Percutaneous peritoneal dialysis catheterization with visualization of rectovesical/rectouterine pouch under ultrasound guidance: a retrospective study of 507 patients

Abstract

Background

The success of urgent-start peritoneal dialysis (USPD) relies on well-functioning catheters and safe, minimally invasive catheterization methods with minimal complications. However, there are currently no large-scale trials demonstrating the significant superiority of any peritoneal dialysis (PD) catheterization technique.

Methods

We conducted a retrospective analysis of 507 patients who underwent “percutaneous peritoneal dialysis catheterization with visualization of rectovesical/rectouterine pouch (RP) under ultrasound guidance (we named ‘PDCVRU method’)” from September 2018 to February 2024. The outcomes of follow-up at 1 month and 1 year were observed.

Results

In this study, all patients received USPD within 48 h except one with technical failure. Of 506 patients with successful catheterization, 377 patients started low-volume manual fluid-exchange PD, which was gradually titrated to the standard peritoneal fluid volume used in continuous ambulatory peritoneal dialysis (CAPD); these patients comprised the CAPD group. The remaining 129 patients initiated low-volume tidal automated peritoneal dialysis (APD) with progressive titration to standard peritoneal fluid volume and were designated as the APD group. The overall success rate of catheterization was 99.8%, with no significant surgical bleeding, bladder injury, or intestinal perforation. At 1-month follow-up, there were 2 cases (0.4%) of peritonitis, 1 case (0.2%) of tunnel infection, 4 cases (0.8%) of transient leakage, and 11 cases (2.0%) of catheter malfunction. No significant differences were observed in the incidence of complications or catheter survival rate between the APD group and the CAPD group during the first month. At 1-year, data from 465 patients were available for analysis. There were 20 patients (4.3%) with catheter malfunction, 9 cases (1.9%) of exit or tunnel infections, 35 cases (7.5%) of peritonitis. The 1-year catheter-related survival rate was 95.8%.

Conclusions

The ‘PDCVRU method’ applied in this study has been proven to be a safe and effective catheterization technique suitable for independent performance by nephrologists, offering significant advantages for USPD.

Clinical trial number

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-025-04697-w.

Introduction

The US Renal Data System report indicates that 60% of patients progressing to end-stage kidney disease (ESKD) start dialysis without a clear plan [1]. Acute hemodialysis (HD) via central venous catheter (CVC) is the most common emergency method but is associated with increased complications and lower survival rates [2]. Compared with HD, peritoneal dialysis (PD) offers a better quality of life, economic advantages, preservation of residual kidney function, and a higher 5-year survival rate [3]. However, PD remains underutilized, especially in urgent-start PD (USPD), due to technical failures and mechanical complications [3]. Previous reports have shown that increasing the number of PD catheter insertions performed by nephrologists may facilitate timely PD initiation and contribute to the growth of PD programs [4, 5]. Currently, open surgery, laparoscopic surgery, peritoneoscopic approaches and Seldinger-based percutaneous puncture are the main PD catheterization methods [6]. However, the optimal method remains debated [7]. Compared with open, peritoneoscopic and laparoscopic surgery, which require skilled surgeons, available operating rooms and equipment, the Seldinger technique for PD catheter placement is increasingly favored for its bedside operational simplicity, minimal incision, shorter procedure time, and cost-effectiveness, especially for patients undergoing USPD [8]. The unguided (“blind”) percutaneous puncture method has become less common due to the increased risk of intestinal perforation and inappropriate catheter positioning [8]. Recently, image-guided percutaneous PD catheter placement with ultrasound or fluoroscopy guidance has gained widespread adoption [9]. Nevertheless, fluoroscopy-guided placement yields several drawbacks, including the need for fluoroscopy equipment, the occupation of medical resources, exposure to X-ray radiation, and the potential risk of bowel injury during peritoneal entry [9]. Therefore, further optimization of the safe, economical, and precise PD catheter placement method suitable for nephrologists is urgently needed. To date, limited studies on percutaneous PD catheterization with a small sample size have been reported [10].

