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Clinical impact of catheter insertion for peritoneal dialysis on patient survival and catheter-related complications

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Abstract

Objectives

The stepwise initiation of peritoneal dialysis (PD) using Moncrief and Popovich’s technique (SMAP) for catheter insertion is recommended for the systemic introduction of PD and prevention of catheter-related infections. In this study, we investigated patient outcomes in patients who underwent insertion of a PD catheter with a direct method versus the SMAP method.

Methods

We enrolled 295 consecutive patients who underwent PD as a primary renal replacement therapy and underwent insertion of a PD catheter at our institute between 2006 and 2021. We retrospectively reviewed their data and investigated patient outcomes, including mortality and PD catheter-related complications.

Results

Median age at PD induction was 65 years in the direct insertion group and 65 years in the SMAP group (P = 0.80). The rate of PD introduction after emergency hemodialysis was significantly higher in the direct insertion group than in the SMAP group (P < 0.001). There was no significant difference in survival between the direct insertion and SMAP groups during the median follow-up period of 54 months (P = 0.12). Additionally, patients who transitioned to hemodialysis or kidney transplantation after PD showed significantly longer survival (P < 0.001). The incidence of PD catheter-related complications was not significantly different between the two groups. A body mass index ≥ 23 kg/m2 was an independent risk factor for peritonitis and exit-site infection (P = 0.006 and P = 0.011, respectively).

Conclusions

Planned sequential renal replacement therapy including hybrid hemodialysis, complete hemodialysis, and kidney transplantation after PD is important for improving patient outcomes. PD catheter insertion by SMAP may not be mandatory in our clinical practice.

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Availability of data and material

The datasets generated and/or analyzed during the current study are not publicly available due to our hospital policy but are available from the corresponding author on reasonable request.

Abbreviations

BMI:

Body mass index

BW:

Body weight

CI:

Confidence interval

CKD:

Chronic kidney disease

EPS:

Encapsulating peritoneal sclerosis

ESI:

Exit site infection

HD:

Hemodialysis

HR:

Hazard ratio

IQR:

Interquartile ranges

KT:

Kidney transplantation

OR:

Odds ratio

PD:

Peritoneal dialysis

RRT:

Renal replacement therapy

SMAP:

Stepwise initiation of peritoneal dialysis using Moncrief and Popovich’s technique

SPIED:

Short-term peritoneal dialysis induction and education

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Acknowledgements

The authors would like to thank all patients who participated in this study for their important contributions.

Funding

No funding was obtained for the present study.

Author information

Authors and Affiliations

  1. Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Shunta Hori, Mitsuru Tomizawa, Kuniaki Inoue, Tatsuo Yoneda, Akira Tachibana, Kenta Onishi, Yosuke Morizawa, Daisuke Gotoh, Yasushi Nakai, Makito Miyake, Kazumasa Torimoto, Nobumichi Tanaka & Kiyohide Fujimoto

  2. Department of Prostate Brachytherapy, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Nobumichi Tanaka

Authors
  1. Shunta Hori
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  2. Mitsuru Tomizawa
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  3. Kuniaki Inoue
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  4. Tatsuo Yoneda
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  5. Akira Tachibana
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  9. Yasushi Nakai
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  11. Kazumasa Torimoto
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  13. Kiyohide Fujimoto
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Contributions

SH, NT, TY, and KF contributed to conception and design. SH, MT, KI, AT, KO, YM, DG, YN, MM, and KT contributed to acquisition of patients’ data, and analysis and interpretation of data. SH, MT, and TY performed the treatment. All authors have been involved in drafting the manuscript and revising it critically for important intellectual content and approved the version to be published. All authors have participated sufficiently in this work to take public responsibility for appropriate portions of the content.

Corresponding author

Correspondence to Kiyohide Fujimoto.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval and consent to participate

The Institutional Review Board of Nara Medical University approved this study. The reference number was 3455.

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Hori, S., Tomizawa, M., Inoue, K. et al. Clinical impact of catheter insertion for peritoneal dialysis on patient survival and catheter-related complications. Clin Exp Nephrol 27, 941–950 (2023). https://doi.org/10.1007/s10157-023-02382-6

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  • DOI: https://doi.org/10.1007/s10157-023-02382-6

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