Risk Factors Associated with Peritoneal Dialysis Catheter Survival: A 9-Year Single-Center Study in 315 Patients

Abstract

PURPOSE To review the peritoneal dialysis (PD) catheter outcomes at our center and assess factors affecting the catheter survival. METHODS We carried out a retrospective study on 315 patients who had their first PD catheter placed between January 2001 and September 2009 at the UT Southwestern/DaVita Peritoneal Dialysis Clinic at Dallas, Texas. Medical records were reviewed for demographic and clinical information of the patients. The primary end point of the study was PD catheter failure, defined as removal of a dysfunctional PD catheter due to catheter-related complications. Catheter survival was estimated using Kaplan Meier method. Cox proportional hazard regression model was used to identify factors that are independently associated with catheter survival. RESULTS The mean age of the patients was 49.7 +/− 29 years. The study population included 54.6% females; 42.5% African American, 27.9% Caucasian and 22.9% Hispanic patients. Diabetes was the primary etiology of end-stage renal disease in 43.2% of patients. More than 90% of patients had one or more co-morbidities; and 57.5% had previous abdominal surgery. The mean BMI for the group was 28.6 +/− 13.8 kg/m2. Less than a quarter of the patients (24.1%) had non-infectious/mechanical catheter problems. Overall PD catheter survival rates over 12, 24 and 36 months were 92.9%, 91.9% and 91.1%, respectively. PD catheter-related non-infectious problem was the only independent variable that was significantly associated with catheter survival (Hazard ratio 22.467; 95% CI 6.665– 75.732). No significant association was observed between the PD catheter survival and other risk factors including age, BMI, diabetic status, comorbidities, previous abdominal surgeries or infections. CONCLUSIONS Our study shows an excellent 3-year PD catheter survival (91.1%). Only PD catheter-related non-infectious problems are significantly associated with catheter failure. Other factors such as age, gender, race, BMI, diabetic status, comorbidities, previous abdominal surgeries, peritoneal infections or exit-site/ tunnel infections were not found to affect the PD catheter survival and should not be considered barriers to PD initiation.

Outcomes of Dialysis Catheters Placed by Y-Tec Peritoneoscopic Technique: A Single Center Surgical Experience

“…We report an overall catheter survival rate comparable with previous reports of laparoscopic or open placement [8,[11][12][13], with an average of 80% survival at 2 years. Gadallah et al [12] showed that a peritoneoscopically placed catheter (using Y-TEC) had fewer complications and higher survival rates compared with those placed by an open technique.…”

Growing a peritoneal dialysis program: A single‐center experience

“…None of the other demographic (age, gender, race) or clinical characteristics (body mass index, diabetic status, co-morbidities, previous abdominal surgeries) or any infections (peritonitis, exit site, or tunnel) were found to be signifi cantly associated with PD catheter survival. 45 Our study suggests that, contrary to the general perception, morbid obesity, multiple abdominal surgeries, the presence of co-morbidities, and advanced age should not be considered barriers to patient selection for PD. Inclusion of the surgeon as a part of the multidisciplinary team caring for CKD and ESRD patients can lead to long-term success and growth of a PD program.…”

“…We have demonstrated excellent catheter survival rates at our center. 45 In a retrospective study of 315 patients examining various risk factors associated with the survival of fi rst PD catheters placed at our center between January 2001 and September 2009, we observed 1-year, 2-year, and 3-year PD catheter survival rates of 92.9%, 91.9%, and 91.1%, respectively. On further investigation of different variables in our study, we observed that PD catheter-related non-infectious complication was the single covariate that signifi cantly reduced the catheter survival time.…”

“…We recently observed that catheter-related mechanical complications are signifi cantly associated with PD catheter failure. 45 These complications include intraluminal/extraluminal catheter obstruction, catheter malpositioning, catheter migration, omental wrap around the catheter, catheter leakage, and catheter extrusion. Many causes of catheter malfunction such as extraluminal occlusion by the bladder or bowels can be prevented or corrected with the use of laxatives or by emptying the bladder.…”

“…49 This is illustrated by the excellent PD catheter outcomes at our PD center, which is one of the largest PD centers in the United States, treating about 120 patients. 45 Most of the U.S. PD programs are small, however, typically comprising 10-15 PD patients.…”