In our center, we have improved the blind percutaneous catheterization technique. A comprehensive preoperative assessment is performed to determine a safe initial puncture site and to facilitate precise catheter placement. Multiple pre- and intraoperative improvements, including a sliding test, continuous ultrasound-guided visualization of the rectovesical/rectouterine pouch (RP) and ‘entry test’, are employed to ensure safe and precise catheter placement and minimize complications. We conducted a retrospective analysis of 507 patients undergoing USPD who received percutaneous PD catheterization with visualization of RP under ultrasound guidance (‘PDCVRU method’).

Materials and methods

Patients and equipments

From September 2018 to February 2024, a total of 507 patients who underwent PD catheterization through the ‘PDCVRU method’ were enrolled and followed for 12 months. Patients (aged ≥ 13 years) with kidney failure requiring renal replacement therapy (RRT) were included. Patients with extensive abdominal adhesions, morbid obesity, active intra-abdominal bleeding, severe coagulation disorders, or other conditions unsuitable for PD were excluded after preoperative evaluation. This study was approved by the ethics committee of Qingdao municipal hospital, and written informed consent were obtained from all patients. The equipment for catheterization included a Baxter med COMP set with a double-cuff straight Tenckhoff catheter, a color doppler ultrasound system with a broadband convex transducer (1.8–6.0 MHz) and a linear high-frequency ultrasound transducer (4.2–12 MHz), a central venous catheter, a tunneling needle, a rigid guidewire, and related accessories. All physicians in our center with more than two years of nephrology experience performed the surgeries after completing six months of training. The training program encompassed comprehensive instruction in abdominal and pelvic ultrasonography, general specifications for ultrasound-guided procedures, relevant anatomical knowledge, puncture techniques, surgical workflows, and intraoperative complication management. Under senior supervision, each nephrologist completed at least 20 supervised procedures before being deemed competent to perform the operation independently.

Preoperative evaluation

In addition to routine blood examinations, all patients underwent ultrasound examinations to measure abdominal wall thickness, identify adhesions, and map the distribution of the inferior epigastric and rectus sheath vessels [11, 12]. Except for a few patients who could not undergo CT scans, the remaining patients underwent abdominal CT to evaluate intra-abdominal conditions.

Innovations

Based on the blind percutaneous puncture method described in ISPD [13], the following improvements were made:

1. Contrary to traditional method, the ‘PDCVRU method’ allows for moderate bladder distension by retaining a small amount of urine in the bladder (Fig. 1A). The optimal diameter (axial height) of the bladder should be approximately 2 to 4 cm, with a bladder volume of 50 to 120 mL. The bladder volume (BV) can be calculated using the formula: BV = 0.7 × (L × W × H), where L, W, and H represent the sagittal length, width, and axial height, respectively [14].

2. Ultrasound visualization of localized visceral slide is utilized for accurate localization and mapping of abdominal wall adhesions to determine a safe initial entry site. The examination is based on real-time ultrasound imaging that displays the movement of abdominal organs, termed visceral sliding, induced by respiratory movement or manual compression (slide test) [11, 12] (Supplementary Video 1). Restricted visceral slide, characterized by the ultrasound detection of less than 1 cm of visceral movement relative to the anterior abdominal wall during maximal respiratory effort, indicates adhesions or adherence of the viscera to the anterior abdominal wall [11, 12, 15, 16] (Supplementary Video 1).

3. By reducing the puncture angle, the length of the PD catheter within the rectus abdominis muscle was prolonged to reduce peritoneal catheter malfunction and pericatheter leakage, especially in patients with malnutrition or thinner rectus abdominis muscles (Figs. 1B and 2).

4. During the operation, real-time ultrasound was employed to maintain continuous visualization of the RP and the puncture trajectory to ensure precise positioning of the catheter tip (Fig. 1C).

5. During the needle insertion through the abdominal wall, the fluctuation of the air-fluid interface level in the semi-transparent needle-hub during respiration confirms that the needle tip is introduced into the peritoneum (referred to as the ‘entry test’).

