Ákos Peth? was born in year of 1971. He finished the Medical University of Debrecen in year 1999. Before the medical studies he had studied at the Technical University of Budapest, Hungary. He became the specialist in internal medicine and nephrology. He had learned multiple practical skills, e.g.: central vein catheter insertion (temporary, permanent), kidney biopsy, per cutaneous peritoneal dialysis catheter insertion and extracorporeal treatments (e.g. hemodialysis, hemoperfusion, plasma exchange, peritoneal dialysis). He is working now at Semmelweis University of Budapest, Hungary 1st Department of Internal Medicine as assistant professor.
Background: The successful implantation of peritoneal dialysis (PD) catheters is a critical skill procedure with the potential to impact both the short- and long-term success of renal replacement therapy and the patients’ survival. The insertion of the PD catheter performed in Hungary historically only with a surgical procedure. The PD treatment used not only in end-stage renal failure. Several clinical studies have demonstrated, that PD is supportive treatment in severe heart failure.
Methods: We started the per cutaneous catheter insertion in Hungary in the spring of 2014. We modified the previously described PDC insertion, the insertion point for PDC was the left lower quadrant for subsequent intraabdominal placements of the catheter. We utilized the straight silicone Tenckhoff catheter with two Dacron rings manufactured by Fresenius Medical Care GmbH (Bad Homburg, Germany) in all cases. We retrospectively reviewed our single-center experience with nephrologist-placed minimally invasive, double-cuffed PD catheters (PDC).
Results: The recruitment period was March 2014 through December 2015. The follow-up period lasted until 2016. The mean age of the subjects was 60 ±18 years and indications for the PD were diuretic resistant acutely decompensated chronic heart failure in 7 patients (47%) and end-stage renal disease in 8 (53%) patients. Acute technical complications within the first month were infrequent: 1 catheter (6%) had drainage problems and 1 (6%) was lost the due to extrusion. There were no serious complications (e.g. organ damage, peritonitis, etc.). We observed that PD-related improvement in left ventricular ejection fraction (LEVF) was associated with better quality of life and reduced hospitalization.
Conclusions: In selected cases, particularly in severe diuretic refractory heart failure, PD catheter placement placed by a nephrologist is feasible with a low rate of complications even in a low-volume center setting. The catheters we placed were all functioning with only minor complications and PD could be started immediately.