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Ito Y, Ryuzaki M, Sugiyama H, Tomo T, Yamashita AC, Ishikawa Y, Ueda A, Kanazawa Y, Kanno Y, Itami N, Ito M, Kawanishi H, Nakayama M, Tsuruya K, Yokoi H, Fukasawa M, Terawaki H, Nishiyama K, Hataya H, Miura K, Hamada R, Nakakura H, Hattori M, Yuasa H, Nakamoto H. Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of the Japanese Society for Dialysis Therapy). RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.
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Affiliation(s)
- Hi Bahl Lee
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Min Sun Park
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Mi Kyung Cha
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Jeong Ho Kim
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Kyoung Song
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Chul Moon
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
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Affiliation(s)
- W. Kirt Nichols
- Department of Surgery University of Missouri Health Sciences Center Columbia, Missouri 65212 U.S.A
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Verrelli M, Fontaine B, Kraushar M, Fine A. Hospitalization is not Necessary for Peritoneal Dialysis Catheter Insertion. Perit Dial Int 2020. [DOI: 10.1177/089686080202200513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mauro Verrelli
- Section of Nephrology St. Boniface General Hospital Winnipeg, Manitoba, Canada
| | - Bunny Fontaine
- Section of Nephrology St. Boniface General Hospital Winnipeg, Manitoba, Canada
| | - Maryann Kraushar
- Section of Nephrology St. Boniface General Hospital Winnipeg, Manitoba, Canada
| | - Adrian Fine
- Section of Nephrology St. Boniface General Hospital Winnipeg, Manitoba, Canada
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Roueff S, Pagniez D, Moranne O, Roumilhac D, Talaszka A, De Sagazan HLM, Dequiedt P, Boulanger E. Simplified Percutaneous Placement of Peritoneal Dialysis Catheters: Comparison with Surgical Placement. Perit Dial Int 2020. [DOI: 10.1177/089686080202200216] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | | | | | - Aline Talaszka
- Service de Néphrologie, Hôpital Victor Provot, Roubaix, France
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Abstract
The ideal method for inserting continuous ambulatory peritoneal dialysis (PD) catheters remains debatable. Minimally invasive techniques are becoming more popular. The routine recommendation for starting PD is 4 – 6 weeks after catheter insertion. We planned a prospective study to evaluate whether this waiting period is necessary. From January 2003 to July 2004, 42 double-cuff Tenckhoff CAPD catheters were inserted into 41 patients. Percutaneous technique was used and PD was started on the sixth day. Only 2 pericatheter leakages (4.8%) were detected. This procedure is comparatively safe, simple, and less costly than surgical and peritoneoscopic placement. The rate of early pericatheter leakage may be lowered with this technique and PD may be started earlier.
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Affiliation(s)
- Oktay Banli
- The Nephrology and Transplantation Center, SSK Ankara Ihtisas Hospital, Ankara, Turkey
| | - Hasan Altun
- The Nephrology and Transplantation Center, SSK Ankara Ihtisas Hospital, Ankara, Turkey
| | - Aysegul Oztemel
- The Nephrology and Transplantation Center, SSK Ankara Ihtisas Hospital, Ankara, Turkey
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Crabtree JH. Fluoroscopic Placement of Peritoneal Dialysis Catheters: A Harvest of the Low-Hanging Fruits. Perit Dial Int 2020. [DOI: 10.1177/089686080802800207] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John H. Crabtree
- Department of Surgery Southern California Permanente Medical Group Kaiser Permanente Bellflower Medical Center Bellflower, California, USA
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Pethő Á, Szabó RP, Tapolyai M, Rosivall L. Bedside placement of peritoneal dialysis catheters - a single-center experience from Hungary. Ren Fail 2020; 41:434-438. [PMID: 31162993 PMCID: PMC6566899 DOI: 10.1080/0886022x.2019.1614058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: The successful implantation of peritoneal dialysis (PD) catheters is a critical skill procedure with the potential to impact both the short- and long-term success of renal replacement therapy and the patients’ survival. Methods: We retrospectively reviewed our single-center experience with nephrologist-placed minimally invasive, double-cuffed PD catheters (PDCs). Results: The recruitment period was March 2014 through December 2015. The follow-up period lasted until 2016. The mean age of the subjects was 60 ± 18 years and indications for the PD were diuretic resistant acutely