Straight Versus Coiled Peritoneal Dialysis Catheters: A Randomized Controlled Trial

Chow, Kai Ming; Wong, Steve Siu Man; Ng, Jack Kit-Chung; Cheng, Yuk Lun; Leung, Chi Bon; Pang, Wing Fai; Fung, Winston Wing‐Shing; Szeto, Cheuk Chun; Li, Philip Kam-Tao

doi:10.1053/j.ajkd.2019.05.024

Cited by 30 publications

(22 citation statements)

References 20 publications

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“…34 In a recent RCT Li et.al reported drainage failure in 5.8% and 0.7% of patients receiving a coiled catheter or a straight catheter respectively, with 5.1% (95% CI, 1.2%-9.1%; P = .02) lower risk of catheter dysfunction in straight catheters. 35 This study noted a higher technique failure in small centres in comparison to large centres. Multiple previous studies have reported better technique survival in large PD centres with proportionally more patients on PD than HD.…”

Section: Discussionmentioning

confidence: 62%

Predictors of technique failure and mortality on peritoneal dialysis: An analysis of New Zealand peritoneal dialysis registry data

Hayat

Saweirs

2020

Nephrology

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Aim: Technique failure is a major disadvantage associated with peritoneal dialysis (PD). This study aimed to analyse the demographic and risk predictors of technique failure and mortality in patients on PD.Methods: All incidental PD patients registered on the New Zealand Peritoneal dialysis registry (NZPDR) from January 1995 to December 2014 were included in the study. The primary outcomes were time to technique failure and its specific causes, while as the secondary outcome was time to death. Risk predictors of technique failure and mortality were analysed using multivariate Cox proportional hazards (PH) regression model. Besides, competitive risk regression analysis was undertaken to analyse the effect of death as a competing event to technique failure.Results: Of 6379 patients, there were 2993 (46.9%) episodes of technique failure and 2684 (42%) deaths. The crude technique failure and mortality rates were 165 ± 5.90 and 147.9 ± 5.50 (mean ± SD)/1000 patient-years, respectively. Hazards of technique failure were lower in older individuals above 60 years, HR 0.72 (95% CI 0.67-0.79), larger centres, HR 0.89 (95% CI 0.79-1.00) and higher with coiled catheters, HR 1.26 (95% CI 1.16-1.37). Early nephrology referral, continuous ambulatory peritoneal dialysis (CAPD) and Asian ethnicities were associated with better technique survival. Infections were the major cause of technique failure (58.4%) with peritonitis being the leading cause (30.2%). Conclusion:There are multiple factors associated with risk of technique failure, therefore it is persuasive to construct a mathematical model for early prediction, for a planned transition to HD. K E Y W O R D Sclinical nephrology, dialysis, end-stage kidney disease Peritoneal dialysis (PD) is equivalent to haemodialysis (HD) as a treatment option in patients with end-stage kidney disease (ESKD). The major advantages of PD include preservation of residual kidney functions, treatment-related flexibility, superior patient satisfaction and a reduced risk of transmission of blood-borne infections. PD is also cost-effective with an annual cost savings of up to 40% compared to in-centre HD. [1][2][3][4] Despite these advantages, the major concerns with PD are progressive attrition in patient numbers due to technique failure, resulting in significant patient risks and health care costs. 5,6 There are inconsistencies among various studies regarding the definition and timing of PD technique failure resulting in significant variability in the outcomes. 7 A comprehensive registry-based study from Australia

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Section: Discussionmentioning

confidence: 62%

Predictors of technique failure and mortality on peritoneal dialysis: An analysis of New Zealand peritoneal dialysis registry data

Hayat

Saweirs

2020

Nephrology

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“…In peritoneal dialysis catheterization, straight and coiled-tip catheters are the most commonly used catheters, but the best choice is controversial. Recent studies have shown that use of a straight Tenckhoff catheter has a significantly lower rate of catheter dysfunction or drainage failure than with coiled catheters [15][16][17]. However, these studies were all based on the technique of open surgery; further study seems indicated in percutaneous catheterization.…”

Section: Discussionmentioning

confidence: 99%

Assessment of complications and short-term outcomes of percutaneous peritoneal dialysis catheter insertion by conventional or modified Seldinger technique

