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Zhao L, Yu Z, Li X, Zhao J, Qin Y, Zhou M, Bai M, Xu G, Sun S. Comparison of different peritoneal dialysis catheters on complication and catheter survival: A network meta-analysis of randomised controlled trials. Perit Dial Int 2024:8968608231224612. [PMID: 38360557 DOI: 10.1177/08968608231224612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND This network meta-analysis (NMA) aimed to compare the clinical advantage of four commonly used peritoneal dialysis catheters (PDCs) including the Swan neck segment with straight tip (Swan neck + S), Tenckhoff segment with straight tip (Tenckhoff + S), Swan neck segment with coiled tip (Swan neck + C) and Tenckhoff segment with coiled tip (Tenckhoff + C). METHODS Randomised clinical trials were searched from PubMed, Embase, the Cochrane Register of clinical trials, China National Knowledge Infrastructure (CNKI) and ChinaInfo from their inception until July 31, 2022. Meta-analysis was performed using Stata 14.0 and RevMan 5.3.5 software to evaluate the four commonly used PDCs. RESULTS Seventeen studies involved 1578 participants were included. NMA showed that compared with Swan neck + C, Swan neck + S significantly reduced catheter tip migration (OR 0.47 95% CI 0.22-0.99). Tenckhoff + S was more effective in reducing catheter dysfunction (OR 0.42, 95% CI 0.23-0.79), catheter tip migration with dysfunction (OR 0.19, 95% CI 0.05-0.78) and catheter removal (OR 0.56, 95% CI 0.34-0.93) which were consistent with the pairwise meta-analysis. According to the surface under the cumulative ranking curve, Swan neck + S emerged as the best PDC in the reduction of catheter tip migration (83.3%), followed by Tenckhoff + S (79.4%). Moreover, Tenckhoff + S (86.5%, 76.3%) and Swan neck + S (72.3, 86.9%) ranked as the first and second PDC for 1 and 2-year technique survival which was significantly higher than those of the other two PDCs. CONCLUSION Our NMA showed Swan neck + S and Tenckhoff + S tended to be more efficacious than Swan neck + C and Tenckhoff + C in lowering the mechanical dysfunction and prolonging the technique survival, which may contribute to better clinical decisions. More randomised controlled trials with larger scales and higher quality are needed in order to obtain more credible evidence.
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Affiliation(s)
- Lijuan Zhao
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zixian Yu
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiayin Li
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jin Zhao
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yunlong Qin
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Meilan Zhou
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ming Bai
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guoshuang Xu
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shiren Sun
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
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Briggs VR, Jacques RM, Fotheringham J, Maheswaran R, Campbell M, Wilkie ME. Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients. Cochrane Database Syst Rev 2023; 2:CD012478. [PMID: 36810986 PMCID: PMC9946371 DOI: 10.1002/14651858.cd012478.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Peritoneal dialysis (PD) relies on the optimal functionality of the flexible plastic PD catheter present within the peritoneal cavity to enable effective treatment. As a result of limited evidence, it is uncertain if the PD catheter's insertion method influences the rate of catheter dysfunction and, thus, the quality of dialysis therapy. Numerous variations of four basic techniques have been adopted in an attempt to improve and maintain PD catheter function. This review evaluates the association between PD catheter insertion technique and associated differences in PD catheter function and post-PD catheter insertion complications OBJECTIVES: Our aims were to 1) evaluate if a specific technique used for PD catheter insertion has lower rates of PD catheter dysfunction (early and late) and technique failure; and 2) examine if any of the available techniques results in a reduction in post-procedure complication rates including postoperative haemorrhage, exit-site infection and peritonitis. