Peritoneal dialysis catheter insertion in patients with obesity: a cohort study and single centre approach to increasing uptake

Background: The global prevalence of obesity in patients with end-stage kidney disease requiring kidney replacement therapy is rising. While peritoneal dialysis (PD) offers advantages for many patients, its use in those with obesity has been historically limited due to concerns about catheter insertion-related complications, mechanical issues, and infection risk. This study aimed to evaluate PD catheter patency, infection rates, and modality outcomes in obese and non-obese patients to inform best practices and guide programme expansion. Methods: This single-region observational study analysed outcomes from 157 patients who underwent PD catheter insertion between 2020 and 2023 at the Northern Ireland Regional Nephrology and Transplant Centre. Patients were classified as obese (BMI ≥ 30, n = 44) or non-obese (BMI < 30, n = 113). Laparoscopic and percutaneous catheter insertion techniques were used, and primary outcomes included catheter patency (primary, primary assisted, secondary) and infection rates (exit site infection, tunnel infection, peritonitis) 1-year post-insertion. Kaplan-Meier survival analysis and descriptive statistics were applied to compare outcomes between groups. Results: Patency rates were high in both groups, with no significant differences: primary patency was 88% in non-obese patients and 80% in obese patients (p = 0.13). Similarly, primary assisted patency was 94% versus 89% (p = 0.26), and secondary patency was 96% versus 89% (p = 0.11). Patency and infection rates remained within standards set in ISPD guidelines for both groups, although obese patients showed a non-significant trend toward higher peritonitis rates (0.09). Transfer to haemodialysis occurred more frequently in the obese group (34% vs. 19%, p = 0.06). Mortality rates were comparable (9% non-obese, 6% obese). Conclusions: This study demonstrates that, with appropriate surgical techniques and periprocedural care, obese patients can achieve PD outcomes comparable to those of non-obese individuals. These findings challenge the traditional reluctance to offer PD to obese patients and advocate for the expansion of PD programs to include this growing demographic.