Impact of Prior Abdominal Procedures on Peritoneal Dialysis Catheter Outcomes: Findings From the North American Peritoneal Dialysis Catheter Registry

Wazaira A Khan; Matthew Oliver; John H Crabtree; Alix Clarke; Sean Armstrong; Danielle Fox; Rachel Fissell; Arsh K Jain; Sarbjit V Jassal; Susie L Hu; Peter Kennealey; Scott Liebman; Brendan McCormick; Bogdan Momciu; Robert P Pauly; Beth Pellegrino; Jeffrey Perl; James L Pirkle Jr; Troy J Plumb; Pietro Ravani; Rebecca Seshasai; Ankur Shah; Nikhil Shah; Jenny Shen; Gurmukteshwar Singh; Karthik Tennankore; Jaime Uribarri; Murray Vasilevsky; Robert Yang; Robert R Quinn

doi:10.1053/j.ajkd.2023.12.023

Impact of Prior Abdominal Procedures on Peritoneal Dialysis Catheter Outcomes: Findings From the North American Peritoneal Dialysis Catheter Registry

Am J Kidney Dis. 2024 Mar 4:S0272-6386(24)00625-5. doi: 10.1053/j.ajkd.2023.12.023. Online ahead of print.

Authors

Wazaira A Khan¹, Matthew Oliver², John H Crabtree³, Alix Clarke⁴, Sean Armstrong⁵, Danielle Fox⁶, Rachel Fissell⁷, Arsh K Jain⁸, Sarbjit V Jassal⁹, Susie L Hu¹⁰, Peter Kennealey¹¹, Scott Liebman¹², Brendan McCormick¹³, Bogdan Momciu¹⁴, Robert P Pauly¹⁵, Beth Pellegrino¹⁶, Jeffrey Perl¹⁷, James L Pirkle Jr¹⁸, Troy J Plumb¹⁹, Pietro Ravani²⁰, Rebecca Seshasai²¹, Ankur Shah¹⁰, Nikhil Shah²², Jenny Shen²³, Gurmukteshwar Singh²⁴, Karthik Tennankore²⁵, Jaime Uribarri²⁶, Murray Vasilevsky²⁷, Robert Yang²⁸, Robert R Quinn²⁹

Affiliations

¹ Cumming School of Medicine, University of Calgary, Calgary, Canada.
² Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada.
³ Division of Nephrology and Hypertension, Harbor-University of California Los Angeles Medical Center, Torrance, California, USA.
⁴ Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada.
⁵ College of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁶ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁷ Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁸ Department of Medicine, Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
⁹ Division of Nephrology, University Health Network, Toronto, Canada and University of Toronto, Toronto, Canada.
¹⁰ Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
¹¹ University of Colorado, School of Medicine, Denver, Colorado, USA.
¹² Department of Medicine, Division of Nephrology, University of Rochester, Rochester, New York, USA.
¹³ Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁴ Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
¹⁵ Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
¹⁶ Division of Nephrology, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
¹⁷ Division of Nephrology St. Michael's Hospital, Department of Medicine, Division of Nephrology, University of Toronto, Canada.
¹⁸ Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
¹⁹ Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
²⁰ Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
²¹ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²² Faculty of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
²³ The Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, California, USA.
²⁴ Kidney Health Research Institute, Geisinger Health, Danville, Pennsylvania, USA.
²⁵ Division of Nephrology, Department of Medicine, Dalhousie University and Nova Scotia, Health, Halifax, Nova Scotia, Canada.
²⁶ Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
²⁷ Division of Nephrology, McGill University Health Centre.
²⁸ Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
²⁹ Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: rob.quinn@ahs.ca.

PMID: 38447707
DOI: 10.1053/j.ajkd.2023.12.023

Abstract

Rationale & objective: A history of prior abdominal procedures may influence the likelihood of referral for peritoneal dialysis (PD) catheter insertion. To guide clinical decision making in this population, this study examined the association between prior abdominal procedures and outcomes in patients undergoing PD catheter insertion.

Study design: Retrospective cohort study.

Setting & participants: Adults undergoing their first PD catheter insertion between November 1, 2011 and November 1, 2020, at 11 institutions in Canada and the US participating in the International Society for Peritoneal Dialysis (ISPD) North American Catheter Registry.

Exposure: Prior abdominal procedure(s), defined as any procedure that enters the peritoneal cavity.

Outcomes: Primary outcome: time to the first of abandonment of the PD catheter, or interruption/termination of PD.

Secondary outcomes: rates of emergency room visits, hospitalizations, and procedures.

Analytical approach: Cumulative incidence curves were used to describe the risk over time and an adjusted Cox proportional hazards model was used to estimate the association between the exposure and primary outcome. Models for count data were used to estimate the associations between the exposure and secondary outcomes.

Results: A total of 855 patients met the inclusion criteria. Thirty-one percent had a history of a prior abdominal procedure and 20% experienced at least one PD catheter-related complication that led to the primary outcome. Prior abdominal procedures were not associated with an increased risk of the primary outcome [Adjusted HR 1.12 (95% CI 0.68-1.84)]. Upper abdominal procedures were associated with a higher adjusted hazard of the primary outcome, but there was no dose-response relationship concerning the number of procedures. There was no association between prior abdominal procedures and other secondary outcomes.

Limitations: Observational study and cohort limited to sample of patients felt to be potential candidates for PD catheter insertion.

Conclusion: A history of prior abdominal procedure(s) does not appear to influence catheter outcomes following PD catheter insertion. Such a history should not be a contraindication to peritoneal dialysis.

Keywords: Dialysis; PD; PD catheter outcomes; end stage kidney disease; peritoneal dialysis; prior abdominal surgery.