Who should place peritoneal dialysis catheters?

Area of Science:

• Nephrology
• Surgical Access Procedures
• Dialysis Program Management

Background:

• Nephrologists struggle to expand peritoneal dialysis programs due to suboptimal surgeon performance in catheter placement.
• A call exists for nephrologists to become primary dialysis access providers.

Purpose of the Study:

• To explore factors influencing nephrologists becoming dialysis access providers.
• To identify reasons for surgeon underperformance and potential motivators for improvement.

Main Methods:

• Analysis of US practice data, including dialysis center size, specialties performing catheter placement, nephrology workforce capacity, implantation techniques, and surgeon performance.
• Review of evidence on resource utilization and outcomes.

Main Results:

• Nephrology workforce is at maximum capacity; training programs lack adequate peritoneal dialysis experience.
• Only 2.3% of peritoneal catheters are placed by nephrologists.
• Laparoscopic methods by surgeons yield best outcomes, but performance is hampered by inadequate training, low volume, and poor reimbursement.

Conclusions:

• Nephrologists are unlikely to become primary dialysis access providers.
• Enhancing surgical workforce performance requires improved training, procedure centralization, and outcomes-based reimbursement.