Paul Erik Dybbro MD, Presenter: Nothing to Disclose

Todd Ellis Drasin MD, MPH, Abstract Co-Author: Nothing to Disclose

Minimally invasive image-guided techniques allow placement of peritoneal catheters into traditionally excluded patients including acutely uremic patients, patients with low cardiac output and /or recent myocardial infarctions, and patients with hepatorenal or cardiorenal syndrome. The following study measures the effectiveness of a community-based minimally invasive image-guided interventional radiology peritoneal dialysis catheter placement service.

The clinical electronic medical records of 100 consecutive image-guided peritoneal dialysis catheter placements were reviewed at a community-based hospital. Cases were performed between July 2012-March 2013. The referral based included low, medium, and high-risk patients. Cases were a random mix of elective, urgent, and emergent procedures. Two interventional radiology physicians performed all the procedures. Procedures were performed in an interventional radiology suite usually under procedural sedation; a few selected patients received local anesthesia. Ultrasound was utilized to achieve safe peritoneal entry and creation of a rectus muscle tunnel to provide catheter stability. Fluoroscopy was utilized to achieve deep mid line pelvic positioning of the curl tip portion of the catheter.

Initial catheter placement success rate was 92%. There were no complications. Mechanical catheter malfunction-free rates were calculated, and were 94% (78/83) at 3 months, 91% (67/74) at 6 months and 85% (44/52) at 1 year. Excluded from the calculations were cases of peritoneal dialysis loss from psychosocial issues, infections, peritoneal membrane failure, migration to transplant status, hydrothorax, hernia formation, and patient death.

Image-guided peritoneal dialysis catheter placement achieves comparable survival rates as laparoscopic catheter based services. Minimal invasive image guided techniques have documented cost advantages to laparoscopic techniques. By expanding the pool of eligible patients for peritoneal dialysis, the imaged guided techniques can increase the utilization of peritoneal dialysis in this country.

Medicare costs for peritoneal dialysis average $20,000 less/patient/year compared to hemodialysis. Increasing utilization rates of peritoneal dialysis as a renal replacement therapy can result in significant cost savings.

Dybbro, P, Drasin, T, The Effectiveness of Image-guided Peritoneal Dialysis Catheter Placement in a Community Hospital.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012367.html