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Peritoneal dialysis catheter function and survival are not adversely affected by obesity regardless of the operative technique used

Surgical Endoscopy volume 32, pages 1714–1723 (2018)Cite this article

Abstract

Background

Obesity has been considered a relative contraindication to peritoneal dialysis (PD). Surprisingly, PD catheter dysfunction rates and longevity have not been studied in the growing obese ESRD population. The aim of this study was to determine the effect of patient weight on PD catheter survival in the three insertion technique categories of advanced laparoscopy (AL), basic laparoscopy (BL), and open.

Methods

We examine retrospectively collected data on 231 consecutive PD catheter insertions at the NorthShore University HealthSystem between 2004 and 2014. Three cohorts were created based on the catheter insertion technique: open, BL using selective adhesiolysis, and AL using rectus sheath tunnel, selective omentopexy, and adhesiolysis. Primary outcomes included catheter dysfunction and catheter dysfunction-free survival for each cohort by BMI: normal weight (18.5–24.9), overweight (25–29.9), obese (≥30). Nominal variables were compared using Chi-square test, continuous variables using ANOVA or Kruskal–Wallis tests, and catheter survival was assessed using the Kaplan–Meier method with log-rank test. Statistical significance was established at 0.05.

Results

For the three BMI categories, there were no statistically significant differences in patient demographics. There were no statistically significant differences in catheter dysfunction or peri-operative complications by BMI category among all patients. This was also true in the AL cohort. Among all patients, similar 2-year dysfunction-free catheter survival was noted for normal weight, overweight, and obese patients (log-rank p = 0.79). This was also true across all insertion techniques: open (log-rank p = 0.87), BL (log-rank p = 0.41), AL (log-rank p = 0.43). In the obese cohort, the 2-year dysfunction-free catheter survival was 91.1% in AL, 83.5% in BL, and 65.7% in open (log-rank p = 0.58).

Conclusion

Obesity does not increase complications or shorten dysfunction-free PD catheter survival regardless of the operative technique used. Obesity should not be considered as a relative contraindication to PD catheter placement as it confers similar technique success to normal- and overweight individuals.

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References

  1. Adult Obesity Facts | Overweight & Obesity | CDC. https://www.cdc.gov/obesity/data/adult.html. Accessed 21 Mar 2017

  2. Kramer HJ, Saranathan A, Luke A, Durazo-Arvizu RA, Guichan C, Hou S, Cooper R (2006) Increasing body mass index and obesity in the incident ESRD population. J Am Soc Nephrol JASN 17:1453–1459. doi:10.1681/ASN.2005111241

    Article  PubMed  Google Scholar 

  3. United States Renal Data System (2015) USRDS annual data report: epidemiology of kidney disease in the United States

  4. Hsu C, McCulloch CE, Iribarren C, Darbinian J, Go AS (2006) Body mass index and risk for end-stage renal disease. Ann Intern Med 144:21–28

    Article  PubMed  Google Scholar 

  5. (1997) NKF-DOQI clinical practice guidelines for peritoneal dialysis adequacy. National Kidney Foundation. Am J Kidney Dis 30:S67–136

  6. Snyder JJ, Foley RN, Gilbertson DT, Vonesh EF, Collins AJ (2003) Body size and outcomes on peritoneal dialysis in the United States. Kidney Int 64:1838–1844. doi:10.1046/j.1523-1755.2003.00287.x

    Article  PubMed  Google Scholar 

  7. Nolph KD, Jensen RA, Khanna R, Twardowski ZJ (1994) Weight limitations for weekly urea clearances using various exchange volumes in continuous ambulatory peritoneal dialysis. Perit Dial Int J Int Soc Perit Dial 14:261–264

    CAS  Google Scholar 

  8. McDonald SP, Collins JF, Johnson DW (2003) Obesity is associated with worse peritoneal dialysis outcomes in the Australia and New Zealand patient populations. J Am Soc Nephrol JASN 14:2894–2901

    Article  PubMed  Google Scholar 

  9. McDonald SP, Collins JF, Rumpsfeld M, Johnson DW (2004) Obesity is a risk factor for peritonitis in the Australian and New Zealand peritoneal dialysis patient populations. Perit Dial Int J Int Soc Perit Dial 24:340–346

    Google Scholar 

  10. Aslam N, Bernardini J, Fried L, Piraino B (2002) Large body mass index does not predict short-term survival in peritoneal dialysis patients. Perit Dial Int J Int Soc Perit Dial 22:191–196