6. Artificial ascites was established by injecting 200–800 mL of saline into the abdominal cavity via the CVC to optimize visualization of the abdominal cavity and rectovesical/rectouterine pouch while minimizing gastrointestinal tract injury. Subsequently, a small amount of sterile gas was introduced into the abdominal cavity to facilitate catheter tip positioning by visualizing floating bubbles (Fig. 1D and Supplementary Video 2).

7. All patients started supine PD immediately with a low retention volume (approximately 1000 mL) within 48 h after catheterization (USPD).

Fig. 1.

Preoperative ultrasound assessment and ultrasound-guided catheterization. (A) Ultrasound examination is used to evaluate the thickness of the abdominal wall, the situation of abdominal wall adhesions, and abdominal vascular distribution. Red arrow, rectus abdominis; white arrow, bladder. (B) The introducer needle (orange arrow) passes through the rectus abdominis muscle (red arrow). (C) The introducer sheath (green arrow) is inserted into the abdominal cavity (The guidewire and introducer have been withdrawn from the sheath). Blue arrow, the artificial ascites. (D) A small amount of sterile gas is injected into the abdominal cavity to identify the position of the catheter tip indicated by the floating bubbles (yellow arrow)

Fig. 2.

Abdominal sites marking. (A) Red arrow, the puncture site; blue arrow, the entry site; black arrow, the deep cuff. (B) Red arrow, the puncture site; blue arrow, the exit site; black arrow, the superficial cuff

Detailed surgical procedures are shown in supplementary Fig. 1.

Observation parameters

The primary outcomes encompassed the surgical success rate, perioperative complications (e.g., postoperative bleeding, organ injury), infectious complications (e.g., peritonitis, exit-site or tunnel infections), mechanical complications (e.g., leakage, catheter migration, wrapping, catheter obstruction), as well as the 1-year catheter survival rates. Secondary outcomes included surgical interventions for catheter-related complications, catheter removal or replacement, postoperative mortality, and a comparison of outcomes between the APD and CAPD groups at 1 month.

Catheter patency is defined as the maintenance of PD treatment without the need for surgical interventions due to catheter-related complications [17].

Statistical analysis

Statistical analysis was conducted using SPSS software (version 26.0). Continuous variables were presented as mean ± standard deviation, while non-continuous variables were presented as percentages. The Pearson chi-squared test, chi-squared test with continuity correction, and Fisher’s exact test were employed for comparisons across groups. A significance threshold of P < 0.05 indicated statistical significance.

Results

The characteristics of patients are summarized in Table 1. Among all 507 patients, 92% suffered from chronic kidney failure, while 8% had acute kidney injury (AKI). The two leading causes of kidney failure were glomerulonephritis (41%) and diabetic nephropathy (37%). In addition, polycystic kidney disease accounted for 2% of patients with kidney failure. In this cohort, 32 individuals (6%) were critically ill patients from the ICU. Forty-eight patients (9.5%) had a history of abdominal surgery, including 9 cases of cesarean section, 7 cases of hysterectomy, 7 cases of nephrectomy, 8 cases of appendectomy, 7 cases of gastrectomy, 2 cases of abdominal aortic dissection surgery, and 8 cases of other surgeries. Notably, two patients with intra-abdominal adhesions, who were unable to undergo hemodialysis, were included in our cohort. One of them had abdominal adhesions resulting from hysterectomy (Supplementary Fig. 2A), while the other had an abdominal aortic aneurysm and developed abdominal adhesions owing to a prolonged interval before ileostomy closure after low anterior resection for rectal cancer (Supplementary Fig. 2B). Additionally, one patient with an abdominal wall hernia was unsuitable for hemodialysis because of a bedridden state and remote residence. Accordingly, low-volume supine PD was administered, achieving satisfactory clinical outcomes without aggravating the abdominal wall hernia (Supplementary Fig. 2C).

Table 1.

