Successful Transition from Haemodialysis to Peritoneal Dialysis in a 68 Y.O. Male with ESRD
PACE Hospitals
PACE Hospitals’ expert Nephrology and Renal Transplantation team successfully performed Peritoneal Dialysis Catheter Insertion on a 68-year-old male patient diagnosed with Stage V Chronic Kidney Disease and dependent on maintenance haemodialysis. The procedure was performed to provide long-term access for peritoneal dialysis, reduce dependence on hospital-based haemodialysis, support effective removal of waste and excess fluid, and improve the patient’s convenience and quality of life.
Chief Compliant
A 68-year-old male patient with a body mass index (BMI) of 21.8 presented to the Nephrology Department at PACE Hospitals, Hitech City, Hyderabad, with Stage V Chronic Kidney Disease requiring renal replacement therapy. He had been receiving maintenance haemodialysis once weekly through an internal jugular vein permcath and was referred for peritoneal dialysis catheter insertion.
Past Medical History
The patient was a known case of end-stage chronic kidney disease with associated Type 2 diabetes mellitus, hypertension, and coronary artery disease. He had been dependent on hospital-based haemodialysis through a permcath.
On Examination
On examination, the patient was conscious, coherent, oriented, and hemodynamically stable. His blood pressure, blood glucose levels, fluid status, and cardiovascular condition were assessed because of the associated diabetes, hypertension, coronary artery disease, and advanced kidney disease. Abdominal examination was performed to assess suitability for catheter placement.
Diagnosis
Upon admission to PACE Hospitals, the patient was thoroughly evaluated by the Nephrology and Renal Transplantation team, including a detailed review of his medical history, dialysis requirements, associated health conditions, and overall suitability for peritoneal dialysis.
The patient was a known case of Stage V Chronic Kidney Disease, and had been receiving maintenance haemodialysis once weekly through an internal jugular vein permcath. He also had Type 2 diabetes mellitus, hypertension, and coronary artery disease.
Baseline investigations, including complete blood count, serum electrolytes, kidney function tests, liver function tests, and abdominal ultrasonography, were carried out. The ultrasound showed no intra-abdominal mass or significant adhesions that would prevent catheter placement.
Based on the confirmed diagnosis and dialysis requirements, the patient was advised to undergo Stage V Chronic Kidney Disease Treatment in Hyderabad, India, under the expert care of the Nephrology Department.
Medical Decision-Making (MDM)
After detailed consultation with Dr. A. Kishore Kumar (Consultant Nephrologist and Renal Transplant Physician), along with Dr. Vishwambhar Nath (Senior Consultant Urologist), Dr. Abhik Debnath (Consultant Urologist), and Dr. K. Ravichandra (Consultant Laparoscopic Urologist), the patient’s kidney function, dialysis requirements, associated medical conditions, and lifestyle needs were comprehensively reviewed.
The patient had Stage V Chronic Kidney Disease and was receiving maintenance haemodialysis through an internal jugular permcath. Considering his long-term dialysis requirement, Type 2 diabetes mellitus, hypertension, coronary artery disease, and the need for a more convenient renal replacement option, transition to peritoneal dialysis was considered appropriate.
Baseline blood tests and abdominal ultrasonography were reviewed to assess procedural fitness and exclude intra-abdominal masses or significant adhesions. Based on the clinical evaluation, peritoneal dialysis catheter insertion was planned to provide reliable access for home-based dialysis and reduce dependence on hospital-based haemodialysis.
The patient and family were counselled regarding the procedure, expected benefits, possible risks such as bleeding, infection, catheter blockage or displacement, and the importance of catheter care, dietary and fluid restrictions, regular dialysis sessions, and follow-up.
Surgical procedure
Following the decision, the patient was scheduled to undergo Peritoneal Dialysis Catheter Insertion in Hyderabad at PACE Hospitals, under the expert care of the Nephrology Department.
The procedure involved the following steps:
- Patient Preparation and Anaesthesia: The procedure was performed in the operation theatre under local anaesthesia with fluoroscopic guidance. The abdomen was cleaned and draped under sterile precautions, and local anaesthesia was administered below the umbilicus.
- Abdominal Access: A small incision was made below the umbilicus, and the tissue layers were carefully separated until the rectus sheath was exposed. The peritoneal cavity was entered safely, and normal saline was instilled to confirm access.
- Fluoroscopic Confirmation: The position of the needle within the peritoneal cavity was confirmed using contrast fluoroscopy to ensure accurate catheter placement.
- Guidewire and Catheter Placement: A guidewire was inserted under fluoroscopic guidance, followed by placement of the peritoneal dialysis catheter using a peel-away sheath. Catheter flow was checked to confirm proper function.
- Tunnel Creation and Exit Site Formation: A subcutaneous tunnel was created, and the catheter exit site was positioned on the left side of the abdomen below the belt line, facing inferolaterally for easier care and reduced discomfort.
- Catheter Fixation and Closure: The inner cuff of the catheter was secured to the rectus sheath. The deeper tissues were closed with absorbable sutures, the skin was closed, and a sterile dressing was applied after confirming hemostasis.
Postoperative Care
After the procedure, the patient was closely monitored for bleeding, fever, breathing difficulty, catheter function, and wound condition. Mild blood seepage from the dressing was managed with a dressing change. An antibiotic-related reaction causing rapid breathing and breathlessness was treated promptly after discontinuing the medicine. The patient also received treatment for anaemia associated with chronic kidney disease and was discharged in stable condition.
Discharge Medications
At discharge, the patient was prescribed medicines for blood pressure control, fluid management, improved circulation, prevention of blood clot formation, fever control, anaemia management, and other supportive care as required.