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 24 November 2022 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials (RCTs) examining adults and children undergoing PD catheter insertion. The studies examined any two PD catheter insertion techniques, including laparoscopic, open-surgical, percutaneous and peritoneoscopic insertion. Primary outcomes of interest were PD catheter function and technique survival. DATA COLLECTION AND ANALYSIS: Two authors independently performed data extraction and assessed the risk of bias for all included studies. Main outcomes in the Summary of Findings tables include primary outcomes - early PD catheter function, long-term PD catheter function, technique failure and postoperative complications. A random effects model was used to perform meta-analyses; risk ratios (RRs) were calculated for dichotomous outcomes, and mean differences (MD) were calculated for continuous outcomes, using 95% confidence intervals (CIs) for effect estimates. The certainty of the evidence was evaluated using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. MAIN RESULTS: Seventeen studies were included in this review. Nine studies were suitable for inclusion in quantitative meta-analysis (670 randomised participants). Five studies compared laparoscopic with open PD catheter insertion, and four studies compared a 'medical' insertion technique with open surgical PD catheter insertion: percutaneous (2) and peritoneoscopic (2). Random sequence generation was judged to be at low risk of bias in eight studies. Allocation concealment was reported poorly, with only five studies judged to be at low risk of selection bias. Performance bias was judged to be high risk in 10 studies. Attrition bias and reporting bias were judged to be low in 14 and 12 studies, respectively. Six studies compared laparoscopic PD catheter insertion with open surgical insertion. Five studies could be meta-analysed (394 participants). For our primary outcomes, data were either not reported in a format that could be meta-analysed (early PD catheter function, long-term catheter function) or not reported at all (technique failure). One death was reported in the laparoscopic group and none in the open surgical group. In low certainty evidence, laparoscopic PD catheter insertion may make little or no difference to the risk of peritonitis (4 studies, 288 participants: RR 0.97, 95% CI 0.63 to 1.48; I² = 7%), PD catheter removal (4 studies, 257 participants: RR 1.15, 95% CI 0.80 to 1.64; I² = 0%), and dialysate leakage (4 studies, 330 participants: RR 1.40, 95% CI 0.49 to 4.02; I² = 0%), but may reduce the risk of haemorrhage (2 studies, 167 participants: RR 1.68, 95% CI 0.28 to 10.31; I² = 33%) and catheter tip migration (4 studies, 333 participants: RR 0.43, 95% CI 0.20 to 0.92; I² = 12%). Four studies compared a medical insertion technique with open surgical insertion (276 participants). Technique failure was not reported, and no deaths were reported (2 studies, 64 participants). In low certainty evidence, medical insertion may make little or no difference to early PD catheter function (3 studies, 212 participants: RR 0.73, 95% CI 0.29 to 1.83; I² = 0%), while one study reported long-term PD function may improve with peritoneoscopic insertion (116 participants: RR 0.59, 95% CI 0.38 to 0.92). Peritoneoscopic catheter insertion may reduce the episodes of early peritonitis (2 studies, 177 participants: RR 0.21, 95% CI 0.06 to 0.71; I² = 0%) and dialysate leakage (2 studies, 177 participants: RR 0.13, 95% CI 0.02 to 0.71; I² = 0%). Medical insertion had uncertain effects on catheter tip migration (2 studies, 90 participants: RR 0.74, 95% CI 0.15 to 3.73; I² = 0%). Most of the studies examined were small and of poor quality, increasing the risk of imprecision. There was also a significant risk of bias therefore cautious interpretation of results is advised. AUTHORS' CONCLUSIONS The available studies show that the evidence needed to guide clinicians in developing their PD catheter insertion service is lacking. No PD catheter insertion technique had lower rates of PD catheter dysfunction. High-quality, evidence-based data are urgently required, utilising multi-centre RCTs or large cohort studies, in order to provide definitive guidance relating to PD catheter insertion modality.
