Percutaneous peritoneal dialysis catheterization with visualization of rectovesical/rectouterine pouch under ultrasound guidance: a retrospective study of 507 patients.

BACKGROUND: The success of urgent-start peritoneal dialysis (USPD) relies on well-functioning catheters and safe, minimally invasive catheterization methods with minimal complications. However, there are currently no large-scale trials demonstrating the significant superiority of any peritoneal dialysis (PD) catheterization technique. METHODS: We conducted a retrospective analysis of 507 patients who underwent “percutaneous peritoneal dialysis catheterization with visualization of rectovesical/rectouterine pouch (RP) under ultrasound guidance (we named ‘PDCVRU method’)” from September 2018 to February 2024. The outcomes of follow-up at 1 month and 1 year were observed. RESULTS: In this study, all patients received USPD within 48 h except one with technical failure. Of 506 patients with successful catheterization, 377 patients started low-volume manual fluid-exchange PD, which was gradually titrated to the standard peritoneal fluid volume used in continuous ambulatory peritoneal dialysis (CAPD); these patients comprised the CAPD group. The remaining 129 patients initiated low-volume tidal automated peritoneal dialysis (APD) with progressive titration to standard peritoneal fluid volume and were designated as the APD group. The overall success rate of catheterization was 99.8%, with no significant surgical bleeding, bladder injury, or intestinal perforation. At 1-month follow-up, there were 2 cases (0.4%) of peritonitis, 1 case (0.2%) of tunnel infection, 4 cases (0.8%) of transient leakage, and 11 cases (2.0%) of catheter malfunction. No significant differences were observed in the incidence of complications or catheter survival rate between the APD group and the CAPD group during the first month. At 1-year, data from 465 patients were available for analysis. There were 20 patients (4.3%) with catheter malfunction, 9 cases (1.9%) of exit or tunnel infections, 35 cases (7.5%) of peritonitis. The 1-year catheter-related survival rate was 95.8%. CONCLUSIONS: The ‘PDCVRU method’ applied in this study has been proven to be a safe and effective catheterization technique suitable for independent performance by nephrologists, offering significant advantages for USPD. CLINICAL TRIAL NUMBER: Not applicable.