Zavodovskyi I. Prevention and treatment of surgical complications of peritoneal dialysis in patients with end-stage chronic kidney disease

This thesis implemented the solution of actual problem: improve the results of the complex treatment of patients with surgical complications of peritoneal dialysis, through the development of diagnostic and treatment algorithms for patients in case of infections of the catheter exit site and dialysis peritonitis and development of ways of catheter implantation for PD in the abdominal cavity in order to prevent his disposition. The developed approaches of prevention and treatment of surgical complications of PD have reduced the three-year rate ESI from 56.2% to 38.2% (p = 0.033), increasing the average term peritoneal dialysis without the ESI with 729,8 ± 41,2 to 854,9 ± days 35.2 days (p = 0.023) and reduced the frequency catheter ablation due to ESI from 17.8% to 5.9% (p = 0.03); increase the cumulative survival without dialysis peritonitis from 32.3% to 58.6% (p = 0.001), the average time before the first DP episode with 648,6 ± 41,1 days to 872,1 ± 31,3 days (p = 0.001) reduced the frequency of the second episode of peritonitis from 26.2% to 14.8%, and the total number of episodes of DP from 0,32 to 0,17 per patient-year (all p = 0.001), and raise thus PD survival (without termination of dialysis because of peritonitis) from 78.1% to 90.9% (p = 0.035); developed ways of preventing Tenckhoff catheter disposition allowed significantly reduce the three-year cumulative incidence of catheter dispositions from 13.2% to 1.5% (p = 0.022) and to extend the indications for its use, especially in patients with concomitant umbilical hernia; in general, thanks to the application of the technique in main group about overall survival techniques was 85.3% (1 episode 220.9 patient-months and 0.05 episodes per patient-year), and in main group overall survival method was 53.2% (1 episode 53.1 patient-months and 0.23 episodes per patient-year 1), р = 0.001.