Similar Outcomes of Catheters Implanted by Nephrologists and Surgeons: Analysis of the Brazilian Peritoneal Dialysis Multicentric Study Thyago P. de Moraes,* Rodrigo P. Campos,* Ma ´rcia Tokunaga de Alca ˆntara,† Domingos Chula,† Marcos A. Vieira,‡ Miguel C. Riella,*† Ma ´rcia Olandowski,* Jose ´ Carolino Divino-Filho,§ and Roberto Pecoits-Filho,– on behalf of the investigators of the BRAZPD *Pontifı ´cia Universidade Cato ´ lica do Parana ´ , Curitiba, Brazil, †Hospital Universita ´ rio Evange ´ lico de Curitiba, Curitiba, Brazil, ‡Fundac ¸a ˜o Pro ´ Rim, Curitiba, Brazil, §Karolinska Institutet, Division of Baxter Novum and Renal Medicine, Stockholm, Sweden, and –Center for Health and Biological Sciences, Pontifı ´cia Universidade Cato ´ lica do Parana ´ , Curitiba, Brazil ABSTRACT A good catheter implantation technique is important to allow for effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with surgeons have been limited to small single-center experiences. Thus, the objective of this study was to explore the impact of the peritoneal dialysis (PD) catheter insertion operator on early catheter complications and on technique survival in a large national multicentric cohort study (Brazilian Peritoneal Dialysis Multicentric Study, BRAZPD). Adult incident patients recruited in the BRAZPD from December 2004 to October 2007 having undergone first PD catheter implantation were included in the analysis. Mechanical and infectious early complication rates were defined as time to the first event occurring up to 3 months after catheter insertion and adjusted for comorbidities. Valid data of 736 patients (mean age of 59 ± 16 years old, 52% women, 61% white) were analyzed. Mechanical (HR 0.99 [CI 0.56– 1.76]; p = 0.98) and infectious (HR 0.63 [CI 0.32–1.23]; p = 0.17) early complication rates were similar between groups. Long-term catheter survival was also similar between groups. Early complications rates and catheter survival were similar between groups defined by operator profile (nephrolo- gist or surgeon), supporting the role of interventional nephrol- ogy in the placement of PD catheters. The development of a permanent peritoneal access is crucial for peritoneal dialysis (PD) in patients with chronic kidney disease (1). Despite efforts made to improve catheter survival, such as the development of new catheter models and minimally invasive surgical techniques (2–5), problems related to peritoneal access continue to be a barrier in the establishment of a PD pro- gram (6). Currently, catheter-related complications are the second most common cause of technique failure (7). Nephrologists were responsible for PD catheter inser- tion in the early days of PD therapy. However, there has been a progressive decrease in the interest of nephrolo- gists in performing this procedure. Potential reasons for this observation are lack of training in catheter implantation during nephrology fellowship programs, inadequate procedure reimbursement for clinicians, and lack of time for procedures by nephrologists in large, busy dialysis clinics. Consequently, PD catheter inser- tion has become a procedure routinely performed mainly by surgeons throughout the world. Nevertheless, open surgical dissection, the most common technique used by surgeons, has disadvantages that could discour- age PD utilization, such as larger incisions, leading to higher risk of leakage and hernia. In addition, in certain regions, there is a lack of committed surgical teams inter- ested in PD catheter insertion, which results in long wait- ing lists. On the other hand, centers that have adopted nephrologists for catheter implantation have reported positive results in terms of complication rates and tech- nique survival, and have also reported an increase in PD penetration (8–11). Independently of the technique performed, there is still controversy with respect to who should perform PD catheter insertion, and comparisons between operator profile have been limited to single-center reports (12– 16). Thus, the objective of this study was to explore the impact of the PD catheter insertion operator on early catheter complications and on technique survival in a large national multicentric cohort study Address correspondence to: Roberto Pecoits-Filho, MD, PhD, Center for Health and Biological Sciences, Pontifı ´cia Universidade Cato ´ lica do Parana ´ , Rua Imaculada Con- ceic ¸a ˜o, 1155, Curitiba, PR – 80215-901, Brazil, e-mail: r.pecoits@pucpr.br. Seminars in Dialysis—Vol 25, No 5 (September–October) 2012 pp. 565–568 DOI: 10.1111/j.1525-139X.2012.01050.x ª 2012 Wiley Periodicals, Inc. 565