Outcomes of Percutaneous Ultrasound-Guided Peritoneal Dialysis Catheter Placement in a Tertiary Hospital in Lima, Peru

Background: Peritoneal dialysis (PD) catheter placement techniques vary in complexity and outcomes. This study aimed to describe clinical outcomes of PD catheter placement techniques, focusing on patients who underwent percutaneous ultrasound-guided implantation. Methods: We analyzed 56 patients who received PD catheters from 2024 to February 2025. Demographics, etiology of end-stage kidney disease (ESKD) and procedural data were collected. Placement techniques included percutaneous ultrasound-guided (44%), minilaparotomy by nephrologists (32%), and surgical placement by general surgeons (23%). A subanalysis of the percutaneous group (n=25) is included. Results: The mean age was 44.8 years. Hypertension was present in 83.9%, and diabetes in 12.5%. ESKD etiology was non-specified in 26.7%. About 69% had previous hemodialysis, and 25% started PD due to lack of vascular access. In the percutaneous group, mean BMI was 24.3. Mean abdominal wall measurements were: 1.8 cm (skin to fascia) and 0.7 cm (rectus muscle thickness). The mean intramuscular catheter trajectory through the rectus muscle was 2.59 cm. This was achieved by adopting a deliberately oblique insertion angle.The incision averaged 1.5 cm, and 25% of patients required only one skin suture. No early peritonitis or catheter-related infections were observed in the first 30 days. Catheter migration occurred in 2 patients (8%); only one required repositioning. Two patients (8%) experienced dialysate leak when infused with >1500 mL during the first week. Technique survival beyond 3 months was achieved in 92% of patients. We hypothesize that increasing the intramuscular trajectory of the catheter, achieved via an oblique percutaneous insertion, may contribute to lower migration rates. The average trajectory of 2.59 cm through the rectus muscle likely serves as a stabilizing anchor, reducing early displacement. Interestingly, the relatively low rectus muscle thickness observed in our population (mean: 0.7 cm) may reflect underlying poor nutritional status, a factor that could potentially affect catheter stability and tissue healing. Conclusion: Percutaneous ultrasound-guided PD catheter placement by nephrologists appears to be a safe, minimally invasive, and effective option, with low complication rates and high short-term technique survival.