Safety and feasibility of initiating peritoneal dialysis within 24 h after percutaneous versus surgical catheter...

End-stage kidney disease (ESKD) is a rising global health challenge. Despite superior quality of life and cost-effectiveness, only 11% of patients initiate renal replacement therapy with peritoneal dialysis (PD), primarily due to the traditional extended break-in period. Recent advancements in percutaneous catheter placement have facilitated urgent-start and early-start PD protocols. This study compared the break-in period [immediate-start PD (<24 h)] and catheter placement-related complications between percutaneous and surgical techniques.

This retrospective multicenter study analyzed 429 patients who underwent PD catheter insertion at three Mexican nephrology centers; 416 patients had confirmed ESKD. Techniques included mini-laparotomy and percutaneous methods (stylet or Seldinger). Data collection encompassed baseline characteristics, break-in periods and 30-day complications, classified as minor (mechanical and infectious) or major (bleeding, visceral perforation and death).

The majority of patients initiated PD within 24 h of catheter placement, and 49% within 6 h, 88% of patients using the Stylet technique and 58% of those using the Seldinger technique, compared with 3.8% using mini-laparotomy (P < .001). Percutaneous techniques represented 97% of the break-in periods within 6 h, whereas mini-laparotomy accounted for 91% of the break-in periods between 25 and 72 h. Complications affected 30% of the patients overall, with mechanical issues (23%) predominating, including outflow failure (19%) and catheter migration (9.1%), with no differences observed between techniques (P = .9, P = .8). The rate of repositioning was greater with the use of percutaneous methods (13%-14% vs 4%, P = .008). Infections were more common with mini-laparotomy (14% vs 7.4%-8.3%, P = .12), with exit-site infections (8.1% vs 1.4%-2.2%, P = .006) and tunnelitis (6.0% vs 0.7%-2.8%, P = .041) exhibiting significance. Mini-laparotomy increased the risk of infection (odds ratio 2.13, 95% confidence interval 1.02-4.44; P = .043).

Immediate-start PD, defined as initiation within 24 h of catheter placement, is safe and feasible. These findings support the expansion of nephrologist training in percutaneous placement.