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. 2024 Apr 1;19(4):472-482.
doi: 10.2215/CJN.0000000000000404. Epub 2024 Jan 8.

The Association of Intra-Abdominal Adhesions with Peritoneal Dialysis Catheter-Related Complications

Mohammad Azfar Qureshi  1 , Serban Maierean  2 , John H Crabtree  3 , Alix Clarke  4 , Sean Armstrong  5 , Rachel Fissell  6 , Arsh K Jain  7 , Sarbjit V Jassal  8 , Susie L Hu  9 , Peter Kennealey  10 , Scott Liebman  11 , Brendan McCormick  12 , Bogdan Momciu  13 , Robert P Pauly  14 , Beth Pellegrino  15 , Jeffrey Perl  16 , James L Pirkle Jr  17 , Troy J Plumb  18 , Rebecca Seshasai  19 , Ankur Shah  9 , Nikhil Shah  20 , Jenny Shen  21 , Gurmukteshwar Singh  22 , Karthik Tennankore  23 , Jaime Uribarri  24 , Murray Vasilevsky  25 , Robert Yang  26 , Robert R Quinn  27 , Ashlie Nadler  28 , Matthew J Oliver  29 ; North American Peritoneal Dialysis Registry
Collaborators, Affiliations

The Association of Intra-Abdominal Adhesions with Peritoneal Dialysis Catheter-Related Complications

Mohammad Azfar Qureshi et al. Clin J Am Soc Nephrol. .

Abstract

Background: This study investigated the association of intra-abdominal adhesions with the risk of peritoneal dialysis (PD) catheter complications.

Methods: Individuals undergoing laparoscopic PD catheter insertion were prospectively enrolled from eight centers in Canada and the United States. Patients were grouped based on the presence of adhesions observed during catheter insertion. The primary outcome was the composite of PD never starting, termination of PD, or the need for an invasive procedure caused by flow restriction or abdominal pain.

Results: Seven hundred and fifty-eight individuals were enrolled, of whom 201 (27%) had adhesions during laparoscopic PD catheter insertion. The risk of the primary outcome occurred in 35 (17%) in the adhesion group compared with 58 (10%) in the no adhesion group (adjusted HR, 1.64; 95% confidence interval [CI], 1.05 to 2.55) within 6 months of insertion. Lower abdominal or pelvic adhesions had an adjusted HR of 1.80 (95% CI, 1.09 to 2.98) compared with the no adhesion group. Invasive procedures were required in 26 (13%) and 47 (8%) of the adhesion and no adhesion groups, respectively (unadjusted HR, 1.60: 95% CI, 1.04 to 2.47) within 6 months of insertion. The adjusted odds ratio for adhesions for women was 1.65 (95% CI, 1.12 to 2.41), for body mass index per 5 kg/m 2 was 1.16 (95% CI, 1.003 to 1.34), and for prior abdominal surgery was 8.34 (95% CI, 5.5 to 12.34). Common abnormalities found during invasive procedures included PD catheter tip migration, occlusion of the lumen with fibrin, omental wrapping, adherence to the bowel, and the development of new adhesions.

Conclusions: People with intra-abdominal adhesions undergoing PD catheter insertion were at higher risk for abdominal pain or flow restriction preventing PD from starting, PD termination, or requiring an invasive procedure. However, most patients, with or without adhesions, did not experience complications, and most complications did not lead to the termination of PD therapy.

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Conflict of interest statement

