Peritoneal dialysis catheterization with an upward tunnel and exit site: An observational study.

BACKGROUND: The preferred techniques for peritoneal dialysis catheterization are uncertain. Catheter implantation with formation of an inferiorly-directed tunnel and exit site is widely recommended to reduce the risk of infective complications. We aimed to compare percutaneous peritoneal dialysis catheter insertion using an upwardly-directed tract to catheter insertion using a downwardly-directed tract. METHODS: A retrospective cohort study was performed on consecutive peritoneal dialysis catheterizations over a 10-year period at a single centre. Participants were classified into two groups: catheter insertion with an upward tunnel and exit site versus insertion with a downward tunnel and exit site. The primary outcome was peritoneal dialysis catheter survival. RESULTS: There were 247 peritoneal dialysis catheters inserted during the study period. The median catheter survival was 18 months, with no difference between the two groups (p = 0.23). The 12-month catheter patency rates were 76% for catheters with an upward tract and 79% for catheters with a downward tract (p = 0.15). Multivariate analysis identified no clinical factors predictive of catheter survival. A downward catheter tunnel and exit site was associated with an increased incidence of peritonitis (0.23 vs 0.11 episodes per year; p ⩽ 0.01). CONCLUSION: In this study, percutaneous peritoneal dialysis catheter insertion with an upward tunnel and exit site demonstrated similar catheter survival to insertion with a downward tunnel and exit site and was not associated with increased infections.

Nocardiosis presenting as a lung mass in a kidney transplant recipient.

Nocardiosis is a potentially life-threatening disease in renal transplant recipients. It is an uncommon infection with high lethality if left untreated. We report a case of a 67 year-old kidney transplant recipient who developed pulmonary nocardiosis and presented with pleural effusion along with an underlying lung mass, which was successfully treated with trimethoprim-sulphamethoxazole in conjunction with a reduction in immunosuppressive therapy. Five months later, graft function remains stable with complete regression of radiological abnormalities and absence of symptoms. Nocardiosis should be suspected in the presence of pulmonary symptoms in a transplant patient with unusual radiological presentation.