Prospective observational study of purse-string suturing of the anterior rectus fascia for urgent-start peritoneal dialysis.

Introduction: To assess the efficacy and safety of a consistent percutaneous procedure for peritoneal dialysis (PD) catheter placement in initiating immediate-start PD in patients with end-stage kidney disease (ESKD).

Materials and methods: In this single-center prospective observational study, we enrolled patients with ESKD who were willing to undergo long-term PD. Tenckhoff catheters were placed under local anesthesia by a nephrologist, with the inner cuffs pushed underneath the anterior rectus fascia and purse-string sutures applied. Automated PD (APD) and continuous ambulatory PD (CAPD) were started within 1 hour following catheter placement. The primary outcomes were peri-catheter leakage, technique failure, and the need for hemodialysis during admission.

Results: APD was initiated in 12 patients, with a median initial dwell volume of 1,350 mL (range 1 - 2 L, 7 exchanges) and CAPD in 8 patients, with a median initial dwell volume of 1,500 mL (range 1 - 1.8 L, 4 exchanges). No cases of peri-catheter leakage, flow restriction, or hemodialysis inception occurred. There were 2 minor complications: 1 case of hemoperitoneum and 1 case of incisional bleeding, both of which were managed conservatively.

Conclusion: The use of purse-string suturing of the rectus fascia may allow for the immediate start of PD within 1 hour of catheter placement, with larger dwell volumes and a low risk of complications.