title: Postimplantation X-ray parameters predict functional catheter problems in peritoneal dialysis.
abstract: Functional catheter problems are a major challenge for peritoneal dialysis (PD) programs. Here we performed a retrospective single-center study of 110 consecutive patients receiving a first PD catheter (swan neck double-cuff Missouri curled catheters, open surgical technique). Using postimplantation X-ray, the following categories were defined: swan neck angle (posterioanterio view (PA): under 45°, 45-90°, over 90°), inclination (angle between intramural part of catheter and horizontal line; lateral view: greater than/equal to 30°, under 30°), and the position of silicone bead relative to spine (PA view: L1-2, L3-4, lower) and catheter tip (PA view: hypogastric, umbilical, subcostal). Covariates included demographics, body size, previous abdominal surgery, and abdominal wall hernias. During a mean follow-up of 36 months, the time to first functional catheter problem was significantly associated with both the swan neck angle and inclination. The need for surgical intervention was significantly associated with inclination only. Technique failure was not associated with any parameter. In multivariate analysis, inclination was the sole variable significantly associated with functional catheter problems (hazard ratio 3.65 [1.98-6.72]) and the need for surgical intervention (hazard ratio 2.86 [1.19-6.88]). Thus, our study defines a set of X-ray variables that predict functional PD catheter problems and can be used for troubleshooting in individual cases as well as for education and internal audit purposes.
authors.affiliation: 1] Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium [2] Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Bammens
authors.affiliation: Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Domien
authors.initials: D
authors.lastname: Peeters
authors.affiliation: Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Joris
authors.initials: J
authors.lastname: Jaekers
authors.affiliation: 1] Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium [2] Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Claes
authors.affiliation: 1] Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium [2] Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Evenepoel
authors.affiliation: 1] Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium [2] Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Kuypers
authors.affiliation: 1] Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium [2] Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
authors.forename: Björn
authors.initials: B
authors.lastname: Meijers
authors.affiliation: 1] Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium [2] Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
authors.forename: Maarten
authors.initials: M
authors.lastname: Naesens
authors.affiliation: 1] Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium [2] Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
authors.forename: Yves
authors.initials: Y
authors.lastname: Vanrenterghem
authors.affiliation: 1] Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium [2] Laboratory of Abdominal Transplantation, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
authors.forename: Diethard
authors.initials: D
authors.lastname: Monbaliu
mesh_terms: D000328:Adult; D000368:Aged; D001530:Belgium; D061807:Catheter Obstruction / Q000209:etiology*; D002408:Catheters, Indwelling; D004867:Equipment Design; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome