Subcutaneous implantation of catheters for peritoneal dialysis

The two-step technique for placing peritoneal dialysis (PD) catheters and then starting Pd at some later point was intended to be used in 98 patients (mean age + 64 yr) from January 1995 to December 1998. Sixty-seven catheters were placed according to this technique, while 31 patients had to start PD immediately; 8 of the 67 patients had not started PD by the end of the observation period. A non-functioning catheter was seen in 2 patients with the two-step technique. A total of 264 hospital days were consumed by 57 patients who had started PD with this technique, including 91 outpatient days (each catheter placed in the outpatient setting was calculated as 1 hospital day). The mean time between cather placement and the start of PD was 92 days. The majority of the patients had their PD-start delayed for more than 30 days. The 31 patients who needed an immediate start of dialysis consumed 493 hospital days. Technique survival for the two-step technique was 98% and 82% at the 6-mo and 12-mo observation times, respectively. The corresponding numbers for patients who started PD on an acute basis were 76% and 67% respectively. Patient survival at the 6-mo observation time was 94% for the two-step technique and 71% among acutely started patients. Comorbid conditions and advanced age were responsible for 8 of 10 deaths within the first 6 mo after started PD. No differences in catheter-derived exit site infections or peritonitis were seen between the two catheter techniques.