Patient demographics

Characteristics	Value
Sample size(n)	507
AKI or acute-on-chronic kidney failure, n (%)	40(8%)
ESKD n (%)	467(92%)
Etiology of kidney failure, n (%)
Glomerulonephritis	207(41%)
Diabetic kidney disease	187(37%)
Hypertensive nephropathy	51(10%)
Polycystic kidney disease	9(2%)
Others (renal amyloidosis, Thrombotic microangiopathy etc.)	53(10%)
Patients in ICU, n (%)	32(6%)
Comorbidities
Sepsis	12(2.4%)
Hematencephalon	3(0.6%)
Acute myocardial infarction (AMI)	4(0.8%)
Multiple organ failure	9(1.8%)
Others	4(0.8%)
Previous abdominal surgery, n (%)	48(9.5%)
Caesarean section	9(1.7%)
Hysterectomy	7(1.4%)
Nephrectomy	7(1.4%)
Appendicectomy	8(1.6%)
Gastrectomy	7(1.4%)
Abdominal aortic dissection surgery	2(0.4%)
Other surgeries	8(1.6%)
Age (years) mean ± SD	65.24 ± 14.81
Male, n (%)	327(64.50%)
BMI (kg/m2)	25.17 ± 3.54

The surgical success rate and perioperative complications

Of 507 patients, 506 (99.8%) had successful ‘PDCVRU method’ procedures without bladder injuries, intestinal perforations, or postoperative mortality. Only one obese male with body mass index (BMI) of 30.86 kg/m² experienced PD catheterization failure, where CT showed the catheter entered the preperitoneal space and was later repositioned in the RP via laparoscopy (Supplementary Fig. 2D). One case (0.2%) of postoperative tunnel-site bleeding occurred in a patient with ESKD complicated by pneumonia, possibly attributable to transient acquired von Willebrand syndrome and potentially associated with cefminox use. Bleeding in this patient was resolved after cessation of cefminox for 36 h. The average length of hospital stay at our center was 7.4 ± 5.3 days.

1-month outcomes

The incidence of mechanical complications was 2.8%. No obvious leakage was observed, except for transient leakage in 4 patients (0.8%) during defecation with indwelling dialysate. Catheter malfunction occurred in 11 patients (2.0%), including 8 cases (1.6%) of catheter migration. All migration cases were successfully resolved and normal catheter function was restored through conservative measures such as saline infusions, laxatives, enemas, or repositioning the patient. The remaining 3 cases (0.4%) were respectively wrapped by omentum, fallopian tube, and intestinal lipoma, all of which returned to normal function following laparoscopic surgery. The incidence of infectious complications was 0.6%, comprising 2 cases (0.4%) of peritonitis and 1 case (0.2%) of tunnel infection, which were improved after antibiotic treatment. The 1-month catheter survival rate was 99.4%, with no mortality observed. 1-month outcomes are shown in Table 2.

Table 2.

1-month outcomes were compared with previous reports

References	Surgical technique	Sample size	Dialysis start time	Organ injury	Hemorrhage	Leakage	Catheter malfunction	Exit-site/tunnel infection	Peritonitis (%/ per patient- year)
This study	PDCVRU method	507	Within 48 h	0	1* (0.2%)	4Δ (0.8%)	11 (2.0%)	1 (0.2%)	2 (0.4%) /0.05
Meena P [17] 2022	Open Surgery	48	Within 48 h	0	0	5.7%	16.7%	0	0
Milan Manani S [18] 2022	Minilaparotomic and Laparoscopic	132	-	0.75%	0	4.54%	-	0.75%	2.2%
Jo YI [19] 2007	Percutaneous	51	Immediately	-	2%	2%	10%	4%	4%
Huang J [7] 2022	Modified percutaneous	34	Immediately	0	17.6%	2.9%	2.9%	0	0
ISPD [13] 2019	-	-	-	< 1%	< 1%	-	-	< 5%	< 5%