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Affiliation(s)
- Victoria R Briggs
- Department of Nephrology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Richard M Jacques
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - James Fotheringham
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ravi Maheswaran
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Martin E Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Influence of peritoneal dialysis catheter type on complications and long-term outcomes: an updated systematic review and meta-analysis. J Nephrol 2021; 34:1973-1987. [PMID: 33751498 DOI: 10.1007/s40620-021-01016-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is currently no consensus regarding the optimal type of peritoneal dialysis catheter (PDC). We compared the outcomes of PDCs according to the number of cuffs, intercuff and intraperitoneal segment shape, and presence of a weighted tip. METHODS A systematic review of the literature was performed using the MEDLINE and Cochrane Library databases (end-of-search date: October 16th, 2019). We included studies comparing double-cuff vs. single-cuff, swan-neck vs. straight-neck, coiled-tip vs. straight-tip, and weighted vs. non-weighted PDCs for the outcomes of interest. We performed meta-analyses using the random-effects model. We assessed the risk of bias using the Newcastle-Ottawa scale and the Cochrane Collaboration's Tool. RESULTS In total, 38 studies were identified, of which 20 were randomized controlled trials (RCTs) and 18 were observational studies. No statistically significant differences were detected between double-cuff vs. single-cuff, swan-neck vs. straight-neck, and coiled-tip vs. straight tip PDCs in any of the outcomes of interest. Weighted catheters were associated with significantly lower rates of tunnel infection (relative risk [RR] 0.52, 95% confidence interval [CI] 0.31-0.95, p = 0.03), migration (RR 0.07, 95% CI 0.03-0.16, p < 0.001), drainage failure (RR 0.62, 95% CI 0.39-0.96, p = 0.03), cuff extrusion (RR 0.40, 95% CI 0.21-0.74, p < 0.001), and complication-related removal (RR 0.53, 95% CI 0.44-0.64, p < 0.001). DISCUSSION Among the different types of PDCs, weighted catheters result in lower complication rates and superior long-term outcomes compared to non-weighted catheters. Other aspects of the catheter design do not significantly affect PDC outcomes. PROTOCOL REGISTRATION PROSPERO 2020 CRD42020158177.
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Elbokl M, Momciu B, Kishibe T, Oliver MJ, Perl J. Peritoneal dialysis access outcomes reported in randomized controlled trials: A systematic review. Perit Dial Int 2020; 41:552-563. [PMID: 33107402 DOI: 10.1177/0896860820966898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Functional peritoneal dialysis (PD) access is critical to the success of PD therapy. The aim of this review is to describe the spectrum of definitions and methods employed in the measurement of unique outcomes across PD access trials particularly focusing on the outcomes of PD access flow restriction and operative-related outcomes. METHODS Using Cochrane CENTRAL registry, MEDLINE, and EMBASE, we searched for studies restricted to randomized controlled trials (RCTs) involving interventions related to PD access without restrictions on age, language, or publication year. Studies were screened and data abstracted by two independent reviewers. Definitions, outcome measures, and time points of measurements were captured and documented separately. Unique combinations of these variables resulted in reporting the different ways of measurements. RESULTS Of the 1768 screened studies, 47 RCTs were included among which 817 PD access outcomes were grouped into 7 broad categories. Interventions evaluated in the RCTs were catheter type/configuration (n = 17), insertion technique (n = 15), multiple interventions (n = 3), and other (6 interventions, n = 12). PD access flow restriction (a subcategory of mechanical outcomes) and operative-related outcomes were reported in 91% and 58% of the included trials, respectively. Tip migration was the most frequently reported flow restriction outcome (59% of RCTs) followed by catheter dysfunction (23% of RCTs). Of the components utilized in definition of flow restriction, description of the impaired flow was reported in 37% of RCTs, need for intervention in 42% of RCTs, and presumed etiology of flow restriction in 60% of RCTs. CONCLUSION Variability exists in the definitions, reporting methods, choice of outcomes, and analysis of the PD access outcomes across RCTs. Operative-related outcomes remain underreported across RCTs. Outcomes relating to PD access flow restriction were the most common complications reported in the included RCTs but were reported heterogeneously with variability in reporting of the three key components of its definition including description and severity of the flow restriction, the need for intervention and etiology of flow restriction. In the future, defining PD access flow restriction should include all of these components to better evaluate the comparative effect of various PD access interventions.
