title: The impact of interventional nephrologists on the growth of a peritoneal dialysis program: Long-term, single-center experience.
abstract: Peritoneal dialysis (PD) is an underutilized form of renal replacement therapy. Although a variety of factors have been deemed responsible, timely insertion of a PD catheter may also be a contributory factor. Furthermore, a good catheter implantation technique is important to allow for effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with surgeons have been limited to small single-center experiences. Thus, the objective of this study was to explore the impact of the peritoneal dialysis (PD) catheter insertion by nephrologists compared to surgeons on early catheter complications and on technique survival. We also examine whether PD catheter insertion by nephrologists has a positive impact on the growth in the number of patients using PD. We performed 313 consecutive procedures: 192 catheter insertions and 121 catheter removal from January 1, 2006 to December 31, 2013. The main reasons for catheter removal were: renal transplantation, 52 (43%) follow of transfer to HD, 48 (40%) and catheter malfunction, 16 (13%). The patients were mostly male (63.4%) with the mean age of 50.8±15.1 years and 23.8 were diabetics. We only observed seven (2.5%) early complications (<4 weeks) associated to peritoneal catheter surgery (3 peritonitis episodes, 2 hemoperitoneum episodes, one complicated hernia and one omental entrapment). There were not significant differences in surgery-related complications in both periods. The penetration ratio of PD after 2006 was 117% higher compared with procedures performing before this date. In conclusions, we have demonstrated a positive impact on the growth of the PD population when catheter insertion is performed by nephrologists with a minimal incidence of complications associated.
authors.affiliation: Servicio de Nefrología, Hospital Regional Universitario Carlos Haya/IBIMA, Málaga, Spain. Electronic address: sirosru@yahoo.es.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ros-Ruiz
authors.affiliation: Servicio de Nefrología, Hospital Regional Universitario Carlos Haya/IBIMA, Málaga, Spain.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Alonso-Esteve
authors.affiliation: Servicio de Nefrología, Hospital Regional Universitario Carlos Haya/IBIMA, Málaga, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Gutiérrez-Vílchez
authors.affiliation: Servicio de Nefrología, Hospital Regional Universitario Carlos Haya/IBIMA, Málaga, Spain.
authors.forename: Edisson
authors.initials: E
authors.lastname: Rudas-Bermúdez
authors.affiliation: Servicio de Nefrología, Hospital Regional Universitario Carlos Haya/IBIMA, Málaga, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Hernández
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000592:standards*; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072104:Nephrologists; D010530:Peritoneal Dialysis; D010538:Peritonitis
keywords: Catheter surgery; Cirugía de catéter; Diálisis peritoneal; Interventional nephrology; Nefrología intervencionista; Peritoneal dialysis