Outcomes of Ambulatory Peritoneal Dialysis Catheter Insertion in the National Kidney and Transplant Institute in the Philippines

Background: The National Kidney and Transplant Institute (NKTI) advocates for the Peritoneal Dialysis (PD) First Policy. As a result, the rising inpatient PD initiation has led to more hospitalizations and has strained medical resources. In 2022, NKTI launched an outpatient or ambulatory PD catheter insertion (PDCI) program to reduce unnecessary hospital admissions. This study is the first in the Philippines to evaluate the outcomes of outpatient PDCI for ESKD patients, offering insights to support its adoption as an alternative to the traditional inpatient approach. Methods: A single-center, descriptive, retrospective study. Data was collected from the electronic medical records of all patients who underwent ambulatory PDCI from August 1, 2022, to December 31, 2023. Results: The study had a total of 28 patients. The median age was 42 years, with a slight female predominance. Most patients had a normal body mass index, while hypertension and diabetes mellitus were observed in 21.4% and 35.7% of cases, respectively. All catheter insertions were performed via an open surgical route. Infectious complications were more common than non-infectious complications, with peritonitis leading at 56%, followed by exit-site infections and tunnel site infections. Peritonitis had a median onset of 192 days. Among non-infectious complications, PD catheter migration was the most frequent (61%), occurring mainly within the first 90 days. Other complications included omental wraps, leaks, and extruded cuffs. The death-censored technique survival was 71%, with most patients followed-up for over a year. Technique failure were primarily due to catheter migration, omental wraps, or peritonitis. Hospitalization occurred in half of the patients, with most events happening within the first 90 days. Mortality was observed in 4 patients with cardiovascular disease as the leading cause. Only one PD-associated death occurred which was due to refractory peritonitis. Conclusion: PD-associated infections were more frequent than non-infectious complications. Patients who experienced early-onset complications were more likely to have repeat episodes, highlighting the need for closer monitoring. The overall findings of this study were consistent with the results of previous inpatient studies that were conducted in our institution and were also comparable with global data.