New research comparing non-surgical (medical) insertion of the abdominal catheter needed for peritoneal dialysis to surgical insertion suggests the medical method is at least as safe and effective, while being generally more convenient.
The findings of the study, which followed 769 kidney patients receiving their first abdominal catheter, should reassure patients undergoing this increasingly common method of insertion.
Peritoneal dialysis is one of the two main dialysis treatment options for people with kidney failure, the other being haemodialysis, where a person’s blood is filtered through a machine to remove waste products and fluids.
In peritoneal dialysis, the lining of the abdomen (the peritoneum) is used instead, requiring the insertion of a catheter into the abdominal space, where it is left permanently.
That procedure can be done by a surgeon under general anaesthetic, or by a doctor using a needle, with no general anaesthetic (medical insertion). In recent years medical insertion has become a more popular option because of a shortage of surgeons and operating space.
Until now, though, there has been a lack of research comparing the effectiveness and safety of the two procedures.
Read more about peritoneal dialysis on our information page.
The study used data from 44 dialysis centres in the UK between 2015 and 2017. Most of the participants received surgical insertions (58%), and the rest received medical insertions (42%).
The researchers assessed outcomes across a number of areas. They found that those who had received the medical insertions experienced fewer ‘safety events’ such as catheter removals, leaks and infections than those with the surgical insertions (55% of patients compared to 63% for surgical insertion) and were less prone to infection (3% compared 11%).
Those who had received surgical insertions had to have their catheters removed slightly less often, however: 18% compared to 22% of the medical insertion patients.
Hospitals that provided both options had the best outcomes and medical insertions are not necessarily suitable for all patients, highlighting the importance of considering choice and the individual needs of patients. Patients who had received abdominal surgery in the past, for instance, were far less likely to undergo medical insertion.
Peritoneal dialysis can be a flexible treatment option, with the potential for at home care and the choice of having dialysis during the daytime or overnight.
Nick Palmer, Patient Ambassador & Involvement Lead at Kidney Care UK, spoke about the impact of the study:
“This interesting study highlights the opportunity to optimise patient choice, clinical outcomes, patient safety and cost-efficiency. This is all central to patient care and planning. We support improved practices that can enhance patients’ experience, especially those with the potential to increase the numbers having home therapy.
We welcome this further evidence to support the design of catheter insertion pathways; this presents a clear opportunity for improved service and choice for patients.”