Resuming automated peritoneal dialysis after laparoscopic peritoneal wall anchoring for peritoneal dialysis catheter fixation

Excerpt

The patient is a 48-year-old man with end-stage kidney disease and a history of diabetic kidney disease. At 46, he underwent incremental start of peritoneal dialysis (PD) using the Moncrief and Popovich technique, and 4 months later, automated peritoneal dialysis (APD) was initiated. However, he developed exit-site and tunnel infections 3 months later which required a catheter diversion procedure with exit-site renewal. Figure 1 shows the PD catheter exit site in the upper right quadrant. Subsequently, he developed poor dialysate fluid drainage and was transitioned from APD to continuous ambulatory peritoneal dialysis (CAPD) to address the frequent cycler low-drain alarms triggered by PD catheter tip migration. To salvage the PD catheter, a noninvasive guidewire-directed manipulation procedure was performed, but poor dialysate fluid drainage recurred 1 month later. While CAPD could have been performed, APD was chosen by the patient because of his work. Therefore, we performed laparoscopic peritoneal wall anchor technique to prevent further migration of the PD catheter tip.

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