    Google Scholar 

  11. Johnson DW, Herzig KA, Purdie DM, Chang W, Brown AM, Rigby RJ, Campbell SB, Nicol DL, Hawley CM (2000) Is obesity a favorable prognostic factor in peritoneal dialysis patients? Perit Dial Int J Int Soc Perit Dial 20:715–721

    CAS  Google Scholar 

  12. Badve SV, Paul SK, Klein K, Clayton PA, Hawley CM, Brown FG, Boudville N, Polkinghorne KR, McDonald SP, Johnson DW (2014) The association between body mass index and mortality in incident dialysis patients. PLoS ONE 9:e114897. doi:10.1371/journal.pone.0114897

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ladhani M, Craig JC, Irving M, Clayton PA, Wong G (2016) Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: a systematic review and meta-analysis. Nephrol Dial Transplant. doi:10.1093/ndt/gfw075

    Google Scholar 

  14. Shibagaki Y, Faber MD, Divine G, Shetty A (2002) Feasibility of adequate solute clearance in obese patients on peritoneal dialysis: a cross-sectional study. Am J Kidney Dis 40:1295–1300. doi:10.1053/ajkd.2002.36904

    CAS  Article  PubMed  Google Scholar 

  15. Boyle SM, Li Y, Wilson FP, Glickman JD, Feldman HI (2017) Association of alternative approaches to normalizing peritoneal dialysis clearance with mortality and technique failure: a retrospective analysis using the United States renal data system-dialysis morbidity and mortality study, wave 2. Perit Dial Int J Int Soc Perit Dial 37:85–93. doi:10.3747/pdi.2015.00227

    Article  Google Scholar 

  16. Piraino B, Bernardini J, Centa PK, Johnston JR, Sorkin MI (1991) The effect of body weight on CAPD related infections and catheter loss. Perit Dial Int J Int Soc Perit Dial 11:64–68

    CAS  Google Scholar 

  17. Nessim SJ, Komenda P, Rigatto C, Verrelli M, Sood MM (2013) Frequency and microbiology of peritonitis and exit-site infection among obese peritoneal dialysis patients. Perit Dial Int J Int Soc Perit Dial 33:167–174. doi:10.3747/pdi.2011.00244

    Article  Google Scholar 

  18. Krezalek MA, Bonamici N, Lapin B, Carbray J, Velasco J, Denham W, Linn J, Ujiki M, Haggerty SP (2016) Laparoscopic peritoneal dialysis catheter insertion using rectus sheath tunnel and selective omentopexy significantly reduces catheter dysfunction and increases peritoneal dialysis longevity. Surgery 160:924–935. doi:10.1016/j.surg.2016.06.005

    Article  PubMed  Google Scholar 

  19. Shahbazi N, McCormick BB (2011) Peritoneal dialysis catheter insertion strategies and maintenance of catheter function. Semin Nephrol 31:138–151. doi:10.1016/j.semnephrol.2011.01.003

    Article  PubMed  Google Scholar 

  20. Mujais S, Story K (2006) Peritoneal dialysis in the US: evaluation of outcomes in contemporary cohorts. Kidney Int. doi:10.1038/sj.ki.5001912

    Google Scholar 

  21. Attaluri V, Lebeis C, Brethauer S, Rosenblatt S (2010) Advanced laparoscopic techniques significantly improve function of peritoneal dialysis catheters. J Am Coll Surg 211:699–704. doi:10.1016/j.jamcollsurg.2010.08.010

    Article  PubMed  Google Scholar 

  22. Crabtree JH, Burchette RJ (2009) Effective use of laparoscopy for long-term peritoneal dialysis access. Am J Surg 198:135–141. doi:10.1016/j.amjsurg.2008.10.019

    Article  PubMed  Google Scholar 

  23. Moist LM, Port FK, Orzol SM, Young EW, Ostbye T, Wolfe RA, Hulbert-Shearon T, Jones CA, Bloembergen WE (2000) Predictors of loss of residual renal function among new dialysis patients. J Am Soc Nephrol JASN 11:556–564

    CAS  PubMed  Google Scholar 

  24. Tam P (2009) Peritoneal dialysis and preservation of residual renal function. Perit Dial Int J Int Soc Perit Dial 29(Suppl 2):S108–S110

    Google Scholar 

  25. Rubin HR, Fink NE, Plantinga LC, Sadler JH, Kliger AS, Powe NR (2004) Patient ratings of dialysis care with peritoneal dialysis vs hemodialysis. JAMA 291:697–703. doi:10.1001/jama.291.6.697

