Ascitic Fluid Drainage Before Dialysis Catheter Removal for Peritoneal Dialysis-Related Peritonitis

Introduction Persistent ascites requiring drainage following catheter removal because of peritoneal dialysis (PD)-related peritonitis is a common complication associated with prolonged hospitalization and increased mortality. To mitigate this risk, a free drainage protocol was introduced before catheter removal. This study evaluated its impact on post-removal paracentesis incidence. Methods This study retrospectively reviewed patients who underwent catheter removal because of refractory PD-related peritonitis between January 2009 and December 2021. Before 2015, 47 patients underwent catheter removal and were transitioned to hemodialysis without prior ascitic drainage. After 2015, 70 patients were transitioned to hemodialysis following free drainage of ascitic fluid before catheter removal. Results Among 117 patients who underwent catheter removal, 98 recovered uneventfully, whereas 19 patients (16.24%) developed drainage-requiring ascites. Patients in the free drainage group (n=70) had reduced need for paracentesis (8.57% versus [vs.] 27.66%, p = 0.01) and a lower incidence of PD-related complications (15.71% vs. 42.55%, p = 0.002) compared with those who did not undergo free drainage. Further multivariate analysis revealed free drainage and fungal infection as significant factors for post-removal paracentesis. Conclusions Pre-removal free drainage of ascitic fluid is a safe and potentially beneficial approach in patients requiring PD catheter removal because of peritonitis. Implementing this strategy may reduce the incidence of drainage-requiring ascites post-removal, thereby improving patient outcomes.