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Affiliation(s)
- Mohamed Elbokl
- Division of Nephrology, University Health Network, 7938University of Toronto, Ontario, Canada
| | - Bogdan Momciu
- Division of Nephrology, University Health Network, 7938University of Toronto, Ontario, Canada
| | - Teruko Kishibe
- St. Michael's Hospital and the Keenan Research Center in the 518773Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Matthew J Oliver
- Division of Nephrology, 494622Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Oliver MJ, Perl J, McQuillan R, Blake PG, Jain AK, McCormick B, Yang R, Pirkle JL, Fissell RB, Golper TA, Shen JI, Hu SL, Pellegrino B, Liebman SE, Krishna VN, Ravani P, Clarke A, Quinn RR. Quantifying the risk of insertion-related peritoneal dialysis catheter complications following laparoscopic placement: Results from the North American PD Catheter Registry. Perit Dial Int 2020; 40:185-192. [PMID: 32063191 DOI: 10.1177/0896860819893813] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is a more cost-effective therapy to treat kidney failure than in-center hemodialysis, but successful therapy requires a functioning PD catheter that causes minimal complications. In 2015, the North American Chapter of the International Society for Peritoneal Dialysis established the North American PD Catheter Registry to improve practices and patient outcomes following PD catheter insertion. AIMS The objective of this study is to propose a methodology for defining insertion-related complications that lead to significant adverse events and report the risk of these complications among patients undergoing laparoscopic PD catheter insertion. METHODS Patients undergoing laparoscopic PD catheter insertion were enrolled at 14 participating centers in Canada and the United States and followed using a Web-based registry. Insertion-related complications were defined as flow restriction, exit-site leak, or abdominal pain at any point during follow-up. We also included infections or bleeding within 30 days of insertion, and any immediate postoperative complications. Adverse events were categorized as PD never starting or termination of PD therapy, delay in the start of PD therapy or interruption of PD therapy, an emergency department visit or hospitalization, or need for invasive procedures. Cause-specific cumulative incidence functions were used to estimate risk. RESULTS Five hundred patients underwent laparoscopic PD catheter insertion between 10 November 2015 and 24 July 2018. The cumulative risk of insertion-related complications 6 months from the date of insertion that led to an adverse event was 24%. The risk of flow restriction, exit-site leak, and pain at 6 months was 10.2%, 5.7%, and 5.3%, respectively. PD was never started or terminated in 6.4% of patients due to an insertion-related complication. Leaks and flow restrictions were most likely to delay or interrupt PD therapy. Flow restrictions were the primary cause of invasive procedures. Fifty percent of the complications occurred before the start of PD therapy. CONCLUSIONS Insertion-related complications leading to significant adverse events following laparoscopic placement of PD catheters are common. Many complications occur before the start of PD. Insertion-related complications are an important area of focus for future research and quality improvement efforts.