decompensated chronic heart failure in seven patients (47%) and end-stage renal disease in eight (53%) patients. Comorbid conditions included diabetes (27%), ischemic heart disease (47%), advanced liver failure (27%), and a history of hypertension (73%). The cohort had a high mortality with five subjects only in severe heart failure group (33%) passing away during the index hospitalization; of the rest, two (13%) had heart transplantation, three (20%) changed modality to hemodialysis, and only five (33%) continued with maintenance PD beyond 1 month. Acute technical complications within the first month were infrequent: one catheter (6%) had drainage problems and one (6%) was lost due to extrusion. There were no serious complications (e.g., organ damage, peritonitis, etc.). Conclusions: In selected cases, particularly in severe diuretic refractory heart failure, PDC placement placed by a nephrologist is feasible with a low rate of complications even in a low-volume center setting. The catheters we placed were all functioning with only minor complications and PD could be started immediately.
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Affiliation(s)
- Ákos Pethő
- a 1st Department of Internal Medicine, Faculty of Medicine , Semmelweis University , Budapest , Hungary
| | - Réka P Szabó
- b Department of Surgery, Faculty of Medicine , University of Debrecen , Debrecen , Hungary
| | - Mihály Tapolyai
- c Medical Services , Ralph H. Johnson VA Medical Center , Charleston , SC , USA.,d Hemodialysis Unit , Fresenius Medical Care Hungary , Hatvan , Hungary
| | - László Rosivall
- e Department of Pathophysiology, International Nephrology Research and Training Center , Semmelweis University , Budapest , Hungary
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Abstract
The complications of peritoneal dialysis catheters are often due to errors made during the initial catheter insertion procedure. Other complications relate to the improper selection of the catheter type or size. Thus, many complications are preventable. This review summarizes the complications resulting from the insertion or presence of a PD catheter and classifies them as either early or late events. A short comment on early diagnosis and appropriate management is also provided.
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George N, Alexander S, David VG, Basu G, Mohapatra A, Valson AT, Jacob S, Pathak HK, Devasia A, Tamilarasi V, Varughese S. Comparison of Early Mechanical and Infective Complications in First Time Blind, Bedside, Midline Percutaneous Tenckhoff Catheter Insertion with Ultra-Short Break-In Period in Diabetics and Non-Diabetics: Setting New Standards. Perit Dial Int 2016; 36:655-661. [PMID: 27044797 PMCID: PMC5174873 DOI: 10.3747/pdi.2015.00097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 02/04/2016] [Indexed: 11/15/2022] Open
Abstract
♦ BACKGROUND: There are no large studies that have examined ultra-short break-in period with a blind, bedside, midline approach to Tenckhoff catheter insertion. ♦ METHODS: Observational cohort study of 245 consecutive adult patients who underwent percutaneous catheter insertion for chronic peritoneal dialysis (PD) at our center from January 2009 to December 2013. There were 132 (53.9%) diabetics and 113 (46.1%) non-diabetics in the cohort. ♦ RESULTS: The mean break-in period for the percutaneous group was 2.68 ± 2.6 days. There were significantly more males among the diabetics (103 [78%] vs 66 [58.4%], p = 0.001). Diabetics had a significantly higher body mass index (BMI) (23.9 ± 3.7 kg/m2 vs 22.2 ± 4 kg/m2, p < 0.001) and lower serum albumin (33.1 ± 6.3 g/L vs 37 ± 6 g/L, p < 0.001) compared with non-diabetics. Poor catheter outflow was present in 6 (4.5%) diabetics and 16 (14.2%) non-diabetics (p = 0.009). Catheter migration was also significantly more common in the non-diabetic group (11 [9.7%] vs 2 [1.5%], p = 0.004). Primary catheter non-function was present in 17(15%) of the non-diabetics and in 7(5.3%) of the diabetics (p = 0.01). There were no mortality or major non-procedural complications during the catheter insertions. Among patients with 1 year of follow-up data, catheter survival (93/102 [91.2%] vs 71/82 [86.6%], p = 0.32) and technique survival (93/102 [91.2%] vs 70/82 [85.4%], p = 0.22) at 1 year was comparable between diabetics and non-diabetics, respectively. ♦ CONCLUSIONS: Percutaneous catheter insertion by practicing nephrologists provides a short break-in period with very low mechanical and infective complications. Non-diabetic status emerged as a significant risk factor for primary catheter non-function presumed to be due to more patients with lower BMI and thus smaller abdominal cavities. This is the first report that systematically compares diabetic and non-diabetic patients.
