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After peritoneal dialysis discontinuation: When will we remove peritoneal dialysis catheter?
1Department of Nephrology, Nagoya Kyoritsu Hospital, Nagoya, Japan.
Insights
Most peritoneal dialysis patients stop therapy, often switching to hemodialysis. Preserving the peritoneal dialysis catheter may be beneficial for patients at high risk of encapsulating peritoneal sclerosis.
Area of Science:
- Nephrology
- Renal Replacement Therapy
Background:
- Peritoneal dialysis (PD) is a common treatment for end-stage kidney disease (ESKD).
- Patients often discontinue PD due to complications like ultrafiltration failure or membrane dysfunction.
- Catheter removal is standard after PD cessation, especially for infections.
Observation:
- Encapsulating peritoneal sclerosis (EPS) is a severe complication of PD, often developing post-discontinuation.
- Risk factors for EPS include high peritoneal equilibration test (PET) values, prolonged PD duration, and frequent peritonitis.
- Current evidence does not offer complete prevention for EPS.
Findings:
- Immediate catheter removal is reserved for refractory peritonitis or tunnel infections.
- The timing of catheter removal warrants consideration for PD discontinuation.
- Preserving the PD catheter allows for monitoring peritoneal function changes post-discontinuation.
Implications:
- This approach may help identify patients at high risk for EPS.
- Monitoring peritoneal function after PD cessation could inform management strategies.
- Further research is needed to optimize PD catheter management and EPS prevention.
Abstract:
Most of the peritoneal dialysis patients stop their peritoneal dialysis therapy and transfer to hemodialysis or kidney transplantation. In Japan, most end-stage kidney disease patients select hemodialysis after peritoneal dialysis discontinuation. Peritoneal dialysis catheter will be removed after stopping peritoneal dialysis. If peritoneal dialysis patients suffer from refractory peritonitis or severe tunnel infection, we remove the peritoneal dialysis catheter immediately. However, the causes of peritoneal dialysis discontinuation are ultrafiltration failure or peritoneal membrane dysfunction, and we have to consider the timing of peritoneal dialysis catheter removal. Encapsulating peritoneal sclerosis is the most important adverse event of peritoneal dialysis. And encapsulating peritoneal sclerosis often develops after stopping peritoneal dialysis. Risk factors associated with encapsulating peritoneal sclerosis are high peritoneal equilibration test values, longer peritoneal dialysis period, frequent peritonitis, and so on. There is no evidence to prevent encapsulating peritoneal sclerosis completely. Therefore, we can preserve the peritoneal dialysis catheter and assess the changes of peritoneal function after peritoneal dialysis discontinuation, if patient is suspected to have high risk of encapsulating peritoneal sclerosis.
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