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Affiliation(s)
- Matthew J Oliver
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeff Perl
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rory McQuillan
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter G Blake
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Arsh K Jain
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Brendan McCormick
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Yang
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - James L Pirkle
- Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rachel B Fissell
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas A Golper
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jenny I Shen
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Susie L Hu
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Scott E Liebman
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Vinay N Krishna
- Division of Nephrology, Department of Medicine, the University of Alabama at Birmingham, AL, USA
| | - Pietro Ravani
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alix Clarke
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert R Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Htay H, Johnson DW, Craig JC, Schena FP, Strippoli GFM, Tong A, Cho Y. Catheter type, placement and insertion techniques for preventing catheter-related infections in chronic peritoneal dialysis patients. Cochrane Database Syst Rev 2019; 5:CD004680. [PMID: 31149735 PMCID: PMC6543877 DOI: 10.1002/14651858.cd004680.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Peritonitis is one of the limiting factors for the growth of peritoneal dialysis (PD) worldwide and is a major cause of technique failure. Several studies have examined the effectiveness of various catheter-related interventions for lowering the risk of PD-related peritonitis. This is an update of a review first published in 2004. OBJECTIVES To evaluate the role of different catheter implantation techniques and catheter types in lowering the risk of PD-related peritonitis in PD patients. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 15 January 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA Studies comparing different catheter insertion techniques, catheter types, use of immobilisation techniques and different break-in periods were included. Studies of different PD sets were excluded. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality and extracted data. Statistical analyses were performed using a random effects model and the results expressed as risk ratio (RR) with 95% confidence intervals (CI). MAIN RESULTS Forty-two studies (3144 participants) were included: 18 evaluated techniques of catheter implantation, 22 examined catheter types, one assessed an immobiliser device, and one examined break-in period. In general, study quality was variable and almost all aspects of study design did not fulfil CONSORT standards for reporting.Catheter insertion by laparoscopy compared with laparotomy probably makes little or no difference to the risks of peritonitis (RR 0.90, 95% CI 0.59 to 1.35; moderate certainty evidence), exit-site/tunnel infection (RR 1.00, 95% CI 0.43 to 2.31; low certainty evidence), catheter removal/replacement (RR 1.20, 95% CI 0.77 to 1.86; low certainty evidence), technique failure (RR 0.71, 95% CI 0.47 to 1.08; low certainty evidence), and death (all causes) (RR 1.26, 95% CI 0.72 to 2.20; moderate certainty evidence). It is uncertain whether subcutaneous burying of catheter increases peritonitis (RR 1.16, 95% CI 0.37 to 3.60; very low certainty evidence). Midline insertion compared to lateral insertion probably makes little or no difference to the risks of peritonitis (RR 0.65, 95% CI 0.32 to 1.33; moderate certainty evidence) and may make little or no difference to exit-site/tunnel infection (RR 0.56, 95% CI 0.12 to 2.58; low certainty evidence). Percutaneous insertion compared with open surgery probably makes little or no difference to the exit-site/tunnel infection (RR 0.16, 95% CI 0.02 to 1.30; moderate certainty evidence).Straight catheters probably make little or no difference to the risk of peritonitis (RR 1.04, 95% CI 0.82 to 1.31; moderate certainty evidence), peritonitis rate (RR 0.91, 95% CI 0.68 to 1.21; moderate certainty evidence), risk of exit-site infection (RR 1.12, 95% CI 0.94 to 1.34; moderate certainty evidence), and exit-site infection rate (RR 1.05, 95% CI 0.77 to 1.43; moderate certainty evidence) compared to coiled catheter. It is uncertain whether straight catheters prevent catheter removal or replacement (RR 1.11, 95% CI 0.73 to 1.66; very low certainty evidence) but straight catheters probably make little or no difference to technique failure (RR 0.82, 95% CI 0.51 to 1.31; moderate certainty evidence) and death (all causes) (RR 0.95, 95% CI 0.62 to 1.46; low certainty evidence) compared to coiled catheter. Tenckhoff catheter with artificial curve at subcutaneous tract compared with swan-neck catheter may make little or no difference to peritonitis (RR 1.29, 95% CI 0.85 to 1.96; low certainty evidence) and incidence of exit-site/tunnel infection (RR 0.96, 95% CI 0.77 to 1.21; low certainty evidence) but may slightly improve exit-site infection rate (RR 0.67, 95% CI 0.50 to 0.90; low certainty evidence). AUTHORS' CONCLUSIONS There is no strong evidence that any catheter-related intervention, including the use of different catheter types or different insertion techniques, reduces the risks of PD peritonitis or other PD-related infections, technique failure or death (all causes). However, the numbers and sizes of studies were generally small and the methodological quality of available studies was suboptimal, such that the possibility that a particular catheter-related intervention might have a beneficial effect cannot be completely ruled out with confidence.
