Ivy N Haskins, MD, Michael J Rosen, MD, FACS, Arielle J Perez, MD, Luciano Tastaldi, MD, Ajita S Prabhu, MD, FACS, David M Krpata, MD, Steven Rosenblatt, MD, FACS. Digestive Disease and Surgery Institute, Cleveland Clinic Foundation
Introduction: The incidence of chronic kidney disease (CKD) continues to rise in the United States while the utilization of peritoneal dialysis (PD) continues to decline. Catheter-associated infections, specifically peritonitis, is reported to occur in 6% of patients and remains a leading complication of PD. PD associated peritonitis is a major impetus for patient transition to hemodialysis (HD) either due to resulting adhesive disease and catheter non-function following successful treatment of peritonitis with antibiotics or catheter removal at the time of peritonitis. Herein, we detail our PD catheter experience and the PD-catheter associated outcomes of those patients diagnosed with peritonitis.
Methods: In 2005, our institution adopted the best-demonstrated principles of PD catheter placement, including laparoscopy, rectus sheath tunneling, and selective omentopexy. Retrospective chart review was performed on all patients who underwent PD catheter placement at our institution from January 2005 through December 2015. Those patients who were diagnosed with peritonitis were identified. The cause of peritonitis, duration of antibiotic treatment, and PD catheter outcomes were recorded.
Results: A total of 457 patients underwent PD catheter placement at our institution during the defined study period. Twenty-seven (5.9%) patients had at least one PD catheter removal related to peritonitis. Within this cohort, the average age at PD catheter placement was 57.3 years, the average body mass index (BMI) was 28.5 kg/m2, and 13 (48.1%) patients were female. Diabetes mellitus and hypertension were the two main causes of end-stage renal disease (n = 18, 66.7%). Twenty-four (88.9%) patients had acute peritonitis at the time of PD catheter removal while 3 (11.1%) patients had their PD catheter removed for chronic peritonitis. The average time from PD catheter placement to peritonitis was 429.6 days. Culture-positive peritonitis occurred in 24 (88.9%) patients. Gram positive and gram negative bacteria and fungi were all causes of peritonitis. Twelve (44.4%) patients had their PD catheter replaced after treatment of peritonitis with antibiotics. The average time from PD catheter removal to replacement was 214.9 days. Of the 12 patients who had their PD catheter replaced, 7 (36.8%) still have their PD catheter in place, for an average time of 196.4 days.
Conclusions: To date, this is the largest single center experience with PD catheters. The rate of PD associated peritonitis at our institution parallels the national average. The prompt diagnosis and treatment of PD associated peritonitis facilitates successful replacement and long-term utilization of PD.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79590
Program Number: P620
Presentation Session: Poster (Non CME)
Presentation Type: Poster