Outcome of percutaneous peritoneal dialysis catheter insertion

Objectives: Peritoneal dialysis (PD) is an effective home-based renal replacement therapy for patients with end-stage renal disease (ESRD). However, timely and safe catheter insertion remains a barrier to its widespread adoption. Percutaneous PD catheter insertion by nephrologists has emerged as a safe alternative to surgical techniques. This study aimed to evaluate the outcomes and safety of nephrologist-performed percutaneous PD catheter insertion using a combined ultrasound and fluoroscopy-guided approach at a regional hospital in Oman. Material and Methods: This was a retrospective cohort study conducted at the Nephrology Department, Nizwa Hospital, Sultanate of Oman, between September 2022 and December 2025. All consecutive adult patients with ESRD who underwent percutaneous PD catheter insertion by the trained nephrology team were included. Procedures were performed under local anesthesia using ultrasound for abdominal wall assessment and fluoroscopy with contrast to confirm intraperitoneal placement. The study evaluated technical success and early procedural and post-insertion complications; 1-year catheter survival, transfer to hemodialysis, and late catheter revision were outside its scope. Results: A total of 79 patients (60.8% male, mean age 56.8 ± 16.6 years) underwent percutaneous PD catheter insertion. The success rate was 88.6% (70/79; 95% confidence interval: 79.5–94.2%). No bowel perforation occurred. The most common causes of failure were preperitoneal placement (33.3%) and surgical adhesions (33.3%). Early leakage was the most frequent mechanical complication (7.6%). Prophylactic antibiotics were administered in 100% of patients. Early peritonitis occurred in 1 patient (1.3%) and exit site infections in 3 patients (3.8%). Pseudomonas aeruginosa was the most common organism (2 cases). Failure of insertion decreased from 15.0% in the first 40 insertions to 7.7% in the last 39 insertions. Urgent-start PD (53.2% of patients) was associated with higher early leakage (11.9% vs. 2.7%). Conclusion: Percutaneous PD catheter insertion by nephrologists using image guidance is safe and effective, with improving outcomes over time. Urgent-start PD is feasible but requires caution due to higher leakage risk.