCLUSION The simple modified peritoneal dialysis catheter insertion procedure decreases the occurrence of catheter migration andomental encapsulation and improves the technical survival rate of the catheter.
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Affiliation(s)
- Yingqin Li
- Radiology Department, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua Road, Zhuhai, 519000, China
| | - Ye Zhu
- Nephrology Department, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua Road, Zhuhai, 519000, China
| | - Zibin Liang
- Radiotherapy Department, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua Road, Zhuhai, 519000, China
| | - Xiaobin Zheng
- Respiration Department, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua Road, Zhuhai, 519000, China
| | - Huitao Zhang
- Nephrology Department, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua Road, Zhuhai, 519000, China
| | - Weiping Zhu
- Nephrology Department, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua Road, Zhuhai, 519000, China.
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Bieber S, Mehrotra R. Peritoneal Dialysis Access Associated Infections. Adv Chronic Kidney Dis 2019; 26:23-29. [PMID: 30876613 DOI: 10.1053/j.ackd.2018.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 11/11/2022]
Abstract
Infection is a significant driver of morbidity and mortality in patients with end-stage renal disease undergoing maintenance dialysis. In the United States, septicemia and other infections account for 8% deaths in patients undergoing dialysis. In patients undergoing peritoneal dialysis (PD), PD-related peritonitis remains the most frequent treatment-related infection and is the greatest contributor to infection-related morbidity, including risk for hospitalization, and temporary or permanent transfer to hemodialysis. In the 4 decades since the introduction of ambulatory PD in clinical practice, a large number of treatment innovations have been shown to be effective in reducing the risk for exit site infection and PD-related peritonitis. Notwithstanding the evidence for efficacy of these innovations and the numerous adverse health consequences with PD-related peritonitis, the uptake of these interventions in clinical practice around the world remains inconsistent. This article reviews current knowledge with regards to prevention of PD-associated infections, and the diagnosis and management of exit site infections and peritonitis.
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Rottembourg J, Rostoker G. La réalité de la dialyse péritonéale en France : 40 ans après. Nephrol Ther 2018; 14:507-517. [DOI: 10.1016/j.nephro.2018.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/03/2018] [Accepted: 02/18/2018] [Indexed: 02/06/2023]
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Crabtree JH. Building Our Future to Provide the Most Optimal Peritoneal Access Through Surgeon Training Programs and Medical Device Development. Perit Dial Int 2018; 38:161-162. [PMID: 29848596 DOI: 10.3747/pdi.2018.00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- John H Crabtree
- Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, CA, USA
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Hu JC, Chiu KY, Wang SS, Chen CS, Ho HC, Yang CK, Chen CC, Wang SC, Lin CY, Hung SC, Cheng CL, Li JR. A Modified Application of Peritoneal Dialysis Catheter Implantation: A Revolution from the Laparoscope- to the Nephroscope-Assisted Surgery. J Endourol 2018; 32:502-508. [DOI: 10.1089/end.2018.0071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ju-Chuan Hu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Applied Chemistry, National Chi Nan University, Naitou, Taiwan
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chuan-Su Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hao-Chung Ho
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Che Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shu-Chi Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Yen Lin
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Sheng-Chun Hung
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chen-Li Cheng
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jian-Ri Li
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine and Nursing, Hung Kuang University, Taichung, Taiwan
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McQuillan RF, Lok CE. Does peritoneal dialysis have a role in urgent-start end-stage kidney disease? Semin Dial 2018; 31:325-331. [PMID: 29676003 DOI: 10.1111/sdi.12700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Despite its many positive attributes, peritoneal dialysis remains underutilized, particularly in the United States. Urgent-start peritoneal dialysis (PD) has been proposed as a method of increasing PD prevalence. Urgent-start PD has been shown to be safe, feasible, and effective. However, urgent-start PD is also accompanied by several multidimensional challenges. This article is intended to equip the reader with a practical sense of whether an urgent-start PD program would be appropriate in his or her own clinical context and if appropriate, what factors would be necessary for such a program to flourish. As such, we summarize latent factors, which are necessary to consider before instituting an urgent-start PD. Then, using a series of clinical vignettes, highlight the component parts of a successful urgent-start PD program and the patient population who stand to benefit most from this strategy. The discussion is then balanced by presenting limitations to consider in the urgent-start PD approach.
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Affiliation(s)
- Rory F McQuillan
- Division of Nephrology, Department of Medicine, University Health Network and The University of Toronto, Toronto, Ontario, Canada
| | - Charmaine E Lok
- Division of Nephrology, Department of Medicine, University Health Network and The University of Toronto, Toronto, Ontario, Canada
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50
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Wang H, Wang Y, Zhu J, Chen X, Chen C, Xiang C, Jia H, Ding G. Wang's Forceps-Assisted Percutaneous Insertion and Fixation of Peritoneal Dialysis Catheter. Artif Organs 2018; 42:728-735. [PMID: 29602176 DOI: 10.1111/aor.13121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/27/2017] [Accepted: 01/02/2018] [Indexed: 01/23/2023]
Abstract
Percutaneous insertion of peritoneal dialysis catheters is theoretically most preferred by nephrologists because of the advantages of bedside performing, surgery independence, and minimal injury over other procedures of catheter placement such as open surgical dissection or laparoscopic operation. However, blindly placing catheters in the percutaneous procedure brings the risk of catheter malposition or bowel perforation; this largely retarded it's implementation. We had previously developed a novel technique termed "Wang's forceps-assisted catheter insertion and fixation," which had been successfully applied in the open surgical catheter insertion and displaced catheter reposition in our center. In this study, we further explored the possibility of applying the Wang's forceps in the procedure of percutaneous catheter insertion both in porcine model and patients with end stage renal disease (ESRD). A total of three miniature pigs successfully received percutaneous catheter insertion using Seldinger's technique with Wang's forceps assistance. The catheters were all placed in the right position and functioning well in dialysate drainage. This novel method of percutaneous catheter insertion was then performed on 20 ESRD patients. The procedure showed effective time-saving with the average operating time of 29.2 ± 3.53 min and was well tolerated by patients with minimal pain and injury. During a follow-up time of 6 months, no complications of catheter displacement, leakage, or blockade occurred. Our preliminary observation demonstrates that utilization of Wang's forceps in a percutaneous procedure conferred benefits of accurately placing and fixing catheters while preserving the merits of minimal invasion and simple performance.
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Affiliation(s)
- Huiming Wang
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
| | - Yujuan Wang
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
| | - Jili Zhu
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
| | - Xinghua Chen
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
| | - Cheng Chen
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
| | - Cuizhi Xiang
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
| | - Houjun Jia
- Division of General Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guohua Ding
- Renal Department of Renmin Hospital, Wuhan University, Wuhan, China
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