Traditionally peritoneal dialysis (PD) catheter was implanted by surgeons using mini-laparotomy or open technique in Malaysia. We introduced peritoneoscopic Tenckhoff catheter insertion technique since the beginning of our PD program. Data were collected from the start of our PD program in February 2006 until April 2008. All Tenckhoff catheters were inserted by nephrologists using the peritoneoscope technique. We also compare the penetration rate of PD versus hemodialysis (HD) in our center, as well as comparing to national PD penetration rate. There were 83 patients who underwent 91 peritoneoscope Tenckhoff catheter insertion procedures from March 2006 until April 2008. The patients were mostly female (66%) with the mean age of 51.99 +/- 1.78 years and the majority (67%) of them were diabetics. All together there were 749.7 patient-months at risk and the overall peritonitis rate was 1 in 93.7 patient-months. The 1-year catheter survival was 86.5%. Primary catheter failure (defined as failure of the catheter within 1 month of insertion) occurred in 16 procedures (17.6%). The main cause of catheter malfunction was catheter tip migration and omentum wrap. The penetration ratio of PD when compared with HD in our center is 44.8%, which is about 4.5 times the national average. With our integrated care approach where nephrologist was heavily involved from the outset of renal replacement therapy discussion, PD access implantation to the assistance of spoke person to whom new patient can identify with, we were able to achieve PD penetration rate which far exceeds that of the national average.
The demands for timely catheter insertion have spurred the growth of peritoneoscopic catheter insertion program by nephrologists in Malaysia. We performed a multicenter analysis to study its impact on the growth of peritoneal dialysis (PD) population. Data were collected retrospectively from five centers at the point of program initiation until December 2009. In Center 1, with this program, PD population continued to grow from 25 patients in 2006 to 120 in 2009. In center 2, the program began in 2005, but comprised only 28.6% of total insertions. From 2007 onwards, nephrologists had overtaken the surgeon, inserting from 85% to 97% of the total insertions. In center 3, with the program at its infancy, a modest growth in its PD population was shown. In center 4, nephrologists maintained an annual average of 41.8% of total catheter insertions, and thus maintaining a stable PD population. In center 5, surgeon-assisted PD catheter insertions helped to maintain the growth of its PD, seeing lesser impact from this program. Subanalysis showed that 1-year catheter survival in Center 1 was 85.4%. This study on PD catheter insertion program by nephrologists showed the greatest impact on new center and center experiencing suboptimal catheter insertions by traditional providers.