Abstract: SA-PO486
Enhancing Peritoneal Dialysis Access: Overcoming Catheter Insertion Barriers for Patients Who Are Older or Have Obesity
Session Information
- Home Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Corr, Michael, Queen's University Belfast, Belfast, United Kingdom
- O'Neill, Stephen, Belfast City Hospital, Belfast, United Kingdom
Background
With rising numbers of patients with end-stage kidney disease, peritoneal dialysis PD is a cost-effective alternative to haemodialysis (HD), aligning with international goals for home-based dialysis. Our study aimed to demonstrate how access to PD was successful expanded in our region, particularly for older frail patients and those with obesity, populations typically underrepresented in PD due to perceived risk of complications from catheter insertion.
Methods
Changes included appointing a PD surgical lead and having a dedicated interventional radiologist for fluoroscopically guided PD catheter insertion. Data were prospectively collected on all patients who had a PD catheter inserted in 2020-2022. Patient demographics, insertion techniques, and outcomes up to 1-year post insertion were summarised. Additionally, a comparison was made between outcomes of PD catheter insertion in patients with and without obesity.
Results
The annual number of PD catheter insertions doubled following service change. Patients receiving percutaneous insertions and able to avoid anaesthesia were older (median age 76 vs. 56, p < 0.0001) and had less previous abdominal surgery (25% vs. 54%, p=0.05. Outcomes showed a primary patency rate of 85%, primary assisted patency of 94%, and secondary patency of 97%. For patients with obesity, primary and primary-assisted patency rates were similar to those without obesity. However, individuals with obesity exhibited lower secondary patency rates. Patients with obesity showed a trend towards higher transfer rates to haemodialysis within the first-year post-insertion.
Conclusion
We have effectively doubled the annual incident PD population in our region, including older, frailer patients and those with obesity. This study highlights the benefits of a flexible, multi-faceted approach to PD catheter insertion, improving access and offering an effective alternative to HD for a wider range of patients. The inclusion of laparoscopic and fluoroscopically guided techniques allowed a tailored approach, ensuring appropriate patient selection and timely catheter insertion. Our results suggest that such reconfigurations can significantly enhance PD accessibility, benefiting both patients and healthcare systems.