S. Armstrong reports consultancy for Baxter and has attended advisory boards for Baxter Healthcare. J.H. Crabtree reports consultancy for Baxter Healthcare and DaVita Kidney Care; honoraria from Baxter Healthcare, DaVita Kidney Care, and Fresenius Medical Care; an advisory or leadership role for Peritoneal Dialysis International Journal; and speakers bureau for Baxter Healthcare, DaVita Kidney Care, and Fresenius Medical Care. R. Fissell reports consultancy for Medcomp and research funding from Renal Research Institute. A.K. Jain reports employment with London Health Sciences Center, consultancy for AWAK Technologies, research funding from Baxter Healthcare, honoraria from Baxter Healthcare, and an advisory or leadership role for Ontario Renal Network. P. Kennealey reports consultancy for Veloxis and advisory or leadership roles for Donor Alliance Advisory Board (Colorado) and National Kidney Foundation Advisory Board (Colorado). S. Liebman reports ownership interest in Amazon, Apple, Chipotle, Disney, Google, Home Depot, Microsoft, Netflix, and Starbucks, and Berkshire Hathaway; honoraria from Home Dialysis University; and an advisory or leadership role as Chair of the ISPD education committee. S. Maierean reports employment with, ownership interest in, and an advisory or leadership role for Phantom Photonics. S. Maierean's spouse is a cofounder of Phantom Photonics. A. Nadler reports ownership interest in Medtronic. M.J. Oliver is the sole owner of Oliver Medical Management Inc., which is a private corporation that licenses the Dialysis Measurement Analysis and Reporting (DMAR) software system. Oliver Medical Management Inc. is coowner of a Canadian Patent for DMAR systems. M.J. Oliver reports employment with and ownership interest in Oliver Medical Professional Corporation, honoraria from Baxter Healthcare, and other interests or relationships as contracted Medical Leads at Ontario Renal Network and Ontario Health. B. Pellegrino reports an advisory or leadership role for DaVita Physician Advisory Board IT. J. Perl reports consultancy for AstraZeneca, Baxter Health Care Canada, Bayer, DaVita Healthcare Partners, Fresenius Medical Care, LiberDi, Otsuka, and Outset Medical; ownership interest in I-Ren; research funding from Agency for Healthcare Research and Quality and Arbor Research Collaborative For Health; honoraria from AstraZeneca Canada, Baxter Healthcare USA/Canada, Bayer Canada, DaVita Healthcare Partners, DCI, Fresenius Medical Care, GSK Canada, Innovative Renal Care, Otsuka Canada, and US Renal Care; speakers bureau for Baxter Healthcare and Fresenius Medical Care; salary support from Agency for Healthcare Research and Quality and Arbor Research Collaborative For Health; and role on the advisory board for Liberdi Ltd. outside of the submitted work. T.J. Plumb reports consultancy for Nebraska Department of Health and Human Services and other interests or relationships as Medical director for DaVita dialysis units and Fresenius. R.R. Quinn is the coinventor of the DMARTM System, and is the coowner of the intellectual property associated with it. R.R. Quinn reports consultancy for Baxter Corporation; research funding from ISPD PD Catheter Registry (Baxter partially funding project); honoraria from Baxter (PD University) and Baxter Advisory Board; speaking fees and attended advisory boards for Baxter Healthcare Corporation; and Canadian patent for Dialysis Measurement, Analysis, and Reporting (DMAR) System. R. Seshasai reports employment with Atria, Clearco, and Compass; consultancy for Atria; ownership interest in Clearco, Compass, and Sanderling; and an advisory or leadership role for Volition. A. Shah reports employment with Brown Physicians Inc.; consultancy for AstraZeneca, CareDX, and Otsuka; and advisory or leadership roles for American College of Physicians Rhode Island Chapter Governor's Advisory Council, American Society of Nephrology Policy and Advocacy Committee, Renal Physicians Association Government Affairs Committee, and Renal Physicians Association Policy Advocacy Leadership Steering Committee. N. Shah reports research funding from, honoraria from, advisory or leadership role for, and speakers bureau for Amgen and Baxter. J. Shen reports the consultancy for Healthmap, Outset Medical, and Spectral Medical and other interests or relationships with American Society of Nephrology, International Society of Peritoneal Dialysis, National Kidney Foundation, and PDOPPS. G. Singh reports employment with Geisinger Health. K. Tennankore reports employment with Dalhousie/Nova Scotia Health; consultancy for Bayer, GSK, Otsuka, and Vifor; research funding from Otsuka Canada; honoraria from Baxter, Bayer, GSK, Otsuka, Vifor Pharmaceuticals, and Virtual Hallway; advisory or leadership role as a Deputy Editor for the Canadian Journal of Kidney Health and Disease; and speakers bureau for Bayer and Otsuka. K. Tennankore has attended advisory boards for AstraZeneca, Baxter, Bayer, GSK, Otsuka, and Vifor Pharmaceuticals. M. Vasilevsky reports consultancy for Doreen Wolpert Consulting Inc., Drug Intelligence.com, and Otsuka Pharmaceuticals and ownership interest in Agnico Eagle, Alpha Tau, Bank of America, Birchcliff, Brookfield Infrastructure Partners, CAE, Canadian National Railway, CCL Industries, Cenovus Energy, Eli Lilly, Enbridge, Forvia, Jamieson Wellness, Lithium Americas, Microsoft, Nuvei, Oncolytics Biotech, Osisko Metals, Pan American Silver, Parkland Corporation, Precigen, Rogers Communications, Solaris Resources, Stellantis, Teck Resources, Toronto Dominion Bank, and West Fraser Timber Co.R. Yang reports employment with McMaster University. Baxter Canada provided an unrestricted educational grant to support the development and operations of the Introductory PD Catheter Insertion Course, by the McMaster PD Catheter Access Centre by SJHH (MPACS). However, Baxter Canada had no influence/control over how the funds were used by MPACS. As the Co-Program Director and one of the faculty members, R. Yang was paid an honorarium for the 2023 course. All remaining authors have nothing to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Cohort creation describing inclusion and exclusion criteria and sample size. PD, peritoneal dialysis.
Figure 2
Figure 2
Cumulative risk of PD catheter complications by the presence of adhesions. PD catheter complications were defined as flow restriction or abdominal pain leading to PD never starting, PD termination, or the need for an invasive procedure to treat the complication. The cumulative risk of the primary outcome 6 months from insertion was 17% in the adhesions group compared with 10% in the nonadhesion group (unadjusted HR, 1.60; 95% CI, 1.09 to 2.35). CI, confidence interval.
See this image and copyright information in PMC

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