Nephrologist-led fluoroscopic PD catheter insertion enables safe urgent-start PD: five-year single-center experience

BACKGROUND: Timely placement of a functional peritoneal dialysis (PD) catheter is critical for PD utilization, particularly for patients requiring urgent dialysis initiation. Nephrologist-led percutaneous catheter insertion has been proposed as a streamlined alternative to surgical placement, but outcome data remain limited in some settings. METHODS: We conducted a retrospective review of all fluoroscopy-guided percutaneous PD catheter insertions performed by an interventional nephrology service at a tertiary center between 2019 and 2023. Outcomes included successful PD initiation, feasibility of urgent-start PD, and early complications within 30 days, including bleeding, mechanical dysfunction, infection, dialysate leak, and visceral injury. Complication rates were contextualized against published benchmarks. RESULTS: A total of 253 catheter insertions were performed in 243 patients (mean age 60.9 years; 56.8% male). PD was successfully initiated in 243 (96.0%) cases. Urgent-start PD was implemented in 75 (29.6%) cases, with a median initiation time of 1 day, whereas elective PD started on day 19. Clinically significant bleeding occurred in 28 (11.1%) cases, with major bleeding requiring transfusion or intervention in eight (3%) patients, occurring more frequently among urgent-start patients. Early mechanical dysfunction occurred in 10 (4.0%) cases. No early exit-site infections, peritonitis, dialysate leaks, or visceral injuries were observed within 30 days. Notably, the cohort included six successful procedures on patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD), a group traditionally considered technically challenging for PD access. CONCLUSIONS: A nephrologist-led, fluoroscopy-guided percutaneous PD catheter insertion program enabled timely PD initiation, including urgent-start PD, with high procedural success and low rates of serious early complications. These findings support the safety and effectiveness of nephrologist-performed PD catheter insertion within a structured interventional nephrology service.