^* Hemorrhage in this patient was unrelated to the surgical procedure

^Δ Transient leakage occurred solely when intra-abdominal pressure significantly increased within two weeks post-operation

h, hour; w, week; m, month

The 506 patients with successful catheterization were allocated to two groups based on patient preference and the availability of automated PD (APD) resources. Among them, 377 patients started low-volume manual fluid-exchange PD, which was gradually titrated to the standard peritoneal fluid volume used in continuous ambulatory peritoneal dialysis (CAPD); these patients comprised the CAPD group. The remaining 129 patients initiated low-volume tidal automated peritoneal dialysis (APD) with progressive titration to standard peritoneal fluid volume and were designated as the APD group. During the first month, there were no significant differences in mechanical complications, infectious complications, or catheter survival rates between the two groups (Supplementary Table 1). After one month, 112 patients in the APD group gradually transitioned to standard CAPD due to economic reasons.

1-year outcomes

During 1-year follow-up, 25 patients died of sepsis, acute myocardial infarction (AMI), multiple organ failure, and COVID-19 infection, including 12 patients from the ICU. In addition, 9 patients with acute kidney injury (AKI) successfully discontinued dialysis, 4 patients received kidney transplantation, and 3 patients were lost to follow-up. At the end of the study, data from 465 patients were available for analysis. A total of 20 cases (4.3%) experienced catheter malfunction, including 12 cases (2.6%) of catheter migration, 6 cases (1.3%) of catheter wrapping, and 2 cases (0.4%) of inflow/outflow obstruction of unknown causes. There were 7 cases (1.5%) of pleuroperitoneal leaks, 9 cases (1.9%) of hernia, and 6 cases (1.3%) of hydrocele. Of these 22 patients, 3 continued supine PD, 9 continued PD after successful surgical repair, while the remaining 10 patients declined surgical correction and transitioned to hemodialysis. Infectious complications occurred in 38 patients (8.2%), including 9 cases (1.9%) of exit-site or tunnel infections and 35 cases (7.5%) of peritonitis. Among them, 14 patients experienced 2–3 episodes of peritonitis, resulting in an average peritonitis rate of 0.15 episodes per patient-year.

Regarding the catheter patency at 1 year, we excluded 12 patients who transitioned to hemodialysis due to non-catheter-related causes (including 5 patients with pleuroperitoneal leaks, 2 of hernias, 3 with hydroceles, and 2 with inadequate dialysis). The 1-year catheter survival rate was 95.8%. A comparison with 1-year outcomes reported in previous studies is shown in Table 3. A total of 31 patients (6.7%) required surgical intervention to address catheter-related issues, of which 42% were attributed to catheter-related factors. Specifically, four cases of catheter wrapping were treated with laparoscopic surgery, while in five cases of catheter migration, normal catheter function was restored using a guidewire-assisted repositioning technique under ultrasound guidance (Supplementary Table 2).

Table 3.

1-year outcomes were compared with previous reports

References	Sample size	Surgical techniqe	Dialysis start time	Fol-low up time	Leakge	Catheter malfunction	Exit-site/ tunnel infection	Peritonitis (%/ per patient- year)	Hernia/ hydrocele	Pleuroperit-oneal leak	Catheter patency
This study	465	PDCVRU method	Within 48 h	12 m	4Δ (0.86%)	20 (4.3%)	9 (1.9%)	35 (7.5%)/0.15	9(1.9%)a/6( 1.3%) b	7c (1.5%)	95.8%
Povlsen JV [20] 2006	52	Surgical	Within 24 h	3 m	7.7%	15.4%	3.9%	15.4%/-	-	-	86.7%
Yang YF [21] 2011	226	Surgical	Within 2w	6 m	2.2%	3.1%	1.3%	4.0%/-	0.4%/ -	-	-
Ghaffari A [22] 2012	18	Percutaneous	Within 2w	3 m	33.3%	11.1%	-	-	-	-	-
Nayak KS [23] 2018	32	Surgical	Within 48 h	3 m	9.4%	25%	-	9.4%/-	-	-	90.6%
Bitencourt Dias D [24] 2017	51	Percutaneous	Within 72 h	6 m	7.8%	15.6%	17%	7.8%/0.5	-	1.9%	86.3%
Huang J [7] 2022	34	Percutaneous	Immediately	6 m	2.9%	2.9%	-	5.9%/0.24	-	-	94.1%

