T SOE1, W MAJONI1, 2, 3, JT HUGHES1, 2, K PRIYADARSHANA1, M SUNDARAM1, A ABEYARATNE1
1Department of Nephrology, Division of Medicine, Royal Darwin Hospital, NT; 2Menzies School of Health Research, Charles Darwin University, Darwin, NT; 3Northern Territory Clinical School, Flinders University, Darwin, NT
Aim: To determine whether subcutaneously buried peritoneal dialysis (SBPD) catheter offers safe and reliable dialysis access for patients with end stage kidney disease (ESKD).
Background: Peritoneal dialysis (PD) is an important treatment modality for ESKD, allowing home based care which is a critical need of many Indigenous patients in the Northern Territory. Potential benefits of a pre-emptively placed SBPD catheter include facilitating timely dialysis initiation, decreased use of central venous catheter and reduced burden of PD catheter care at dialysis initiation.
Methods: We analysed all cases of SBPD catheters between 2006 and 2014 at Royal Darwin Hospital. The duration of catheter embedment, functionality of catheters at first use and complications at placement and exteriorization were described.
Results: SBPD catheters were inserted in 97 patients (48% male, mean age: 50 ±13years). Exteriorisation occurred in 62 patients (63%) at median 161 days (range: 33 to 2598) of embedment. Eighteen catheters (30%) had suboptimal flow. After surgical revision, fibrin removal and constipation management, 54 (87%) of exteriorised catheters achieved adequate function for dialysis. Thirty-five (36%) of total catheters were never exteriorised (pre-emptive transplant (n=2), modality change (n=22), surgical or catheter related complications (n=8) and death prior to starting dialysis (n=3)). Few insertion related complications (haematoma n=6, infection n=3, perforated bowel n=1, ileus n=1, peritoneal fluid leak n=1 and delayed wound healing n=1) were documented. After exteriorisation, exit site infection (n=5), peritonitis (n=1), traumatic exteriorisation (n=5), bleeding (n=2), perforated bowel (n=1) and damaged or short exteriorised portion of catheters (n=6) were recorded.
Conclusions: SBPD catheters were safe and achieved a favourable rate of optimal function (87%). Careful selection of patient is important to minimise futile catheter placement and complications.