Current position of Moncrief and Popovich's technique in patients on peritoneal dialysis: who really benefits from this technique from the perspective of mortality and peritonitis development?

BACKGROUND

The stepwise initiation of peritoneal dialysis (PD) using Moncrief and Popovich's technique (SMAP) is widely used for systemic PD introduction and catheter-related infection prevention. This study aimed to investigate patients who would benefit from SMAP in terms of mortality and PD-related peritonitis development.

METHODS

In total, 328 consecutive patients underwent PD catheter implantation at our institute. Inverse probability of treatment weights was calculated, and patients who benefited from SMAP were explored retrospectively.

RESULTS

Overall, 285 patients were analyzed (direct group, n = 96; SMAP group, n = 189). Patients in the SMAP group tended to have a lower mortality risk than those in the direct group, whereas this tendency decreased in the IPW-adjusted population. Peritonitis was observed in 40 and 85 patients in the direct and SMAP groups, and PD catheters were removed in 59 and 118 patients in the direct and SMAP groups. The two main causes were peritonitis and insufficient dialysis. The risk of mortality decreased with SMAP among patients with a nutrition risk index score for Japanese hemodialysis patients ≥ 8, prognostic nutritional index score ≤ 40, serum creatinine level < 8 mg/dl, and body mass index < 23 kg/m2. Additionally, the risk of peritonitis decreased in patients with emergent hemodialysis induction before PD and with previous abdominal surgery.

CONCLUSION

PD catheter implantation using SMAP may not be mandatory in clinical practice. However, this technique can be a good option, depending on the patient, in terms of mortality and peritonitis. Personalized treatment strategies should be considered to improve patient outcomes.