    CAS  Article  PubMed  Google Scholar 

  26. Juergensen E, Wuerth D, Finkelstein SH, Juergensen PH, Bekui A, Finkelstein FO (2006) Hemodialysis and peritoneal dialysis: patients’ assessment of their satisfaction with therapy and the impact of the therapy on their lives. Clin J Am Soc Nephrol CJASN 1:1191–1196. doi:10.2215/CJN.01220406

    Article  PubMed  Google Scholar 

  27. Fenton SS, Schaubel DE, Desmeules M, Morrison HI, Mao Y, Copleston P, Jeffery JR, Kjellstrand CM (1997) Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates. Am J Kidney Dis 30:334–342

    CAS  Article  PubMed  Google Scholar 

  28. Heaf JG, Løkkegaard H, Madsen M (2002) Initial survival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transplant 17:112–117

    Article  PubMed  Google Scholar 

  29. Davis WT, Dageforde LA, Moore DE (2014) Laparoscopic versus open peritoneal dialysis catheter insertion cost analysis. J Surg Res 187:182–188. doi:10.1016/j.jss.2013.09.041

    Article  PubMed  Google Scholar 

  30. Klarenbach SW, Tonelli M, Chui B, Manns BJ (2014) Economic evaluation of dialysis therapies. Nat Rev Nephrol 10:644–652. doi:10.1038/nrneph.2014.145

    Article  PubMed  Google Scholar 

  31. Shih Y-CT, Guo A, Just PM, Mujais S (2005) Impact of initial dialysis modality and modality switches on Medicare expenditures of end-stage renal disease patients. Kidney Int 68:319–329. doi:10.1111/j.1523-1755.2005.00413.x

    Article  PubMed  Google Scholar 

  32. Prasad N, Sinha A, Gupta A, Sharma RK, Bhadauria D, Chandra A, Prasad KN, Kaul A (2014) Effect of body mass index on outcomes of peritoneal dialysis patients in India. Perit Dial Int J Int Soc Perit Dial 34:399–408. doi:10.3747/pdi.2013.00056

    Article  Google Scholar 

  33. Unal A, Hayri Sipahioglu M, Kocyigit I, Elmali F, Tokgoz B, Oymak O (2014) Does body mass index affect survival and technique failure in patients undergoing peritoneal dialysis? Pak J Med Sci 30:41–44. doi:10.12669/pjms.301.3807

    PubMed  PubMed Central  Google Scholar 

  34. Singh N, Davidson I, Minhajuddin A, Gieser S, Nurenberg M, Saxena R (2010) Risk factors associated with peritoneal dialysis catheter survival: a 9-year single-center study in 315 patients. J Vasc Access 11:316–322

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hsieh Y-P, Chang C-C, Wen Y-K, Chiu P-F, Yang Y (2014) Predictors of peritonitis and the impact of peritonitis on clinical outcomes of continuous ambulatory peritoneal dialysis patients in Taiwan–10 years’ experience in a single center. Perit Dial Int J Int Soc Perit Dial 34:85–94. doi:10.3747/pdi.2012.00075

    CAS  Article  Google Scholar 

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Author notes

  1. Monika A. Krezalek and Nicolas Bonamici have contributed equally to this work.

Affiliations

  1. Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA

    Monika A. Krezalek

  2. Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA

    Nicolas Bonamici, Kristine Kuchta, Brittany Lapin, JoAnn Carbray, Woody Denham, John Linn, Michael Ujiki & Stephen P. Haggerty

  3. Highland Park Hospital, 777 Park Avenue West, Ste 3464, Highland Park, IL, 60035, USA

    Stephen P. Haggerty

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  1. Monika A. Krezalek
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  2. Nicolas Bonamici
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Correspondence to Stephen P. Haggerty.

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Disclosures

Stephen P. Haggerty has following disclosures: consultant and speaker for Covidien and Medtronic Since 2013, Honorarium from Bard 2013. Monika Krezalek, Nicolas Bonamici, Brittany Lapin, JoAnn Carbray, Jose Velasco, Woody Denham, John Linn, and Michael Ujiki have no conflict of interest or financial ties to disclose.

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Krezalek, M.A., Bonamici, N., Kuchta, K. et al. Peritoneal dialysis catheter function and survival are not adversely affected by obesity regardless of the operative technique used. Surg Endosc 32, 1714–1723 (2018). https://doi.org/10.1007/s00464-017-5852-y

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Keywords

  • Peritoneal dialysis
  • Obesity
  • Peritoneal dialysis catheter dysfunction
  • Advanced laparoscopic insertion technique
  • Omentopexy
  • Rectus sheath tunnel