Peritoneal Dialysis Underutilization: The Impact of an Interventional Nephrology Peritoneal Dialysis Access Program

Arif Asif, Patricia M Byers, Florin Gadalean, David Roth

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Peritoneal dialysis (PD) is an underutilized form of renal replacement therapy. Recent data have emphasized that only 12% of end-stage renal disease (ESRD) patients are initiated on this form of therapy in the United States. Patients requiring PD have most often been referred to general surgeons for catheter placement. This has incurred additional delays in starting treatment and loss of decision-making control by the referring nephrologist. To address this issue, we developed and incorporated our own PD access placement program into the preexisting chronic kidney disease (CKD) education program. To date, 46 patients have undergone 71 procedures. These included 51 (72%) PD catheter insertions, 14 (20%) removals, and 6 (8%) repositioning procedures for poor drainage. PD catheter insertion was performed peritoneoscopically under local anesthesia and a Fogarty catheter was used to reposition a migrated catheter. All of the procedures were performed by nephrologists in a dedicated interventional nephrology (IN) laboratory. All six repositioning procedures failed to restore optimal drainage. Five of these patients had the catheter removed and a new catheter placed during the same procedure. Of these five patients, one had recurrence of poor drainage and opted for hemodialysis (HD). The sixth patient declined reinsertion and chose HD. Of the remaining seven removal procedures, three were due to fungal peritonitis, one due to bowel perforation, one due to severe depression, one due to transplant, and one catheter was removed at the request of the primary physician in a terminally ill patient. Eight of the 51 catheter insertions were during the initial admission of a catastrophic dialysis start. Two of these patients started acute PD and avoided catheter placement for HD. Thirty-seven of 46 patients have a functional PD catheter with a follow-up of 8.6 ± 0.8 (mean ± SE) months. During an 18-month period our PD population has increased from 43 to 80 patients. We conclude that a dedicated PD access placement program coupled with a CKD education program can have a dramatic impact on patient choice and PD growth.

Original languageEnglish
Pages (from-to)266-271
Number of pages6
JournalSeminars in Dialysis
Volume16
Issue number3
DOIs
StatePublished - May 1 2003

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Nephrology
Peritoneal Dialysis
Catheters
Renal Dialysis
Drainage
Chronic Renal Insufficiency
Education
Terminally Ill
Renal Replacement Therapy
Local Anesthesia
Peritonitis
Chronic Kidney Failure
Dialysis
Decision Making
Depression
Physicians
Transplants

ASJC Scopus subject areas

  • Nephrology

Cite this

Peritoneal Dialysis Underutilization : The Impact of an Interventional Nephrology Peritoneal Dialysis Access Program. / Asif, Arif; Byers, Patricia M; Gadalean, Florin; Roth, David.

In: Seminars in Dialysis, Vol. 16, No. 3, 01.05.2003, p. 266-271.

Research output: Contribution to journalArticle

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