NDT Advance Access published online on February 16, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn003
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Complications and catheter survival with prolonged embedding of peritoneal dialysis catheters
1 Department of Medicine, University of Ottawa, Ottawa, Ontario 2 Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario 3 Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Canada
Correspondence and offprint requests to: Brendan B. McCormick, Division of Nephrology, The Ottawa Hospital–Riverside Campus, 1967 Riverside Drive, Ottawa ON, K1H 7W9, Canada. Tel: +1-613-738-8400; Fax: +1-613-738-8337; E-mail: bmccormick{at}ottawahospital.on.ca
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Abstract |
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Background. Our centre uses a modification of the Moncrief technique of embedding peritoneal dialysis (PD) catheters. We undertook this study to test the hypothesis that catheter survival on PD is a function of the time a catheter is left embedded prior to use.
Methods. Data were retrospectively abstracted from review of patient records of those who received a first PD catheter over a 5-year period. Patients were divided into tertiles based on the number of days between insertion of the catheter and exteriorization to create three equal groups representing early (group 1, 11–47 days), mid (group 2, 48–133 days) and late (group 3, 134–2041 days) exteriorization strategies.
Results. 435 embedded PD catheters were inserted, 349 were exteriorized and total observation period was 5624 patient-months. Time to catheter loss was shortest in group 1 and longest in group 2 (P = 0.04). The overall rate of primary catheter failure was 6% and was significantly different in the three groups (6.9% in group 1, 1.7% in group 2 and 9.4% in group 3, P = 0.04). The time to first episode of peritonitis was longest in group 3 and shortest in group 1 (group 1 versus group 3, P = 0.009; group 2 versus group 3, P = 0.03). Adjusted peritonitis rates, however, were not different between the three groups.
Conclusions. Mechanical complications and catheter loss are associated with the length of time a catheter is embedded. We recommend insertion 6 weeks to 5 months ahead of the need for PD to maximize catheter survival.
Keywords: buried peritoneal dialysis catheter; embedded peritoneal dialysis catheter; infectious complications; mechanical complications; Moncrief–Popovich technique
Received for publication: 5. 9.07
Accepted in revised form: 2. 1.08