Clinical Characteristics and Outcomes of Ultrasound-Guided Percutaneous Peritoneal Dialysis Catheter Insertion: An ISN Interventional Nephrology Training Center Experience

Background: A functioning dialysis catheter is vital in initiating patients in peritoneal dialysis. The catheter can be inserted through the following techniques: Open surgery, laparoscopy, peritoneoscopy, or percutaneous. The advantages of percutaneous technique are the following: Less delay in initiation of renal replacement therapy, can performed at bedside or in a day-surgery room, can be done with local anesthesia alone, lower cost and shorter hospital stay. The objective of this study is to demonstrate the clinical characteristics and outcomes of ultrasound-guided peritoneal dialysis catheter insertion at the National Institute of Cardiology, Mexico City, Mexico and an International Society of Nephrology (ISN) Training Hospital for Interventional Nephrology.

Methods: The medical records of patients who underwent the ultrasound-guided percutaneous peritoneal dialysis catheter insertion from July 2019 to September 2022 were retrospectively reviewed. A total of 36 patients were analyzed. The different clinical characteristics such as age, gender, diagnosis, BMI, blood pressure and laboratory results were recorded. The outcomes: Successful catheter insertions, location of puncture, duration of procedure and early complications (<30 days) were also recorded and analyzed.

Results: The mean age was 51.58 ± 17.2 years with equal distribution of males and females. More than half of patients (55.6%) had a previous abdominal surgery, with appendectomy as the most common (13.9%). Their diagnoses were generally classified into two–chronic kidney disease stage 5 (55.6%) and cardiorenal syndrome (44.4%). The main indication for the procedure was initiation of renal replacement therapy (88.9%). The mean BMI was 23.09 ± 0.763 kg/m². The majority of patients had anemia with mean hemoglobin of 8.43 ± 0.51 g/L, but the bleeding parameters were within normal: Platelets 204.05 ± 14.88 × 109/L, INR 1.09 (1.03–1.18) and PTT 31.70 (28.3–34.70) seconds. The mean BUN was 48.59 ± 4.3 mg/dl and mean creatinine was 5.88 ± 0.65 mg/dl.

Successful percutaneous insertion of the peritoneal dialysis catheter occurred in 77.8% (28/36). The majority of the procedures were done using a left paramedian approach (92.9%) as the entry or puncture site. Punctures were successful on the first attempt (89.3%). The average duration of the procedure was 84.82 ± 31 minutes. A high percentage (89.3 %) of patients did not develop any early complication. One patient had an exit site leak (3.6%) and two patients suffered visceral injuries [intestinal puncture (3.6%) and uterine injury (3.6%)]. Only age was noted to be significantly different from the patients with complications, as compared to the patients without complications. Patients with complications were older with a mean age of 68 ± 3.60 years old.

Conclusion: An ultrasound-guided percutaneous placement of peritoneal dialysis catheter can be performed safely and offers a clinically effective alternative to surgical technique. The majority of the outcomes are similar or better compared to what has been reported in the literature.

Author(s): Rafael Parcarey Montepio1,2*, Jose Daniel Juarez Villa1, Mariza Wendy Colque Cano1, Benjamin Garcia Aguilar1, Hirepam Armenta Alvarez 1, Magdalena Madero Rovalo1 and Bernardo Moguel Gonzalez1

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