Safety and feasibility of initiating peritoneal dialysis within 24 hours after percutaneous versus surgical catheter placement

Background End-stage kidney disease (ESKD) is a rising global health challenge. Despite superior quality of life and cost-effectiveness, only 11% of patients initiate renal replacement therapy with peritoneal dialysis (PD), primarily due to the traditional extended break-in period. Recent advancements in percutaneous catheter placement have facilitated urgent-start and early-start PD protocols. This study compared the break-in period (immediate-start PD (<24 hours)) and catheter placement-related complications between percutaneous and surgical techniques. Methods This retrospective multicenter study analyzed 429 patients who underwent PD catheter insertion at three Mexican nephrology centers; 416 patients had confirmed ESKD. Techniques included minilaparotomy and percutaneous methods (stylet or Seldinger). Data collection encompassed baseline characteristics, break-in periods, and 30-day complications, classified as minor (mechanical and infectious) or major (bleeding, visceral perforation, and death). Results The majority of patients-initiated PD within 24 hours of catheter placement, and 49% of within 6 hours, 88% of patients using the Stylet technique and 58% of those using the Seldinger technique, compared to 3.8% using minilaparotomy (p < 0.001). Percutaneous techniques represented 97% of the break-in periods within 6 hours, whereas minilaparotomy accounted for 91% of the break-in periods between 25 and 72 hours. Complications affected 30% of the patients overall, with mechanical issues (23%) predominating, including outflow failure (19%) and catheter migration (9.1%), with no differences observed between techniques (p = 0.9, p = 0.8). The rate of repositioning was greater with the use of percutaneous methods (13–14% vs. 4%, p = 0.008). Infections were more common with minilaparotomy (14% vs. 7.4–8.3%, p = 0.12), with exit-site infections (8.1% vs. 1.4–2.2%, p = 0.006) and tunnelitis (6.0% vs. 0.7–2.8%, p = 0.041) exhibiting significance. Mini-laparotomy increased the risk of infection (OR 2.13, 95% CI 1.02–4.44; p = 0.043). Conclusion Immediate-start PD, defined as initiation within 24 hours of catheter placement, is safe and feasible. These findings support the expansion of nephrologist training in percutaneous placement.