title: Tenckhoff Peritoneal Dialysis Catheter Insertion in a Northern Ireland District General Hospital.
abstract: BACKGROUND
  Chronic kidney disease (CKD) affects approximately 5% of the population. Based on 2014 data, peritoneal dialysis (PD) is underutilised in Northern Ireland with a prevalence of only 11% in patients requiring renal replacement therapy (RRT). Recent National Institute of Clinical Excellence (NICE) guidelines aim to increase the rate of PD utilisation to 39% amongst patients requiring RRT. In order to implement these guidelines, nephrologists must have access to a reliable, effective PD catheter insertion service. The aim of this study was to assess the outcomes of PD catheter insertions and incident rates of PD use in a single centre in anticipation of a potential increased uptake.
  
  
  METHODS
  A retrospective analysis was conducted of all patients who underwent PD catheter insertion between April 2003 and October 2011. Case notes were reviewed for demographic information, complications, need for re-intervention, and primary catheter patency at 12 months. The UK Renal Registry annual reports were also reviewed for data on annual uptake of PD in our institution.
  
  
  RESULTS
  Fifty-four patients underwent PD catheter insertion between 2005 and 2011; 61% were male with a median age of 58 (range 21-82) years. Early complications (≤30 days) included bowel perforation (n=1) and wound infection (n=2). During this study period 17 (31%) patients required manipulation or reinsertion for catheter obstruction/migration. The primary catheter patency at 12 months was 76%. The average uptake of PD as the first treatment modality (incident use) was 21.3% compared to a Northern Ireland (NI) average of 12.4%.
  
  
  CONCLUSIONS
  Complication rates were comparable to the International Society of Peritoneal Dialysis (ISPD) guidelines in this case series and PD uptake was higher than the NI average. Therefore, local provision of an expert surgical PD catheter insertion service may potentially facilitate an increased uptake of this modality amongst RRT patients but further research is warranted.
authors.affiliation: Department of General Surgery, Daisy Hill Hospital, Newry, Northern Ireland, UK.
authors.forename: Donna
authors.initials: D
authors.lastname: McCartan
authors.affiliation: Department of General Surgery, Daisy Hill Hospital, Newry, Northern Ireland, UK ; Department of Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Northern Ireland, UK.
authors.forename: Ronan
authors.initials: R
authors.lastname: Gray
authors.affiliation: Department of Nephrology, Daisy Hill Hospital, Newry, Northern Ireland, UK.
authors.forename: John
authors.initials: J
authors.lastname: Harty
authors.affiliation: Department of General Surgery, Daisy Hill Hospital, Newry, Northern Ireland, UK.
authors.forename: Geoff
authors.initials: G
authors.lastname: Blake
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061807:Catheter Obstruction; D002404:Catheterization / Q000009:adverse effects; D005260:Female; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D011475:Prosthesis Failure; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*; D055815:Young Adult