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Affiliation(s)
- Htay Htay
- Singapore General HospitalDepartment of Renal Medicine20 College StreetSingaporeSingapore169856
| | - David W Johnson
- Princess Alexandra HospitalDepartment of NephrologyIpswich RoadWoolloongabbaQueenslandAustralia4102
- University of QueenslandBrisbaneAustralia
| | - Jonathan C Craig
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
- Flinders UniversityCollege of Medicine and Public HealthAdelaideSAAustralia5001
| | - Francesco Paolo Schena
- University of BariDepartment of Emergency and Organ TransplantationPoliclinicoPiazza Giulio Cesare 11BariItaly70124
| | - Giovanni FM Strippoli
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
- University of BariDepartment of Emergency and Organ TransplantationPoliclinicoPiazza Giulio Cesare 11BariItaly70124
- DiaverumMedical Scientific OfficeLundSweden
- The University of SydneySydney School of Public HealthSydneyAustralia
| | - Allison Tong
- The University of SydneySydney School of Public HealthSydneyAustralia
- The Children's Hospital at WestmeadCentre for Kidney ResearchLocked Bag 4001WestmeadNSWAustralia2145
| | - Yeoungjee Cho
- Princess Alexandra HospitalDepartment of NephrologyIpswich RoadWoolloongabbaQueenslandAustralia4102
- University of QueenslandBrisbaneAustralia
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Eriguchi M, Tsuruya K, Yoshida H, Haruyama N, Tanaka S, Tsuchimoto A, Fujisaki K, Torisu K, Masutani K, Kitazono T. Extended Swan-Neck Catheter With Upper Abdominal Exit-Site Reduces Peritoneal Dialysis-Related Infections. Ther Apher Dial 2016; 20:158-64. [DOI: 10.1111/1744-9987.12358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 07/18/2015] [Accepted: 07/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Masahiro Eriguchi
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Kazuhiko Tsuruya
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Hisako Yoshida
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Naoki Haruyama
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Shigeru Tanaka
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Akihiro Tsuchimoto
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Kiichiro Fujisaki
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Kumiko Torisu
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Kosuke Masutani
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Takanari Kitazono
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
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Jiang C, Xu L, Chen Y, Yan X, Sun C, Zhang M. A modified open surgery technique for peritoneal dialysis catheter placement decreases catheter malfunction. Perit Dial Int 2014; 34:358-67. [PMID: 24991051 DOI: 10.3747/pdi.2011.00298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This retrospective study was conducted to evaluate the effect of a new, modified open surgery technique on catheter-related malfunction. METHODS During the period from January 1997 to June 2009, 216 patients received initial peritoneal catheters. For the present study, patients were divided into four groups according to the catheter types and the surgery techniques: TO-S: traditional open surgery, straight Tenckhoff catheter TO-C: traditional open surgery, coiled Tenckhoff catheter TO-SN: traditional open surgery, swan-neck catheter MO-S: modified open surgery, straight Tenckhoff catheter The modified surgery was characterized by a low incision site, a short intra-abdominal catheter segment and an additional upward straight subcutaneous tunnel. All patients were followed up for 2 years or until death. Survival rates, complications caused by catheter placement, and the probability of malfunction-free catheter survival were compared between the groups. RESULTS Catheter malfunction was the most frequent mechanical complication, found in 31 patients (14.4%), who experienced 38 malfunctions. Only 2 episodes of catheter malfunction were found in the MO-S group, representing a rate significantly less than those in the TO-S and TO-C groups (both p < 0.05). Kaplan-Meier curves for malfunction-free PD catheter survival showed a significantly different malfunction-free probability for the various groups (p = 0.009). After 2 years of follow-up, 136 patients (63.0%) survived with their initial PD catheter. The initial catheter survival rate was 76.8% in the MO-S group. Kaplan-Meier curves for initial catheter survival showed that the highest survival rate was found in the MO-S group (p = 0.001). CONCLUSIONS The modified open surgery technique is a reliable method for catheter placement.
