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Analysis of mechanical complications in urgent-start peritoneal dialysis

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Abstract

Background

Peritoneal dialysis (PD) is an excellent, but underutilized dialysis technique. Thus, its implementation may depend also on the chance to offer this modality of treatment to patients referred late to the nephologists. This approach has recently been named “urgent-start peritoneal dialysis” (UPD). The main barrier to this practice is represented by the fear of early mechanical complications.

Methods

All prevalent patients needing urgent-start PD at our institution between 1 January, 2009 and 31 December, 2019 were included in the study. During this period, 242 peritoneal catheters were inserted in 222 patients. In all patients, an anti-leakage/dislocation suture was made. PD was started within 24 h from catheter placement.

Results

The early incidence of leakages, catheter dislocations, omental wrappings, bleedings, peritonitis and exit-site infections was 11/242 (4.5%), 5/242 (2%), 3/242 (1.2%), 2/242 (0.8%), 6/242 (2.5%) and 4/242 (1.6%), respectively. No bowel perforations were observed. Nearly one third of the late complications (13/45; 35.2%) resulted in discontinuation of PD, while one fourth (11/45; 24.4%) required surgical revision. The remaining episodes (21/45; 46.6%) were successfully managed by a conservative approach. The survival of the catheter at 3, 6, 12, 24, 36 and 48 months was 93.6, 91.2, 84.8, 77.4, 65.5 and 59.3%, respectively. The technique survival at 3, 6, 12, 24, 36 and 48 months was 97.2, 94.9, 87.6, 78.9, 66.6 and 60.0%, respectively. The main causes of PD drop-out included infectious complications (36.8%) followed by mechanical complications (17.5%).

Conclusions

A tight seal between deep cuff and surrounding tissues (double purse-string technique) in association with a starting low-volume exchange scheme allows to minimize early and late mechanical complication in UPD.

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Authors and Affiliations

  1. Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy

    Antonio Scalamogna, Luca Nardelli, Elisa Cicero & Giuseppe Castellano

  2. Università Degli Studi di Milano, Milan, Italy

    Luca Nardelli, Elisa Cicero & Giuseppe Castellano

Authors
  1. Antonio Scalamogna
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  2. Luca Nardelli
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  3. Elisa Cicero
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  4. Giuseppe Castellano
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Contributions

Research idea and study design: LN, AS; data acquisition: LN, EC; data analysis/interpretation: LN, AS; statistical analysis: LN; supervision or mentorship: GC. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

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Correspondence to Luca Nardelli.

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We have read and understood Journal of Nephrology’s policy on disclosing conflicts of interest and declare that we have none.

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Scalamogna, A., Nardelli, L., Cicero, E. et al. Analysis of mechanical complications in urgent-start peritoneal dialysis. J Nephrol 35, 1489–1496 (2022). https://doi.org/10.1007/s40620-022-01294-0

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  • DOI: https://doi.org/10.1007/s40620-022-01294-0

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