Bernardo Moguel-Gonzáles

Background and Objectives: Ultrasound-guided placement of tunneled hemodialysis catheters may be useful when fluoroscopy is unavailable or radiation exposure should be avoided. This study describes a technique based on direct ultrasound visualization of the metallic guidewire within the right atrium and evaluates one-year clinical and functional outcomes. Materials and Methods: We conducted a single-center retrospective observational study of 319 adult hemodialysis patients undergoing tunneled catheter placement. The technique combined intravascular guidewire length measurement with subcostal ultrasound visualization of the guidewire tip in the right atrium. Baseline characteristics, insertion site, immediate complications, blood flow rate, Kt/V, and extracorporeal circuit pressures were analyzed. Results: Mean age was 55.9 ± 14.5 years, and 58.6% were women. The main causes of chronic kidney disease were diabetes mellitus and arterial hypertension. Mean blood flow rate was 349 mL/min at 3 months and 357 mL/min at 12 months. Mean Kt/V at 12 months was 1.57. No catheter malpositions requiring immediate repositioning were documented. Procedure-related complications were infrequent and mainly local. Conclusions: Ultrasound-guided tunneled catheter placement using direct visualization of the guidewire within the right atrium was technically feasible and associated with favorable functional parameters and few immediate complications. Given the retrospective design and lack of a comparative group, these findings should be interpreted with caution. Prospective comparative studies are needed to confirm safety, reproducibility, and clinical utility.

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 (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). 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.