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Affiliation(s)
- Ninoo George
- Department of Nephrology, Christian Medical College, Vellore, India
| | | | | | - Gopal Basu
- Department of Nephrology, Christian Medical College, Vellore, India
| | - Anjali Mohapatra
- Department of Nephrology, Christian Medical College, Vellore, India
| | - Anna T Valson
- Department of Nephrology, Christian Medical College, Vellore, India
| | - Shibu Jacob
- Department of Nephrology, Christian Medical College, Vellore, India
| | - Harish K Pathak
- Department of Nephrology, Christian Medical College, Vellore, India
| | - Antony Devasia
- Department of Urology, Christian Medical College, Vellore, India
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Van den Berg HR, O'Hagan S, Hurter D. Percutaneous placement of peritoneal dialysis catheters in resource-limited developing countries as an alternative to conventional placement methods. SA J Radiol 2015. [DOI: 10.4102/sajr.v19i1.707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The percutaneous placement of peritoneal dialysis (PD) catheters using conscious sedation with ultrasound and fluoroscopic guidance is underutilised and has several advantages over the open surgical and laparoscopic placement methods, especially in the resource-limited developing world. Objectives: To describe our patients’ demographics and clinical characteristics, our method of PD catheter placement within the Radiology Department at Kimberley Provincial Hospital, compare our early complication types and frequencies, overall peritonitis rate and one-year catheter survival rate with findings in the international literature and, by demonstrating comparable outcomes, propose that percutaneous placement be considered as a feasible alternative to conventional placement techniques. Method: We conducted a retrospective study on 25 patients who had their PD catheters inserted between January 2009 and May 2013. Medical records were reviewed for demographic and clinical information as well as type and frequency of early (within 30 days) and late (between 30 days and one-year) complications related to the PD catheter. Early complication types and frequencies were then compared with similar internationally published data. The overall peritonitis rate, in terms of episodes per patient-year, was calculated and compared with international recommendations, and our one-year catheter survival rate was calculated using the Kaplan Meier method and compared with similarly calculated international studies.Results: The study group comprised 16 male and 9 female patients with a median age of 44 years. Hypertension was the primary cause of end-stage renal disease (ESRD), and was found in 10 (40%) patients. Our early exit site infection rate of 12% was slightly higher than that found in the literature. Literature varies on the overall infection rates; however, our overall peritonitis rate of 0.75 episodes per patient-year was higher than that recommended by the International Society of Peritoneal Dialysis. This finding might be attributed to the lower socio-economic grouping of our patients and the small number in the study group. All but two peritonitis cases were successfully treated with antibiotics, and we had no major procedure-related complications. Our early peritonitis rate of 8%, as well as the other early complication types and rates, and our one-year catheter survival rate of 84%, compared favourably with international studies. Conclusion: Percutaneous PD catheter placement under conscious sedation with the aid of ultrasound and fluoroscopy is a sound alternative to conventional methods in the resourcelimited developing world.
