Advanced image-guided percutaneous technique ‘acceptable’ for PD catheter placement
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Key takeaways:
- Both advanced image-guided percutaneous and advanced laparoscopic techniques had rare major complications.
- Each technique showed excellent and acceptable 1-year catheter survival.
Advanced image-guided percutaneous and advanced laparoscopic techniques are both acceptable options to place peritoneal dialysis catheters, published data show.
“Peritoneal dialysis (PD) is an underutilized therapy for kidney replacement,” Sijie Zheng, MD, PhD, of the division of nephrology at the Kaiser Permanente Medical Center in Oakland, California, wrote in a study. “Compared with in-center [hemodialysis], PD provides better preservation of residual kidney function, improvement of cognitive functioning, greater quality of life and higher likelihood of employment. Despite its many advantages, PD remains widely underutilized in the United States.”
Researchers conducted a retrospective cohort study to compare the time from referral to procedure, complication rate and 1-year catheter survival between the two options.
The study included patients who had advanced laparoscopic or advanced image-guided percutaneous peritoneal dialysis catheter placement from 2011 to 2013 in an integrated Northern California health care delivery system. Investigators identified 203 unique advanced image-guided percutaneous and 316 advanced laparoscopic procedure cases. If a patient had multiple procedures, only the first was used, leaving 197 and 288 advanced image-guided percutaneous and advanced laparoscopic cases, respectively.
Main outcomes were 1-year peritoneal dialysis catheter survival; major, minor and infectious complications; time from referral to catheter placement; and procedure time.
Advanced image-guided percutaneous and advanced laparoscopic techniques had less than 1% major complications and excellent and acceptable 1-year catheter survival, individually. The adjusted 1-year peritoneal dialysis catheter survival rate was 80% for the advanced image-guided percutaneous technique and 91% for the advanced laparoscopic technique (P = .01), according to the results. Minor and infectious complications were higher with each technique; however, reaching 45.6% in advanced image-guided percutaneous and 38.7% in advanced laparoscopic techniques (P = .01).
The median time from referral to procedure of 12 days was shorter with advanced image-guided percutaneous compared with 33 days for the advanced laparoscopic technique (P = .01). The 30-minute median procedure time for the advanced image-guided percutaneous technique was less than the 44.5 minutes seen with the advanced laparoscopic approach (P = .01).
“Overall, either approach may be appropriate, depending on patient factors, setting, available expertise and local resources,” according to Zheng and colleagues. “For patients referred for PD catheter placement at centers where advanced laparoscopic resources or expertise remain limited, the advanced image-guided percutaneous technique can provide a complementary and timely option. ... Future efforts should focus on training more laparoscopic surgeons and improving the long-term patency success of PD catheters.”
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