Peritoneal dialysis catheter implantation in Germany – retrospective, nationwide analysis of all cases (2011–2021)

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Abstract
Background: Strengthening peritoneal dialysis (PD) utilization in Germany is crucial to ensure dialysis care for patients with kidney failure in an aging population with a predicted decline in the number of health care professionals. PD catheter implantations are a key indicator for the utilization of PD. We performed the first comprehensive study on PD catheter implantation rates and inpatient outcomes in Germany. Methods: For this retrospective study we queried the diagnosis related group statistics of the Federal Statistical Office of Germany for the years 2011 to 2021, which includes demographics and information on the medical course from all German inpatient cases. Results: During the observation period, 14,158 PD catheters were implanted, with an average of 1272 ± 127 (mean ± standard deviation) per year. Nationally, annual implantation rates were stable, without notable changes over time. Notably, there were significant regional differences in implantation rates within Germany. The average patient age at the time of PD catheter implantation was 59.7 years, with a male-to-female ratio of 1.7:1. During the hospital stay for PD catheter implantation, 517 patients (3.7%) died. Centers with higher implantation rates had more favorable outcomes. Age, number of comorbidities and certain comorbidities (e.g., cancer and heart failure) were associated with higher mortality. The length of stay in the hospital for PD catheter implantation was 19.5 (±22.3) days. Conclusion: Our analysis reveals that relatively few PD catheters are implanted in Germany each year. Over the observation period, there was no substantial increase, indicating a continued underutilization of PD in Germany.

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