Advice on Discharge
The patient was advised to keep the peritoneal dialysis catheter dressing clean and dry and avoid soaking it for two weeks. Fluid intake was restricted to less than 1,000 ml per day, and daily salt intake was limited to less than 5 grams, as advised by the treating team. He was also instructed to monitor blood glucose levels regularly and follow all catheter-care, dietary, and dialysis instructions carefully.
Emergency Care
The patient was advised to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, abdominal pain, repeated vomiting, breathing difficulty, redness or discharge around the catheter site, bleeding, cloudy dialysis fluid, reduced catheter flow, or any sudden deterioration in his condition.
Review and Follow-Up
The patient was advised to return for a follow-up consultation with the Nephrologist in Hyderabad at PACE Hospitals after 5 days.
Conclusion
This case highlights the successful management of Stage V Chronic Kidney Disease through peritoneal dialysis catheter insertion. The procedure provided a reliable access for peritoneal dialysis and supported the patient’s transition from hospital-based haemodialysis to a more convenient long-term dialysis option. The patient recovered well after the procedure and was discharged in stable condition with catheter-care instructions, dietary and fluid restrictions, medications, and follow-up advice.
Importance of Peritoneal Dialysis Access in End-Stage Kidney Disease Management
Peritoneal dialysis catheter placement plays an important role in providing long-term dialysis access for patients with Stage V Chronic Kidney Disease. Careful evaluation of kidney function, fluid status, associated medical conditions, abdominal findings, and lifestyle requirements helps determine whether peritoneal dialysis is a suitable option. In this case, the catheter provided an alternative to hospital-based haemodialysis and supported a more flexible dialysis plan.
Proper catheter positioning, sterile insertion technique, secure fixation, and regular flushing are essential for effective dialysis and reducing complications. Careful catheter-site care and follow-up with a nephrologist/nephrology doctor help identify infection, bleeding, blockage, or drainage problems at an early stage. Adherence to fluid and salt restrictions, blood glucose control, medication use, and scheduled reviews remains important for maintaining catheter function and improving quality of life.
Frequently Asked Questions (FAQs)
Why does a patient with end-stage kidney disease need dialysis?
In end-stage kidney disease, the kidneys can no longer remove enough waste, extra fluid, and harmful substances from the blood. Dialysis performs part of this filtering work and helps control fluid balance and symptoms. It supports the patient’s health, but it does not cure kidney failure.
What is peritoneal dialysis, and how does it work?
Peritoneal dialysis uses the natural lining of the abdomen, called the peritoneum, to filter the blood. A special dialysis fluid enters the abdomen through a catheter, absorbs waste and excess fluid, and is then drained out. This process is repeated regularly with fresh dialysis fluid.
Why was the patient shifted from haemodialysis to peritoneal dialysis?
Peritoneal dialysis can provide a more flexible treatment option and may reduce the need for frequent hospital-based haemodialysis sessions. The decision depends on the patient’s health, abdominal condition, lifestyle, ability to manage dialysis care, and personal preference. The nephrology team selects the most appropriate dialysis method after a detailed assessment.
Why was abdominal ultrasonography performed before catheter insertion?
Abdominal ultrasonography helps doctors examine the abdominal organs and identify problems that could affect safe catheter placement. It may help detect an abdominal mass, fluid collection, or other abnormality requiring further evaluation. In this patient, no mass or significant problem preventing catheter insertion was identified.
Can peritoneal dialysis be performed at home?
Yes, peritoneal dialysis is commonly performed at home after the patient and caregiver receive proper training. Exchanges may be carried out manually during the day or automatically at night using a dialysis machine. A clean environment, correct technique, and regular follow-up are essential for safe home dialysis.
What is peritonitis, and what symptoms can it cause?
Peritonitis is an infection or inflammation of the lining inside the abdomen and is an important complication of peritoneal dialysis. Symptoms may include abdominal pain, fever, nausea, vomiting, and cloudy dialysis fluid. These symptoms require urgent medical attention because early treatment helps protect the patient and preserve catheter function.
What may cause bleeding or blood seepage around the catheter site?
A small amount of blood seepage may occur soon after insertion because the skin and tissues around the catheter are still healing. It may also result from irritation, catheter movement, injury to a small blood vessel, or medicines that affect blood clotting. Persistent, heavy, or increasing bleeding should be reported promptly.
How do diabetes, hypertension, and coronary artery disease affect dialysis care?
These conditions require careful monitoring because they can affect blood sugar, blood pressure, circulation, fluid balance, and heart function. Poorly controlled diabetes or hypertension may increase health risks, while excess fluid can place additional strain on the heart. Treatment therefore includes regular monitoring, medicines, dietary guidance, and coordination between nephrology and cardiac care teams.
Why is fluoroscopic guidance used during peritoneal dialysis catheter placement?
Fluoroscopy provides real-time X-ray images that help the doctor guide the wire and catheter into the correct position inside the abdominal cavity. It can improve placement accuracy and help confirm the catheter’s course and position during the procedure. Fluoroscopy-guided placement is an accepted technique for inserting peritoneal dialysis catheters.
Why are catheter flushing and regular nephrology follow-up important?
Catheter flushing helps confirm that dialysis fluid can flow freely through the catheter and may help identify blockage or poor drainage before regular dialysis begins. Follow-up visits allow the nephrology team to assess wound healing, catheter function, infection risk, dialysis adequacy, blood pressure, fluid status, and laboratory results. Proper catheter care and regular monitoring help maintain effective dialysis and reduce complications.
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