^Δ Transient leakage occurred solely when intra-abdominal pressure significantly increased within two weeks post-operation

^a Of the 9 patients with hernias, 2 were transitioned to hemodialysis, while the others continued peritoneal dialysis

^b Of the 6 patients with hydrocele, 3 were transitioned to hemodialysis, while the others continued peritoneal dialysis

^c Of the 7 patients with Pleuroperitoneal leak, 5 were transitioned to hemodialysis, while the others continued peritoneal dialysis

Discussion

Traditionally, PD catheter insertion performed by surgeons is associated with prolonged wait times, whereas nephrology teams achieve significantly shorter delays, reducing the average time to PD catheter insertion to 6.4 ± 0.9 days compared with 34.3 ± 1.6 days by surgeons [25]. During this waiting period, potential PD candidates may start HD and lose interest in PD. Referring a patient to a surgeon for dialysis access placement often results in delays in obtaining critical diagnostic information and disrupts the continuity of care [25]. Additionally, surgical approaches incur additional costs for anesthesia and operating room use [26]. Previous studies have shown that PD catheter insertion by nephrologists under local anesthesia can be safely performed in various settings, such as a procedure room, the intensive care unit, or even at the bedside [27, 28]. However, Ku E et al. observed higher rates of subsequent procedures for catheters placed by nephrologists [5]. Therefore, further improvements in PD catheter insertion methods suitable for nephrologists are critically needed.

In this study, we employed the ‘PDCVRU method’ to enhance procedural safety and minimize complications. In previous studies, bladder emptying was recommended to avoid organ injury [29], however, bladder injury may still occur [30]. In our center, we retained a small amount of urine in the bladder, creating artificial ascites, along with real-time ultrasound visualization of the abdominal cavity and RP, which effectively reduced organ injury risk. Our study demonstrated a markedly higher catheter insertion success rate compared with other studies using open surgery or blind Seldinger-based catheter insertion techniques [6, 31], even though we included patients with prior abdominal surgeries and complex conditions. Polycystic kidney disease and abdominal aortic aneurysm have previously been considered relative contraindications to PD. However, in this study, real-time ultrasound-guided percutaneous puncture effectively avoided potential injury to enlarged kidneys or blood vessels. It is noteworthy that two patients in our cohort with intra-abdominal adhesions successfully underwent catheterization, suggesting that this approach may be a feasible option in patients with intra-abdominal adhesions when other treatments are unavailable. Furthermore, this technique can be independently performed by nephrologists after a short training period under local anesthesia in diverse clinical settings. Overall, the ‘PDCVRU method’ greatly enhances procedural safety and improves the precision of PD catheter positioning.

Catheter malfunction, including migration, obstruction and wrapping, is the primary cause of technical failure and patient withdrawal, especially in USPD [13]. This study revealed a significantly lower incidence of catheter malfunction than that reported in previous studies (Tables 2 and 3 [7, 13, 17–24]). Prior studies have consistently highlighted the necessity for additional catheter fixation to prevent migration. However, these fixation methods often involve laparoscopic procedures or invasive abdominal wall incisions, which are complex and invasive [32–34]. In our study, ultrasound visualization of localized visceral sliding is utilized for accurate localization and mapping of abdominal wall adhesions to determine a safe initial entry site. With fine adjustments under ultrasound guidance, in addition to avoiding vascular bundles and intra-abdominal adhesions, the needle puncture site in the rectus abdominis is thick enough to receive the deep cuff of the catheter, which establishes a long rectus sheath tunnel, thus securing the catheter fixation and reducing migration, omental wrapping, and dialysate leakage (Figs. 1B and 2). These improvements have reduced the exposure length of the catheter in the abdominal cavity, thereby increasing catheter stability and reducing the risk of wrapping with the greater omentum. This study revealed that the incidence of catheter malfunction at 1 month and 1 year was significantly lower than that reported in previous studies (2.9–15.6% at 1 month and 3.1–25% at 6 months), as shown in Tables 2 and 3 [7, 13, 17–24]. Therefore, our ‘PDCVRU method’ showed an advantage in reducing catheter migration and wrapping incidence. It should be acknowledged that advanced video-laparoscopic techniques yield excellent outcomes for the management of mechanical complications, and nephrologists often require surgical assistance for such cases [13]. Nevertheless, in the majority of placements, the ‘PDCVRU’ procedure can be independently performed by nephrologists, thereby indisputably enhancing patient access to PD catheterization.

