Comparison of Peritoneal Dialysis Catheter (PDC) Placement Outcomes via Image-Guided Percutaneous (IGP) Technique vs. Laparoscopic Surgical (ALS) Technique

Background: The IGP technique presents several potential opportunities when placing PDCs. Some cited factors include avoiding general anesthesia, better availability of IR suites, and being less resource-intensive than OR suites. As part of the Kaiser Permanente Northern California (KPNC) quality assurance effort, we have monitored patient and procedure characteristics and compared PDC outcomes by IGP vs. ALS. Methods: In this retrospective study, we analyzed the outcomes of patients undergoing PDC placement in KPNC from 1/1/18 to 12/31/22. Patients were identified based on procedure codes and ESKD diagnoses. Baseline and outcome variables were extracted electronically. Results: 3,062 patients underwent PDC placement, and 27% were placed via the IGP technique. As shown in Table 1, patients in the IGP had statistically significantly lower BMI, eGFR, and albumin levels at PDC placement but a significantly higher number of patients with heart failure. A greater proportion of patients in the IGP group had their procedure done while inpatient for other indications. The average length of stay for patients admitted post-procedure was shorter in the IGP group. The 90-day and 180-day catheter intervention rates were lower in the IGP group (not accounting for confounders). There was no statistical difference between the two groups' 30-day readmission and mortality rates. Conclusion: Expanding utilization of home dialysis is one of the pillars of value-based care in nephrology. This QA study illustrates that IGP can be a safe and effective approach to lowering the barriers to peritoneal dialysis adoption by expanding access to care while maintaining desirable patient outcomes and utilizing fewer healthcare resources. Funding: Clinical Revenue SupportBaseline characteristics and key outcomes.