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12
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Guidelines for laparoscopic peritoneal dialysis access surgery. Surg Endosc 2014; 28:3016-45. [DOI: 10.1007/s00464-014-3851-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
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Nicholas J, Thomas M, Adkins R, Sandhu K, Smith S, Odum J, Dasgupta I. Percutaneous and surgical peritoneal dialysis catheter placements have comparable outcomes in the modern era. Perit Dial Int 2014; 34:552-6. [PMID: 25074999 DOI: 10.3747/pdi.2013.00125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Johann Nicholas
- Dept of Renal Medicine Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom Dept of Renal Medicine Heart of England Foundation Trust, Birmingham, United Kingdom
| | - Mark Thomas
- Dept of Renal Medicine Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom Dept of Renal Medicine Heart of England Foundation Trust, Birmingham, United Kingdom
| | - Roger Adkins
- Dept of Renal Medicine Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom Dept of Renal Medicine Heart of England Foundation Trust, Birmingham, United Kingdom
| | - Kanwaljit Sandhu
- Dept of Renal Medicine Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom Dept of Renal Medicine Heart of England Foundation Trust, Birmingham, United Kingdom
| | - Steve Smith
- Dept of Renal Medicine Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom Dept of Renal Medicine Heart of England Foundation Trust, Birmingham, United Kingdom
| | - Jonathan Odum
- Dept of Renal Medicine Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom Dept of Renal Medicine Heart of England Foundation Trust, Birmingham, United Kingdom
| | - Indranil Dasgupta
- Dept of Renal Medicine Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom Dept of Renal Medicine Heart of England Foundation Trust, Birmingham, United Kingdom
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Medani S, Hussein W, Shantier M, Flynn R, Wall C, Mellotte G. Comparison of Percutaneous and Open Surgical Techniques for First-Time Peritoneal Dialysis Catheter Placement in the Unbreached Peritoneum. Perit Dial Int 2014; 35:576-85. [PMID: 25082842 DOI: 10.3747/pdi.2013.00003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/02/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The percutaneous Seldinger method of peritoneal dialysis catheter (PDC) insertion has gained favor over recent years whereas traditionally it was reserved for patients considered not fit for general anesthesia. This blind technique is believed to be less safe, and is hence avoided in patients with previous laparotomy incisions. Reports on the success of this method may therefore be criticized for selection bias. In those with no prior abdominal surgery the optimal method of insertion has not been established. METHODS We retrospectively reviewed the outcomes of first-time PDC placements comparing the percutaneous (group P) and surgical (group S) insertion techniques in patients without a history of previous abdominal surgery in a single center between January 2003 and June 2010. We assessed catheter survival at 3 and 12 months post-insertion and compared complication rates between the two groups. RESULTS A total of 63 percutaneous and 64 surgical catheter insertions were analyzed. No significant difference was noted in catheter survival rates between group P and group S (86.2% vs 80% at 3 months, p = 0.37; and 78.3% vs 71.2% at 12 months, p = 0.42 respectively). Early and overall peritonitis rates were similar (5% vs 5.3%; p = 1, and 3.5 vs 4.9 episodes per 100 patient-months; p = 0.13 for group P and group S respectively). There were also no significant differences between the two groups in exit site leaks (15.9% in group P vs 6.3% in group S; p = 0.15), poor initial drainage (9.5% in group P vs 10.9% in group S, p = 0.34) or secondary drainage failure (7.9% in group P vs 18.8% in group S, p = 0.09). CONCLUSION This study illustrates the success and safety of percutaneous PDC insertion compared with the open surgical technique in PD naive patients without a history of prior abdominal surgery. Catheter survival was favorable with percutaneous insertion in this low-risk patient population but larger prospective studies may help to determine whether either method is superior. The percutaneous technique can be recommended as a minimally invasive, cost-effective procedure that facilitates implementing an integrated care model in nephrology practice.