Peritoneal fluid leakage, a risk factor for catheter infection and malfunction, poses a challenge to USPD initiation [19, 35]. The ISPD guidelines recommend initiating PD at least 2 weeks post-surgery to reduce leakage [13]. Catheter insertion technique, PD initiation strategy, and abdominal-wall weakness are closely associated with dialysate leakage [19, 35]. Our study documented only 4 cases (0.8%) of transient leakage, which occurred solely when intra-abdominal pressure significantly increased within 2 weeks post-operation. These findings indicate a low leakage rate even among USPD patients (Tables 2 and 3) compared with rates reported in prior studies (2.2%–33.3%) [7, 13, 17–24].

Peritonitis remains a leading cause of mortality among PD patients worldwide, contributing directly to 20% of technical failures and 2%~6% of mortality, with potential complications including severe encapsulating peritoneal sclerosis and impaired peritoneal function [36]. Our study reported a low incidence of peritonitis (0.15, episodes/patient-year), significantly below the ISPD-recommended threshold [13] and other studies following open surgery and percutaneous procedures (Tables 2 and 3 [7, 13, 17–24]).

The ISPD guidelines recommend 12-month catheter patency of > 95% for laparoscopic catheterization and > 80% for other catheter insertion methods [13]. A meta-analysis revealed a catheter survival rate of 72.6% for the percutaneous group and 66.2% for the surgical group [37]. In our study, the 1-year catheter survival rate was 95.8%, exceeding the threshold recommended by the ISPD and the rates reported in other studies (Table 3 [7, 20, 22–24, 32]). In the field of USPD, our study demonstrated that the ‘PDCVRU method’ was safer and associated with fewer complications than other catheterization methods (Tables 2 and 3 [7, 13, 17–24]). Furthermore, during the first month, no significant differences in outcomes were observed between the APD and CAPD groups (Supplementary Table 1). In addition, the reduction in postoperative complications and hospital stay, along with the successful application of USPD in critically ill patients, resulted in decreased utilization of continuous renal replacement therapy (CRRT), thereby producing economic benefits.

This study has several limitations. The single-center retrospective design limits external generalizability, and the lack of a control group precludes direct comparisons and causal inference. Nonetheless, the study includes a relatively large sample and a broad spectrum of etiologies of kidney failure, improving applicability to similar clinical settings. Despite these limitations, the findings offer evidence regarding the safety and effectiveness of the ‘PDCVRU method’, and future prospective multicenter studies are warranted to further validate these observations.

Conclusion

We present a large, single-center study evaluating outcomes of a modified Seldinger-based technique for PD catheter insertion, referred to as the ‘PDCVRU method’. This safe and effective method can be performed independently by nephrologists and achieved high procedural success with low complication rates in USPD.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

All authors participated in the data analysis and preparation of the manuscript and approved the final manuscript for publication.

Funding

Funding Agency: National Natural Science Foundation of China (NSFC) Grant Number: [82170717].

Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Declarations

Ethics approval and consent to participate

This study was approved by the ethics committee of Qingdao municipal hospital (Approval No.: 2024-KY-027). Informed consent to participate in the study was obtained from all individual participants, in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.