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Affiliation(s)
- Chunming Jiang
- Department of Nephrology, and Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, PR China
| | - Linfeng Xu
- Department of Nephrology, and Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, PR China
| | - Yun Chen
- Department of Nephrology, and Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, PR China
| | - Xiang Yan
- Department of Nephrology, and Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, PR China
| | - Cheng Sun
- Department of Nephrology, and Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, PR China
| | - Miao Zhang
- Department of Nephrology, and Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, PR China
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9
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Zuo ML, Yue WS, Yip T, Ng F, Lam KF, Yiu KH, Lui SL, Tse HF, Siu CW, Lo WK. Prevalence of and Associations With Reduced Exercise Capacity in Peritoneal Dialysis Patients. Am J Kidney Dis 2013; 62:939-46. [DOI: 10.1053/j.ajkd.2013.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 05/21/2013] [Indexed: 11/11/2022]
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10
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A systematic review and meta-analysis of the influence of peritoneal dialysis catheter type on complication rate and catheter survival. Kidney Int 2013; 85:920-32. [PMID: 24088961 DOI: 10.1038/ki.2013.365] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/01/2013] [Accepted: 08/08/2013] [Indexed: 11/08/2022]
Abstract
Peritoneal dialysis (PD) is an effective treatment for end-stage renal disease. There are several configurations of PD catheter design that may impact catheter function, such as the shape of the intraperitoneal segment, the number of cuffs, and the subcutaneous configuration. This review and meta-analysis was carried out to determine whether there is a clinical advantage for one of the catheter types or configurations. Comprehensive searches were conducted in MEDLINE, Embase, and CENTRAL (the Cochrane Library 2012, issue 10). The methodology was in accordance with the Cochrane Handbook for Interventional Systematic Reviews and written based on the PRISMA statement. The initial search yielded 682 hits from which 13 randomized controlled trials were identified. Outcomes of interest were as follows: catheter survival, drainage dysfunction, migration, leakage, exit-site infections, peritonitis, and catheter removal. Comparing straight vs. swan neck and single vs. double-cuffed catheters, no differences were found when results were pooled. Comparison of straight vs. coiled-tip catheters demonstrated that survival was significantly different in favor of straight catheters (hazard ratio 2.05; confidence interval 1.10-3.79, P=0.02). For surgically inserted catheters, the removal rate and survival at 1 year after insertion were significantly in favor of straight catheters. Our meta-analysis clearly demonstrates benefits for catheters with a straight intraperitoneal segment.
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The choice of peritoneal dialysis catheter implantation technique by nephrologists. Int J Nephrol 2013; 2013:940106. [PMID: 23431443 PMCID: PMC3569939 DOI: 10.1155/2013/940106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/05/2013] [Indexed: 11/29/2022] Open
Abstract
Peritoneal dialysis catheter (PDC) is the lifeline of peritoneal dialysis (PD) patients. One of the critical issues for successful PD is a well-functioning PDC which is timely inserted. It is the implantation technique rather than the catheter design that determines the outcome of the catheter. Dedication in acquiring the appropriate technique is vital to the success of a PD program. In this paper, we discuss the pros and cons of various techniques used for PDC implantation. A detailed description of PDC implantation by using the minilaparotomy method is presented. We strongly recommend mini-laparotomy as the method of choice for PDC implantation by nephrologists.
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12
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Yip T, Lo WK. Should the "trocar and cannula" method be used for peritoneal catheter implantation? Perit Dial Int 2011; 30:506-8. [PMID: 20829550 DOI: 10.3747/pdi.2010.00046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Terence Yip
- Department of Medicine Tung Wah Hospital Hong Kong
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