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Affiliation(s)
- Samar Medani
- Nephrology, Adelaide & Meath Hospital, Dublin, Ireland
| | - Wael Hussein
- Nephrology, Adelaide & Meath Hospital, Dublin, Ireland
| | | | - Robert Flynn
- Urology, Adelaide & Meath Hospital, Dublin, Ireland
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Medani S, Shantier M, Hussein W, Wall C, Mellotte G. A comparative analysis of percutaneous and open surgical techniques for peritoneal catheter placement. Perit Dial Int 2012; 32:628-35. [PMID: 22550118 DOI: 10.3747/pdi.2011.00187] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is the preferred available option of renal replacement therapy for a significant number of end-stage kidney disease patients. A major limiting factor to the successful continuation of PD is the long-term viability of the PD catheter (PDC). Bedside percutaneous placement of the PDC is not commonly practiced despite published data encouraging use of this technique. Its advantages include faster recovery and avoidance of general anesthesia. METHODS We carried out a retrospective analysis of the outcomes of 313 PDC insertions at our center, comparing all percutaneous PDC insertions between July 1998 and April 2010 (group P, n = 151) with all surgical PDC insertions between January 2003 and April 2010 (group S, n = 162). RESULTS Compared with group P patients, significantly more group S patients had undergone previous abdominal surgery or PDC insertion (41.8% vs 9.3% and 33.3% vs 3.3% respectively, p = 0.00). More exit-site leaks occurred in group P than in group S (20.5% vs 6.8%, p = 0.002). The overall incidence of peritonitis was higher in group S than in group P (1 episode in 19 catheter-months vs 1 episode in 26 catheter-months, p = 0.017), but the groups showed no significant difference in the peritonitis rate within 1 month of catheter insertion (5% in group P vs 7.4% in group S, p = 0.4) or in poor initial drainage or secondary drainage failure (9.9% vs 11.7%, p = 0.1, and 7.9% vs 12.3%, p = 0.38, for groups P and S respectively).Technical survival at 3 months was significantly better for group P than for group S (86.6% vs 77%, p = 0.037); at 12 months, it was 77.7% and 68.7% respectively (p = 0.126). No life-threatening complications attributable to the insertion of the PDC occurred in either group. CONCLUSIONS Our analysis demonstrates further encouraging outcomes of percutaneous PDC placement compared with open surgical placement. However, the members of the percutaneous insertion group were primarily a selected subset of patients without prior abdominal surgery or PDC insertion, therefore limiting the comparability of the groups. Studies addressing such confounding factors are required. Local expertise in catheter placement techniques may affect the generalizability of results.
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Affiliation(s)
- Samar Medani
- Nephrology, Adelaide and Meath Hospital, Dublin, Ireland.
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Crabtree JH. The Use of the Laparoscope for Dialysis Catheter Implantation: Valuable Carry-On or Excess Baggage? Perit Dial Int 2009. [DOI: 10.1177/089686080902900405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John H. Crabtree
- Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower, California, USA
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Crabtree JH, Burchette RJ. Effect of Prior Abdominal Surgery, Peritonitis, and Adhesions on Catheter Function and Long-Term Outcome on Peritoneal Dialysis. Am Surg 2009; 75:140-7. [DOI: 10.1177/000313480907500206] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adhesions from previous surgery and peritonitis can lead to peritoneal dialysis catheter insertion failure, visceral injury, and poor dialysis function. Employing a laparoscopic approach, the effect of adhesiolysis on mechanical catheter complications and long-term catheter survival was prospectively examined in 436 catheter placement procedures having a 57.8 per cent prevalence rate of previous surgery. Adhesiolysis was required in 31.8 per cent of cases with prior surgery and in 3.3 per cent of procedures without previous operations. The incidence of adhesiolysis was directly related to the number of prior surgeries ( P < 0.0001). The incidence of catheter insertion failure from extensive adhesions was 1.8 per cent. Survival probability free from catheter obstruction was lower in patients requiring adhesiolysis compared with subjects with prior surgery not requiring adhesiolysis ( P = 0.01). Laparoscopic rescue procedures limited catheter losses from flow obstruction to only 0.7 per cent. As a result, long-term catheter survival was not different among patients regardless of prior surgery and/or adhesion status ( P = 0.2). Scars on the abdomen and prior peritonitis do not predict the extent of adhesions and should not be used to judge eligibility for peritoneal dialysis. Presently, laparoscopy is the only practical way to provide optimal peritoneal access in patients with a history of surgery and peritonitis.
