Surgical and Image-Guided Percutaneous Peritoneal Dialysis Catheter Placement Associated With Similar Outcomes: A Single-Center Retrospective Study in Canada
Bibliographic record
Abstract
Background: The current ISPD guidelines do not recommend any specific peritoneal dialysis (PD) catheter placement technique due to lack of demonstrated superiority of one technique over the others. We aimed to evaluate outcomes following catheter placement in our center, comparing surgical placement and image-guided percutaneous insertion. Methods: In this retrospective cohort study, all patients (prevalent and incident) enrolled in our PD program from June 2017 until December 2021 were included. Incidence of immediate complications and early (<30 days) exit-site infections and peritonitis were evaluated. Time-to-first peritonitis and first exit-site infection were also analyzed using the Kaplan-Meier product-limit method and log-rank test. Results: Of the 73 patients enrolled in our PD program during the study period, 39 and 34 underwent surgical and percutaneous catheter placement, respectively. Baseline characteristics were similar in both groups, except for history of cancer, year of PD start and left/right localization of the peri-umbilical catheter exit-site. There were 1 and 3 immediate complications; 2 and 1 early exit-site infections; 0 and 1 (associated to an immediate complication) early peritonitis in the surgical and percutaneous groups, respectively. Two patients in each group required repositioning or new catheter placement within 90 days of the first intervention. Percutaneous catheter placement showed similar time-to-first peritonitis (p=0.35) and time-to-first exit-site infection (p=0.30) compared to surgical placement. Conclusions: Surgical and percutaneous PD catheter placement showed similar outcomes in our center. Future studies could also evaluate other aspects of catheter placement techniques, such as cost and patient experience. Table 1. - Baseline characteristics at time of PD catheter placement Surgical placement N=39 Percutaneous placement N=34 p=value Age (years; mean ± SD) 58.4 ± 14.2 57.1 ± 12.0 0.663 Male sex 20 (51%) 23 (68%) 0.156 BMI (kg/m2) 0.917 <18.5 1 (3%) 2 (6%) 18.5-24.9 13 (33%) 11 (32%) 25-29.9 13 (33%) 11 (32%) 30+ 12 (31%) 10 (29%) Primary kidney disease 0.899 Diabetic nephropathy 10 (26%) 8 (24%) Glomerulonephritis 11 (28%) 9 (26%) Polycystic disease 5 (13%) 4 (12%) Hypertension/nephrosclerosis 3 (8%) 2 (6%) Others 6 (15%) 4 (12%) Uncertain 4 (10%) 7 (21%) Previous kidney transplant 4 (10%) 5 (15%) 0.564 Comorbidities Diabetes 0.259 Type 1 2 (5%) 2 (6%) Type 2 20 (51%) 11 (32%) CAD 7 (18%) 6 (18%) 0.973 Cerebrovascular disease 3 (8%) 1 (3%) 0.374 PVD 4 (10%) 3 (9%) 0.836 History of cancer 5 (13%) 0 (0%) 0.031 Chronic lung disease 7 (18%) 3 (9%) 0.258 Smoking 0.075 Never 16 (41%) 21 (62%) Curren 9 (23%) 2 (6%) Former 14 (36%) 11 (32%) Era <0.001 Before 1 June 2017 30 (77%) 0 (0%) From 1 June 2017 9 (23%) 34 (100%) Catheter exit-site localization (peri-umbilical) 0.012 Right 19 (49%) 7 (21%) Left 20 (51%) 27 (79%) Time from placement to first PD treatment (days; median (IQR)) 34 (19-52) 28 (22-35) 0.183
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".