A Single Center Study of CAPD Catheter Placement Using the Seldinger Technique
Hong Kong Journal of Nephrology
Percutaneous peritoneal dialysis catheter placement is a rapidly performed procedure to facilitate rapid initiation of CAPD. We evaluated the complication and survival rates of CAPD catheters inserted using the Seldinger technique in our center. Methods: We retrospectively reviewed 70 doubledcuff, coiled catheters inserted by nephrologists using the modified Seldinger technique in 70 consecutive patients between January 2002 and January 2005. The total experience accumulated was 1,115
... was 1,115 patient-months. Results: The mean age of patients was 54 15 years; 81% were male; 10% had bloody dialysate (which was mild); 5.7% had subcutaneous leakage; and 1.4% had hernia. There was no cuff erosion. The main complication was infection. The incidence of exit site infection was 1 episode/58 patient-months, while the incidence of peritonitis was 1 episode/80 patient-months. Catheter failure was defined as catheter malfunction or persistent infection requiring catheter removal. Twenty patients had their CAPD catheters removed but only 13 were due to catheter failure. Six were due to catheter malfunction, including catheter tip migration and obstruction, while seven were due to persistent peritonitis or exit site infection. Five had their catheters removed after renal transplantation and two were removed due to accidental damage of the catheters by the patients. The 1and 2-year technical survivals were 85% and 80%, respectively. Conclusion: The complication and survival rates of percutaneous CAPD catheter insertion were comparable with those reported using surgical techniques. We can state that percutaneous catheter insertion is a well-tolerated and rapidly performed alternative procedure. Background: Sleep apnea is prevalent among dialysis patients. Nocturnal hemodialysis has been shown to improve sleep apnea in patients receiving conventional hemodialysis. Whether NPD is also effective in correcting sleep apnea in patients receiving CAPD remains unknown. Methods: We performed overnight polysomnography in 38 stable NPD and CAPD patients in a sleep laboratory. NPD patients (n = 19) received a total of 8-10 L of overnight PD fluid exchanges everyday using an automated cycler, while CAPD patients (n = 19) underwent 3-4 daily exchanges of 2-L PD fluid. Polysomnographic findings were scored manually by two independent experts in sleep study who were blinded to the mode of dialysis. Results: The two groups were matched for age (mean SD for NPD group = 61.4 16.8 years; for CAPD group = 60.2 16.7 years), gender (% male = 47% vs 53%), underlying renal disease and comorbidities, duration on dialysis (27.8 36.2 months vs 23 14.4 months), body mass index (22.3 3.1 vs 23.9 4.3 kg/m 2 ), and weekly KT/V urea (2.4 0.6 vs 2.3 0.4). The prevalence of sleep apnea, defined as an apnea-hypopnea index (AHI, or total number of episodes of apnea and hypopnea per hour of sleep) higher than 15, was 58% for NPD patients and 95% for CAPD patients (p = 0.008). The mean SD AHI was 31.6 25.6 versus 50.9 26.4 (p = 0.025), while the minimum oxygen saturation was 84.1 8.4% versus 71.0 17.7% (p = 0.008). The frequency of arousal during sleep, periodic leg movement, and biochemical parameters (serum urea, creatinine, bicarbonate, and albumin levels) were not significantly different between the two groups. Conclusion: NPD may have a therapeutic edge over CAPD in sleep apnea associated with renal failure, which can be validated in further cross-over studies.