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Affiliation(s)
- John H. Crabtree
- Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower, California
| | - Raoul J. Burchette
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, California
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Borazan A, Comert M, Ucan BH, Comert FB, Sert M, Sekitmez N, Cesur A. The comparison in terms of early complications of a new technique and percutaneous method for the placement of CAPD catheters. Ren Fail 2006; 28:37-42. [PMID: 16526317 DOI: 10.1080/08860220500461237] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Starting continuous ambulatory peritoneal dialysis (CAPD) immediately after insertion of a peritoneal dialysis catheter is essential in end-stage renal disease (ESRD). In relation to the insertion methods, various mechanical and infectious complications may arise. In this study, we aimed to compare early complications of the laparoscopic tunneling method of CAPD placement that we developed recently in order to minimize the complications, with those of the conventional percutaneous method. SUBJECTS AND METHOD Included in this study were 12 consecutive patients with ESRD to whom we introduced catheters for CAPD by way of laparoscopic tunneling between April 2003 and July 2003 and followed up for at least 6 months, and 30 patients to whom the catheters were placed percutaneously in the same time period with the same follow-up time. The complications seen during the first 6 months after catheter placement with these two different methods were compared. RESULTS In all of the subjects, dialysis was started soon after catheter placement. No peroperative morbidity was seen in any of the patients. While with laparoscopic tunneling method no mechanical problem was seen, the percutaneous method resulted in early leakage in 10%, pericatheter bleeding in 3.3%, and hernia in 3.3% of the patients. As infectious complications, peritonitis occurred as one episode/36 patient-months in laparoscopic tunneling and one episode/22.5 patient-months in percutaneous method; catheter insertion site infection was seen in none in the laparoscopic method, while one episode/90patient-months was seen with the percutaneous method. Tunnel infection did not arise in any of the subjects. CONCLUSION The authors of this study think that the peritoneal tunneling method for introducing CAPD, which has been recently developed and began to be routinely used by them, is rather safe in terms of early complications.
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Affiliation(s)
- Ali Borazan
- Department of Internal Medicine, Zonguldak Karaelmas University, The School of Medicine, Zonguldak, Turkey.
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Dauchy FA, Etienne G, Deminière C, Combe C, Merville P, Longy-Boursier M. [Lymphoma with initial renal involvement: four cases]. Rev Med Interne 2006; 27:909-15. [PMID: 16952412 DOI: 10.1016/j.revmed.2006.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Revised: 07/06/2006] [Accepted: 07/24/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To present a comprehensive description of the clinical features of patients with renal manifestations during lymphoma. METHODS Retrospective review of medical records from all patients diagnosed with lymphoma associated with kidney involvement in our hospital between 1996 to 2004. Four cases were identified and analysed. RESULTS Four patients presented a non-Hodgkin's lymphoma. One patient showed intravascular large B-cell lymphoma, revealed by proteinuria. Another patient had a nephrotic syndrome, and two had a renal mass. Renal histology allowed diagnosis of lymphoma in 3 cases. CONCLUSION The diagnosis of lymphoma associated with renal involvement is rather difficult, and more specifically in case of intravascular large B-cell lymphoma, or even primary renal lymphoma. We present here a comprehensive review of the literature and we discuss pathogenesis of these conditions.
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Affiliation(s)
- F-A Dauchy
- Médecine interne et maladies tropicales, hôpital Saint-André, CHU de Bordeaux, université Bordeaux-II, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France.
