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Peritoneal dialysis catheter function and survival are not adversely affected by obesity regardless of the operative technique used

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Abstract

Background

Obesity has been considered a relative contraindication to peritoneal dialysis (PD). Surprisingly, PD catheter dysfunction rates and longevity have not been studied in the growing obese ESRD population. The aim of this study was to determine the effect of patient weight on PD catheter survival in the three insertion technique categories of advanced laparoscopy (AL), basic laparoscopy (BL), and open.

Methods

We examine retrospectively collected data on 231 consecutive PD catheter insertions at the NorthShore University HealthSystem between 2004 and 2014. Three cohorts were created based on the catheter insertion technique: open, BL using selective adhesiolysis, and AL using rectus sheath tunnel, selective omentopexy, and adhesiolysis. Primary outcomes included catheter dysfunction and catheter dysfunction-free survival for each cohort by BMI: normal weight (18.5–24.9), overweight (25–29.9), obese (≥30). Nominal variables were compared using Chi-square test, continuous variables using ANOVA or Kruskal–Wallis tests, and catheter survival was assessed using the Kaplan–Meier method with log-rank test. Statistical significance was established at 0.05.

Results

For the three BMI categories, there were no statistically significant differences in patient demographics. There were no statistically significant differences in catheter dysfunction or peri-operative complications by BMI category among all patients. This was also true in the AL cohort. Among all patients, similar 2-year dysfunction-free catheter survival was noted for normal weight, overweight, and obese patients (log-rank p = 0.79). This was also true across all insertion techniques: open (log-rank p = 0.87), BL (log-rank p = 0.41), AL (log-rank p = 0.43). In the obese cohort, the 2-year dysfunction-free catheter survival was 91.1% in AL, 83.5% in BL, and 65.7% in open (log-rank p = 0.58).

Conclusion

Obesity does not increase complications or shorten dysfunction-free PD catheter survival regardless of the operative technique used. Obesity should not be considered as a relative contraindication to PD catheter placement as it confers similar technique success to normal- and overweight individuals.

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Author notes

  1. Monika A. Krezalek and Nicolas Bonamici have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA

    Monika A. Krezalek

  2. Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA

    Nicolas Bonamici, Kristine Kuchta, Brittany Lapin, JoAnn Carbray, Woody Denham, John Linn, Michael Ujiki & Stephen P. Haggerty

  3. Highland Park Hospital, 777 Park Avenue West, Ste 3464, Highland Park, IL, 60035, USA

    Stephen P. Haggerty

Authors
  1. Monika A. Krezalek
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  2. Nicolas Bonamici
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  3. Kristine Kuchta
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Correspondence to Stephen P. Haggerty.

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Disclosures

Stephen P. Haggerty has following disclosures: consultant and speaker for Covidien and Medtronic Since 2013, Honorarium from Bard 2013. Monika Krezalek, Nicolas Bonamici, Brittany Lapin, JoAnn Carbray, Jose Velasco, Woody Denham, John Linn, and Michael Ujiki have no conflict of interest or financial ties to disclose.

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Krezalek, M.A., Bonamici, N., Kuchta, K. et al. Peritoneal dialysis catheter function and survival are not adversely affected by obesity regardless of the operative technique used. Surg Endosc 32, 1714–1723 (2018). https://doi.org/10.1007/s00464-017-5852-y

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