Andrew Walker, Michael Corr, Daniel Conroy, James McDaid, Damian McGrogan, Damian Fogarty, Stephen O'Neil
Regional Nephrology & Transplant Unit-Belfast Health and Social Care Trust, Belfast, UK.
Centre for Public Health, Institute of Clinical Sciences B, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
BMC Nephrol. 2025 Jul 1;26(1):293. doi: 10.1186/s12882-025-04210-3.
The global prevalence of obesity in patients with end-stage kidney disease requiring kidney replacement therapy is rising. While peritoneal dialysis (PD) offers advantages for many patients, its use in those with obesity has been historically limited due to concerns about catheter insertion-related complications, mechanical issues, and infection risk. This study aimed to evaluate PD catheter patency, infection rates, and modality outcomes in obese and non-obese patients to inform best practices and guide programme expansion.
This single-region observational study analysed outcomes from 157 patients who underwent PD catheter insertion between 2020 and 2023 at the Northern Ireland Regional Nephrology and Transplant Centre. Patients were classified as obese (BMI ≥ 30, n = 44) or non-obese (BMI < 30, n = 113). Laparoscopic and percutaneous catheter insertion techniques were used, and primary outcomes included catheter patency (primary, primary assisted, secondary) and infection rates (exit site infection, tunnel infection, peritonitis) 1-year post-insertion. Kaplan-Meier survival analysis and descriptive statistics were applied to compare outcomes between groups.
Patency rates were high in both groups, with no significant differences: primary patency was 88% in non-obese patients and 80% in obese patients (p = 0.13). Similarly, primary assisted patency was 94% versus 89% (p = 0.26), and secondary patency was 96% versus 89% (p = 0.11). Patency and infection rates remained within standards set in ISPD guidelines for both groups, although obese patients showed a non-significant trend toward higher peritonitis rates (0.09). Transfer to haemodialysis occurred more frequently in the obese group (34% vs. 19%, p = 0.06). Mortality rates were comparable (9% non-obese, 6% obese).
This study demonstrates that, with appropriate surgical techniques and periprocedural care, obese patients can achieve PD outcomes comparable to those of non-obese individuals. These findings challenge the traditional reluctance to offer PD to obese patients and advocate for the expansion of PD programs to include this growing demographic.
Not Applicable.
需要肾脏替代治疗的终末期肾病患者的全球肥胖患病率正在上升。虽然腹膜透析（PD）对许多患者具有优势，但由于担心导管插入相关并发症、机械问题和感染风险，其在肥胖患者中的应用历来有限。本研究旨在评估肥胖和非肥胖患者的PD导管通畅率、感染率及透析方式结局，以提供最佳实践并指导项目扩展。
这项单区域观察性研究分析了2020年至2023年期间在北爱尔兰地区肾病与移植中心接受PD导管插入术的157例患者的结局。患者分为肥胖组（BMI≥30，n = 44）和非肥胖组（BMI＜30，n = 113）。采用腹腔镜和经皮导管插入技术，主要结局包括插入术后1年的导管通畅情况（初次通畅、初次辅助通畅、二次通畅）和感染率（出口处感染、隧道感染、腹膜炎）。应用Kaplan-Meier生存分析和描述性统计来比较组间结局。
两组的通畅率均较高，无显著差异：非肥胖患者的初次通畅率为88%，肥胖患者为80%（p = 0.13）。同样，初次辅助通畅率分别为94%和89%（p = 0.26），二次通畅率分别为96%和89%（p = 0.11）。两组的通畅率和感染率均保持在国际腹膜透析学会（ISPD）指南设定的标准范围内，不过肥胖患者的腹膜炎发生率有升高趋势但无统计学意义（0.09）。肥胖组转为血液透析的情况更频繁（34%对19%，p = 0.06）。死亡率相当（非肥胖组9%，肥胖组6%）。
本研究表明，通过适当的手术技术和围手术期护理，肥胖患者可以获得与非肥胖患者相当的PD结局。这些发现挑战了传统上不愿为肥胖患者提供PD的观念，并主张扩大PD项目以纳入这一不断增长的人群。
不适用。