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20
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Comert M, Borazan A, Kulah E, Uçan BH. A new laparoscopic technique for the placement of a permanent peritoneal dialysis catheter: the preperitoneal tunneling method. Surg Endosc 2004; 19:245-8. [PMID: 15529192 DOI: 10.1007/s00464-003-9302-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2003] [Accepted: 03/17/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Mechanical outflow obstruction and leakage from the exit site of the catheter are two common complications of continuous ambulatory peritoneal dialysis. To lessen these complications and to achieve immediate use of the catheter, we developed a new laparoscopic technique for catheter placement. METHODS A total of 12 consecutive patients with end-stage renal failure were included in this study between April 2003 and July 2003. The average age of the patients was 42.4 years (range, 37-72). Patients were excluded only if a serious risk for general anesthesia was found. Using two 5-mm ports and a 3.3-mm mini-laparoscope, a peritoneal dialysis catheter was passed through a preperitoneal tunnel before the tip of the catheter was introduced into the pelvis. Routine peritoneal dialysis was started immediately after the operation while the patients were still in the operating room. RESULTS The mean operating time was 18.6 min (range, 12-37). There was no operative morbidity. The mean follow-up period was 4.3 months (range, 3-7). No leakage of the dialysate liquid or outflow obstruction was observed during this period. CONCLUSION The advantages of this method include accurate placement, preperitoneal fixation, and immediate use of the catheter for routine peritoneal dialysis. We also believe that because of the preperitoneal fixation of the catheter, this technique will decrease outflow obstruction, which usually occurs due to omental wrapping or displacement of the catheter tip.
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Affiliation(s)
- M Comert
- Department of surgery, School of Medicine, Z.K.U. Arastrima Ve Uygulama Hastanesi Bashekimligi, 67700 Zonguldak, Kozlu, Turkey.
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Abstract
The fragmented care of nephrology patients that results from referral to a radiologist for renal ultrasound (US) and biopsy, a surgeon for dialysis access placement, and an interventional radiologist for dialysis catheter placement and vascular access procedures often leads to delays in the treatment of these patients. Many specialists perform and interpret sonograms particular to their specialty rather than relying on technicians for performance and radiologists for interpretation, and nephrologists recently have begun to embrace this technology as an aid in the diagnosis and treatment of their patients. By combining an understanding of the pathophysiology of renal disease with the ability to perform clinical correlation and apply the laboratory data, the nephrologist is ideally suited to perform and interpret renal US and US guidance for percutaneous renal biopsies. Additionally, patients requiring peritoneal dialysis (PD) access have traditionally been referred to a general surgeon for catheter placement, which incurs additional delay in therapy and loss of decision-making control by the referring nephrologist. Recent data has emphasized that the peritoneal dialysis access procedure can be performed safely and effectively by a nephrologist trained in PD access procedures. Nephrologists also successfully perform tunneled hemodialysis catheter placement and vascular access procedures on an outpatient basis. The medical needs of patients with renal disease can be safely and efficiently delivered by a nephrologist trained in interventional nephrology (IN). This growing area of expertise will minimize delays, reduce cost, and allow physicians with training in the management of end-stage renal disease (ESRD) patients to be involved in the procedural aspects of their patients' care. An aggressive approach to the development of IN training programs at academic centers is warranted.
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Affiliation(s)
- Arif Asif
- Division of Nephrology, Department of Medicine, University of Miami, School of Medicine, Miami, Florida 33136, USA.
