Peritoneal catheter survival: The impact of unroofing

Abstract

Background: Unroofi ng is a controversial procedure to avoid catheter removal in the treatment of the chronic exit site and tunnel infection, but is now rarely recommended. Here we aimed to evaluate the effects of the unroofi ng procedure on peritoneal catheter survival. Methods: From our database, we prospectively evaluated the outcome of 139 peritoneal catheters placed in 121 patients (1.14 catheters per patient, 73 female, 48 male) from 08-03-1993 to 12-31-2016. Twenty-three infected catheters needed surgical unroofi ng of the tunnel tract. We calculated the cumulative catheter survival rates (Kaplan-Meier) of 1) overall catheters and 2) not unroofed catheters, considering catheter removal as an endpoint. We also calculated 3) the unroofed catheter survival, considering the date of unroofi ng or catheter removal as the endpoint and, 4) continuity of the unroofed catheters post-unroofi ng, considering the unroofi ng date as if it were a new catheter and catheter removal as the endpoint. Likewise, we compared the survival of: a) unroofed catheters vs. continuity of the unroofed catheters and, b) no unroofed catheters vs. continuity of the unroofed catheters (Log-rank test) (signifi cance value P< 0.05). Results: 1) The overall catheter survival rates were 94%, 84%, 76%, 55%, 40% and 26% at 12, 36, 60, 84, 120 and 210 months respectively. 2) The not unroofed catheter survival rates were 93%, 83%, 77%, 59%, 44% and 44% at 12, 36, 60, 84, 120 and 210 months respectively. 3) The unroofed catheter survival rates were 84%, 53%, 31%, 23% and 9% at 12, 36, 60, 84 and 120 months respectively. 4) The post-unroofed catheters survival rates were 91%, 77%, 66%, 66%, 50% and 33% at 12, 36, 60, 84, 120 and 160 months respectively. We detected a statistical signifi cance when comparing unroofed catheters vs. continuity of the unroofed catheters and no statistical signifi cance was observed when comparing not unroofed catheters vs. continuity of the unroofed catheters post-unroofed. Conclusion: The overall catheter survival was satisfactory. Unroofi ng contributed signifi cantly in the lifespan of the catheters.

Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

“…Other contraindicated drugs that experienced a reduction in use at discharge were diclofenac, glimepiride, metformin, and olmesartan. Reduction in their consumptions could be related to substitution with other alternative therapeutics, including glucagon-like peptide-1 receptor agonists (GLP-1 RA) and thiazolidinediones (Barone et al, 2017;Kristensen et al, 2019) or analgesics (Baker and Perazella, 2020). The NSAIDs, comprising diclofenac, should be avoided in older CKD subjects even if their consumptions continue to be frequent after discharge because of their availability over the counter (Mirishova and Hammad, 2018).…”

Outcomes of laparoscopic and open CAPD catheter placement: A single-center experience

“…affects patient outcomes [10] , [11] . While individual studies offer conflicting results on each of these topics [10] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] meta-analysis review studies have offered important insights. Xie et al found that there was no significant advantage with either the laparoscopic or open method in regards to surgical outcomes [2] .…”