Comparison of peritoneal dialysis catheter (PDC) placement outcomes: image-guided percutaneous (IGP) technique versus advanced laparoscopic surgical (ALS) technique

Abstract Background Peritoneal dialysis (PD) is an increasingly emphasized modality in nephrology care, due to patient autonomy, reduced healthcare cost, and alignment with value-based care initiatives. A critical factor influencing successful PD uptake is the timely placement of peritoneal dialysis catheters (PDCs). Traditional advanced laparoscopic surgical (ALS) methods are effective but constrained by the need for general anesthesia and operating room access. The image-guided percutaneous (IGP) approach has emerged as a potentially safer and more accessible alternative. Methods We conducted a retrospective study of adult patients who underwent PDC placement within Kaiser Permanente Northern California (KPNC) from January 1, 2018, to December 31, 2022. Patient characteristics, procedural variables, post-procedure length of stay, 90- and 180-day catheter intervention rates, 30-day readmission, and mortality rates were compared between IGP and ALS techniques. Results Among 3 062 patients, 835 (27%) received PDCs via IGP and 2 227 (73%) via ALS. While there were differences in patient characteristics due to selection biases, with the IGP group having higher prevalence of heart failure and lower BMI, eGFR, hemoglobin, and albumin levels, IGP was associated with significantly shorter post-procedure length of stay among admitted outpatients (1.8 vs. 3.1 days, P = 0.01) and lower catheter intervention rates at 90 days (1% vs. 2.5%, P = 0.006) and 180 days (1.3% vs. 4%, P < 0.0001). After adjustment for patient gender, race, BMI, and polycystic kidney disease status, the ALS technique remained significantly associated with higher odds of catheter re-intervention compared to IGP at both 90 days (adjusted OR 2.76, 95% CI 1.30–5.85, P = 0.008) and 180 days (adjusted OR 3.16, 95% CI 1.67–5.96, P < 0.0004). Overweight BMI was independently associated with increased intervention risk. Conclusions Despite being applied to a potentially sicker patient cohort, IGP was associated with favorable short- and intermediate-term outcomes compared to ALS, including reduced catheter interventions without compromising safety outcomes.