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22
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Dalgic A, Ersoy E, Anderson ME, Lewis J, Engin A, D'Alessandro AM. A novel minimally invasive technique for insertion of peritoneal dialysis catheter. Surg Laparosc Endosc Percutan Tech 2002; 12:252-4. [PMID: 12193820 DOI: 10.1097/00129689-200208000-00010] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The placement of a continuous ambulatory peritoneal dialysis (CAPD) catheter by conventional open surgical or trocar technique may cause a number of complications such as infection, hemorrhage, leakage, incisional hernia, and visceral organ perforation. Most complications are related to open surgery or insertion of the catheter with the guidewire without direct visualization. Insertion of the catheter laparoscopically under direct visualization has been previously described. The authors who described this technique used two or three ports for the camera and instruments. In this study we describe a laparoscopic technique for insertion of the peritoneal dialysis catheter under direct visualization with use of one-camera port and an accessory 2-mm umbilical incision. This prospective study was performed with the approval of the ethics committee of the Gazi University Hospital, in Ankara, Turkey. There were a total of eight patients: five males and three females, with an average age of 34.3 years (range, 11-54), who underwent laparoscopic CAPD insertion between 1997 and 2000. The catheter was inserted into the abdominal cavity 2 cm below the umbilicus. The subcutaneous tunnel was made with the assistance of a specially designed L-shaped trocar. All patients did well after the operation and had excellent cosmetic results. There was one leak in the early postoperative period, which was treated conservatively. The average operating time was 34.7 minutes (range, 25-45 minutes). The laparoscopic approach for peritoneal dialysis catheter insertion, for management of transmigrated CAPD catheters, and to resolve omental occlusions should be considered as an alternative to open surgery, especially for patients who have peritoneal adhesions secondary to a history of abdominal surgeries or recurrent peritonitis.
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Affiliation(s)
- Aydin Dalgic
- Department of Surgery, Gazi University Hospital, Besevler, 06510 Ankara, Turkey.
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23
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Moll S, Nickeleit V, Mueller-Brand J, Brunner FP, Maecke HR, Mihatsch MJ. A new cause of renal thrombotic microangiopathy: yttrium 90-DOTATOC internal radiotherapy. Am J Kidney Dis 2001; 37:847-51. [PMID: 11273886 DOI: 10.1016/s0272-6386(01)80135-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The chelator somatostatin analogue dota-D-phe(1)-tyr(3)-octreotide (DOTATOC), which is stably labeled with the beta-emitting radioisotope yttrium 90 ((90)Y), is used as internal radiotherapy for the treatment of patients with advanced neuroendocrine tumors. We report 5 patients who developed chronic renal failure, caused in 3 patients by biopsy-proven thrombotic microangiopathy (TMA). Twenty-nine patients (14 men, 15 women) with normal renal function before therapy were treated with divided intravenous doses of (90)Y-DOTATOC approximately 6 weeks apart (mean normalized cumulative dose, 165.4 +/- 36.4 mCi/m(2)). Twenty-two of 29 patients were administered a normalized cumulative dose of 200 mCi/m(2) without side effects. Among the 7 patients (6 women, 1 man) administered a normalized cumulative dose greater than 200 mCi/m(2), 5 patients (4 women, 1 man) developed renal failure. Increasing serum creatinine levels were observed within 3 months after the last (90)Y-DOTATOC injection. The evolution was rapidly progressive in 3 patients, resulting in end-stage renal failure within 6 months. The remaining 2 patients developed chronic renal insufficiency (mean serum creatinine level, 300 micromol/L an average 16 months after the end of treatment). Renal biopsies performed in 3 patients showed typical signs of TMA involving glomeruli, arterioles, and small arteries. Patients treated with high-dose (90)Y-DOTATOC internal radiotherapy (cumulative dose > 200 mCi/m(2)) are at high risk to develop severe renal failure caused by TMA lesions. The histopathologic lesions are identical to those found after external radiotherapy, which suggests a causal relationship between (90)Y-DOTATOC and renal TMA.
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Affiliation(s)
- S Moll
- Institute of Pathology, Institute of Nuclear Medicine, and Department of Medicine, University of Basel, Kantonsspital, Switzerland
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24
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Eklund B. Peritoneal Dialysis Access. Int J Artif Organs 1996. [DOI: 10.1177/039139889601900701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- B.H. Eklund
- Fourth Department of Surgery, Helsinki University Central Hospital, Helsinki - Finland
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