Peritoneal dialysis doesn't increase risk of catheter infections

By Robin Russell / March 28-31, 2011

When Lavern Morgan needed dialysis in 2004 for kidney failure, she dreaded the idea of sitting in a dialysis clinic three times a week.

Dr. Ramesh Saxena, associate professor of internal medicine and her physician, instead recommended peritoneal dialysis, a portable and less-costly method that allowed her to self-administer the procedure.

“I love it. I can do this at home,” said Ms. Morgan, 40, of Coppell. “I can help my son with his homework. I can cook and clean with it. I can travel.”

Dr. Ramesh Saxena, associate professor of internal medicine and her physician

Ms. Morgan is among the nearly 400,000 patients in the U.S. with end-stage renal disease who are undergoing dialysis. But only 7 percent of them opt for peritoneal dialysis (removal of waste fluids through a catheter inserted in the abdominal cavity) over hemodialysis (administered through an access in the arm at a dialysis clinic).

In a new study in the Journal of Vascular Access, Dr. Saxena shows that patients with end-stage renal disease who opt for peritoneal dialysis experience no greater risk of catheter infection than those who undergo hemodialysis.

Peritoneal dialysis is less costly, easier on the body and provides greater mobility than hemodialysis, the more common procedure in the U.S.

“Patients actually survive better on peritoneal dialysis, have a better quality of life and the procedure is cheaper,” said Dr. Saxena, a senior author of the study. “Factors such as obesity, age and previous abdominal surgeries should not be considered as barriers in selecting patients for peritoneal dialysis.”

Peritoneal dialysis (PD) is easier on patients because it mimics natural kidney function through a slower and continuous process of replenishing the body with healthy fluids. It also affords greater flexibility for patients because the equipment is portable and the process can be self-administered.

Dr. Saxena said U.S. nephrologists do not receive enough training in peritoneal dialysis, though it is a common form of dialysis worldwide. UT Southwestern has one of the largest peritoneal dialysis clinics in the country, treating up to 120 patients at one time, compared with an average of 20 patients at a typical hemodialysis clinic in the U.S.

“The myth is that peritoneal dialysis is seen as infectious and difficult to manage, but there has been no formal study on these factors affecting catheter survival,” Dr. Saxena said.

His study, the first of its kind, showed three-year catheter survival rates of more than 91 percent, regardless of age, gender or race, in more than 300 patients who had their first peritoneal dialysis catheter placed between 2001 and 2009 at the UT Southwestern/DaVita Peritoneal Dialysis Clinic. Other factors normally expected to affect the outcome of catheter survival, such as diabetic status, body mass index or previous abdominal surgeries or infections, did not affect the catheter survival rate.

PD catheter failure was defined in the study as removal of the dysfunctional PD catheter due to any catheter-related complication. Complications were divided into infectious and noninfectious groups.

Sixty percent of the patients had no episode of peritoneal infection; 21 percent had a single episode; and about 19 percent had multiple episodes. Peritoneal infections were not found to be significantly associated with PD catheter survival, most likely due to prompt treatment and care for infectious episodes.

Only noninfectious complications were associated with catheter failure. These included obstruction, malpositioning, catheter migration, abdominal wall herniation, leakage, trauma, chronic abdominal pain and extrusion. The study showed just 23 catheter failures in the three years of the follow-up period.

Ms. Morgan said she’s spreading the word about PD. “I’ve told all my friends about it. It’s easier, and it’s portable.”

The research was supported by a grant from the National Institutes of Health’s George M. O’Brien Kidney Research Core Center at UT Southwestern.