Zhou

Chao

et al. 2021

Renal Failure

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Objective: To explore the efficacy and short-term complications of a modified technique to percutaneously insert a peritoneal dialysis catheter. Methods: We reviewed the outcomes of 94 patients who underwent peritoneal dialysis catheterization between October 2017 and April 2020. Of these, 47 cases were placed by a conventional Seldinger technique, whereas 47 cases were placed by a modified technique based on the Seldinger method. The success rates of the catheter insertion and three-month postoperative complications were compared between these two groups. Results: The catheter insertion success rates were comparable between the two groups: 93.6% in the conventional technique group and 97.9% in the modified technique group (p ¼ 0.307). The incidence of postoperative catheter migration was lower using the modified technique (4.3%) than the conventional technique (18.3%) (p ¼ 0.037). None of the patients in the modified technique group had postoperative dialysate leakage, whereas this occurred in 9.0% of patients in the conventional technique group (p ¼ 0.036). There were no statistically significant differences in the incidence of postoperative bleeding, infection, or visceral damage between the two groups. Conclusions: The modified Seldinger technique for percutaneous peritoneal dialysis catheter insertion reduced the short-term postoperative complications of catheter migration and dialysate leakage, with a comparable successful catheter insertion rate compared with the conventional Seldinger technique.

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“…Thirteen studies included 'incident' PD patients only (11-12, 14-15, 17-19, 24, 26-27, 29, 32, 34 and 1460 participants), with two studies stating, 'new to PD' (28 and 86 participants) or 'starting CAPD' (23 and 59 participants). Three studies specified prevalent only (16,22,35 and 852 participants), whereas seven studies included both incident and prevalent PD patients (13, 20-21, 25, 30-31, 33 and 1188 participants). In studies with prevalent patients, one study specified a duration of KRT of over 6 weeks as inclusion criteria (16 and 118 participants).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…When the terminology used was 'transfer to HD', it was assumed but not explicitly stated that death was censored in all the studies. In studies using the technique survival/failure terminology, the outcome included death as an event in five studies (12,16,22,26,30 and 950 participants), it was a censoring event in five studies (11,13,19,24,27 and 902 participants) and it was not explicit how it was treated in the remaining seven studies. Transplantation was a censoring event in nine studies (11-13, 16, 19, 22, 26-27, 30 and 1706 participants) although it was not explicit that it was censored in the remaining 16 studies (Table 2).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The percentage or number of events included in the definition of technique survival were reported in 22 studies (11-12, 14-24, 26, 28-35 and 2948 participants) although the follow up period varied and rates were not provided in any study. Twenty-two studies (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(24)(25)(26)(27) Two analyses done, one including and one excluding death as a cause for technique failure.…”

Section: Reporting Of Technique Survivalmentioning

confidence: 99%

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Outcome measures for technique survival reported in peritoneal dialysis: A systematic review

et al. 2021

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Background: Peritoneal dialysis (PD) technique survival is an important outcome for patients, caregivers and health professionals, however, the definition and measures used for technique survival vary. We aimed to assess the scope and consistency of definitions and measures used for technique survival in studies of patients receiving PD. Method: MEDLINE, EMBASE and CENTRAL databases were searched for randomised controlled studies (RCTs) conducted in patients receiving PD reporting technique survival as an outcome between database inception and December 2019. The definition and measures used were extracted and independently assessed by two reviewers. Results: We included 25 RCTs with a total of 3645 participants (41–371 per trial) and follow up ranging from 6 weeks to 4 years. Terminology used included ‘technique survival’ (10 studies), ‘transfer to haemodialysis (HD)’ (8 studies) and ‘technique failure’ (7 studies) with 17 different definitions. In seven studies, it was unclear whether the definition included transfer to HD, death or transplantation and eight studies reported ‘transfer to HD’ without further definition regarding duration or other events. Of those remaining, five studies included death in their definition of a technique event, whereas death was censored in the other five. The duration of HD necessary to qualify as an event was reported in only four (16%) studies. Of the 14 studies reporting causes of an event, all used a different list of causes. Conclusion: There is substantial heterogeneity in how PD technique survival is defined and measured, likely contributing to considerable variability in reported rates. Standardised measures for reporting technique survival in PD studies are required to improve comparability.

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Straight Versus Coiled Peritoneal Dialysis Catheters: A Randomized Controlled Trial

Cited by 30 publications

References 20 publications

Predictors of technique failure and mortality on peritoneal dialysis: An analysis of New Zealand peritoneal dialysis registry data

Predictors of technique failure and mortality on peritoneal dialysis: An analysis of New Zealand peritoneal dialysis registry data

Assessment of complications and short-term outcomes of percutaneous peritoneal dialysis catheter insertion by conventional or modified Seldinger technique

Outcome measures for technique survival reported in peritoneal dialysis: A systematic review

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