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Peritoneal catheter-related complications: a comparison between hemodialysis and intermittent peritoneal dialysis in
Insights
Hemodialysis (HD) and intermittent peritoneal dialysis (IPD) are safe for peritoneal catheter (PC) break-in periods. However, IPD is linked to higher pericatheter leakage, cuff erosion, and delayed training.
Area of Science:
- Nephrology
- Surgical Innovation
- Renal Replacement Therapy
Background:
- Peritoneal dialysis (PD) is a crucial renal replacement therapy.
- Catheter complications can impact PD efficacy and patient outcomes.
- Optimizing the initial 'break-in' period for PD catheters is essential.
Purpose of the Study:
- To compare the incidence of peritoneal catheter (PC)-related complications between hemodialysis (HD) and intermittent peritoneal dialysis (IPD) support during the PC break-in period.
- To identify risk factors for PC complications, particularly pericatheter leakage.
Main Methods:
- Prospective monitoring of 89 patients with double-cuff PCs over one year.
- Group A: 36 patients supported with HD.
- Group B: 53 patients supported with IPD for four weeks before continuous ambulatory peritoneal dialysis (CAPD).
Main Results:
- Higher incidence of pericatheter leakage in the IPD group (13%) compared to the HD group (0%) (p < 0.05).
- Diabetic patients showed a significantly higher rate of pericatheter leakage (71% vs 22%).
- IPD patients with leakage experienced more external cuff erosion and delayed CAPD training.
Conclusions:
- Both HD and IPD are safe for the PC break-in period.
- IPD support is associated with an increased risk of pericatheter leakage.
- Pericathether leakage in IPD patients correlates with cuff erosion and delayed CAPD training, highlighting the need for careful monitoring.
Abstract:
We prospectively monitored the clinical outcome of 89 curled, double-cuff peritoneal catheters (PC) implanted by surgeons over one year. Thirty-six cases (40%) were supported with hemodialysis (HD) (group A) and 53 cases (60%) were supported with weekly intermittent peritoneal dialysis (IPD) (small exchange volume with a cycler) (group B) for four weeks before commencing continuous ambulatory peritoneal dialysis (CAPD). PC-related complications between the two groups were compared. Ten cases failed to complete the six-month observation period (8 died, 1 received kidney transplant, and 1 defaulted follow-up),Total experience accumulated was 494 patient-months (195 patient-months in group A, 299 patient-months in group B). The incidence of pericatheter leakage (group A vs group B) was significantly higher in group B (0% vs 13%, p < 0.05). There were no significant differences in the incidence of other PC-related complications, removal of PC, and mortality rate in the two groups. The incidence of pericatheter leakage was significantly higher in diabetic patients (71% vs 22%, p < 0.05), and group B patients with leakage had a higher incidence of external cuff erosion 57% vs 7%, p < 0.005) and delay in CAPD training (71% vs 7%, p < 0.005). We conclude that both HD and IPD are equally safe renal replacement therapies in the break-in period, while patients supported with IPD had a higher incidence of pericatheter leakage, which was associated with other catheter-related morbidities including external cuff erosion and delay in CAPD training.