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Peritoneal Dialysis Catheter Emplacement by Advanced Laparoscopy: 8-year Experience from a Medical Center of China.

ABSTRACT: Laparoscopic experience and relevant reports about PD catheter emplacement in Chinese patients are seldom. In this study, we described our experience with advanced laparoscopy for PD catheter implantation in Chinese patients. There were one hundred and thirty Chinese patients accepted advanced laparoscopic approach for PD catheter emplacement in this study. Six of 26 patients with prior abdominal operations had abdominal adhesion, while six of 104 patients without prior abdominal surgeries showed abdominal adhesion. Operation time required 10 to 180?minutes. During a mean follow-up time of 26.46 months, the catheter complications were shown as outflow obstruction (n?=?6, 4.62%), pericatheter leaking (n?=?3, 2.31%), hydrocele of tunica vaginalis (n?=?1, 0.77% in all), and umbilical hernia (n?=?2, 1.54%). Cumulative revision-free survival probability for catheter loss from mechanical complications at 8 years was 0.95. During the postoperative follow-up ranged between 6 and 106 months, 98 patients (75.38%) were still on CAPD, 17 patients (13.08%) died, 8 patients (6.15%) were transferred to hemodialysis, 6 patients (4.62%) received kidney transplantation, and 1 patient (0.77%) showed improved renal function. These results showed that PD catheter placement with advanced laparoscopy is a safe and effective approach in Chinese patients with or without prior abdominal surgeries.

SUBMITTER: Mo M

PROVIDER: S-EPMC5567303 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Peritoneal Dialysis Catheter Emplacement by Advanced Laparoscopy: 8-year Experience from a Medical Center of China.

Mo Min M Ju Yongle Y Hu Haitang H Zhang Wei W Pan Jianyi J Zheng Qingkun Q Chen Jinzhong J Su Lijuan L Dou Xianrui X

Scientific reports 20170822 1

Laparoscopic experience and relevant reports about PD catheter emplacement in Chinese patients are seldom. In this study, we described our experience with advanced laparoscopy for PD catheter implantation in Chinese patients. There were one hundred and thirty Chinese patients accepted advanced laparoscopic approach for PD catheter emplacement in this study. Six of 26 patients with prior abdominal operations had abdominal adhesion, while six of 104 patients without prior abdominal surgeries showe ...[more]

PMID: 28831180

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Project description:The COVID-19 pandemic has transformed the health landscape by hampering the management of patients with chronic diseases. Providing optimal healthcare has become a critical issue, especially for patients with end-stage renal disease (ESRD) receiving in-center dialysis. Peritoneal Dialysis (PD) has the advantage of being a home-based therapy. Several papers about COVID-19 in the chronic kidney disease (CKD) population have been published, but few studies focused on the PD population, with limited case series. In this paper, we share our strategy for managing PD patients during the pandemic and describe the characteristics of 24 episodes of COVID-19 that occurred in our PD patients. Also, we report the impact of the pandemic on different outcomes and discuss the challenges of renal replacement therapy (RRT) in the time of COVID-19 and the advantages of PD. During the period from December 2019 to September 2021, 127 patients received PD in our center. Among them, we recorded 24 episodes of COVID-19 that occurred in 20 patients, corresponding to an incidence of 8.4 per 1000 patient-months. None of the 20 patients with COVID-19 were vaccinated and there was a significant male gender predominance in the COVID-19 group compared to the non-COVID-19 group. The prevalence of diabetic nephropathy and primary glomerulonephritis were also significantly higher in the COVID-19 group. The revealing symptoms were asthenia, dry cough, and the deterioration of general conditions in 100%, 75%, and 63% of the patients, respectively. A biological inflammatory syndrome was found in 30% of the patients. Chest computed tomography (CT) scan, performed in 5 patients, showed features of COVID pneumonia with an average extent of damage of 55%. The rate of patients starting PD during the study period was comparable to that before the pandemic. Furthermore, we did not find a significant difference between the infected and the non-infected groups regarding the incidence of peritonitis, PD technique failure, and mortality (6.1 [0-1.46] vs 3.9 [0.15-0.64] deaths per 1000 patient-months. COVID-19 does not seem to have influenced the outcomes of our patients treated with PD even before the launch of mass immunization in our country. Thus, PD can be a great option for RRT in the era of the COVID-19 pandemic since many issues could be managed remotely to avoid regular hospital visits and contribute to maintaining social distancing, which is the cornerstone of breaking the chain of transmission of the novel virus.

Project description:IntroductionUrgent-start peritoneal dialysis (PD) in patients with newly diagnosed end-stage renal disease (ESRD) is a well-tolerated alternative to hemodialysis (HD). The primary aim of this study was to identify the demographic and clinical characteristics of ESRD patients, as well as the presurgical, surgical, and postsurgical factors associated with urgent-start PD complications.MethodsA retrospective cross-sectional observational study was performed on 102 patients with ESRD who merited urgent-start PD from January 2015 to June 2019. The primary clinical outcome measures were catheter leakage, dysfunction, and peritonitis, whereas the secondary outcomes were catheter removal, repositioning, and death. Statistical inferences were made with the χ2 or Fisher's exact test and independent samples t tests.ResultsOne hundred two subjects (65 men, 63.7%) 56.2 ± 15.1 years old were included in this study; 64 of the subjects had diabetes and hypertension (62.7%). Catheter leakage occurred in 8 patients (7.8%), catheter dysfunction in 27 patients (26.5%), and peritonitis in 14 patients (13.7%); meanwhile, catheter removal occurred in 6 patients (5.9%), catheter repositioning in 21 patients (20.6%), and death in 3 patients (2.9%). Peritonitis was associated with younger age (i.e., 47.0 ± 16.8 vs. 57.6 ± 14.4 years; P = 0.014; 95% confidence interval [CI]: 2.2-19.1; odds ratio [OR] 0.96; P = 0.018; 95% CI: 0.92-099), higher creatinine levels upon admission (i.e., 20.2 ± 9.8 vs. 14.1 ± 8.3; P = 0.014; 95% CI: -10.9 to -1.2), and heart failure (OR 4.79; P = 0.043; 95% CI: 1.05-21.88). Patients with abdominal hernia were 7.5 times more likely to have their catheter leak (OR 7.5; P = 0.036; 95% CI: 1.14-49.54). Catheter removal was associated with obesity (i.e., body mass index [BMI] of 31.6 ± 4.1 vs. 25.9 ± 4.9; P = 0.007; 95% CI: -9.8 to -1.6; OR 1.26; P = 0.013; 95% CI: 1.05-1.51) and Modification of Diet in Renal Disease glomerular filtration rate (MDRD-GFR) (i.e., 2.5 ± 0.6 vs. 3.7 ± 2.3; P = 0.003; 95% CI: 0.5-1.9).ConclusionPeritonitis was associated with younger age, higher creatinine levels upon admission, and heart failure; meanwhile, catheter removal was linked to obesity and lower glomerular filtration rate. Compared with previous reports, our study included patients in which PD was initiated shortly after catheter insertion, making the intervention a true urgent-start PD. This study contributes to the existing urgent-start PD literature by providing evidence that urgent-start PD with catheter opening within 72 hours has limited complications, making it a relatively safe option.

Dataset Information

Peritoneal Dialysis Catheter Emplacement by Advanced Laparoscopy: 8-year Experience from a Medical Center of China.

Publications

Peritoneal Dialysis Catheter Emplacement by Advanced Laparoscopy: 8-year Experience from a Medical Center of China.

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