Complications and catheter survival with prolonged embedding of peritoneal dialysis catheters.
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.
Brown
Pierre Antoine
PA
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
McCormick
Brendan B
BB
Knoll
Greg
G
Su
Yinghua
Y
Doucette
Steve
S
Fergusson
Dean
D
Lavoie
Susan
S
D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000295:instrumentation* / Q000379:methods; D010538:Peritonitis / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors