title: Comparison of Early Mechanical and Infective Complications in First Time Blind, Bedside, Midline Percutaneous Tenckhoff Catheter Insertion with Ultra-Short Break-In Period in Diabetics and Non-Diabetics: Setting New Standards.
abstract: ♦ BACKGROUND: There are no large studies that have examined ultra-short break-in period with a blind, bedside, midline approach to Tenckhoff catheter insertion. ♦ METHODS: Observational cohort study of 245 consecutive adult patients who underwent percutaneous catheter insertion for chronic peritoneal dialysis (PD) at our center from January 2009 to December 2013. There were 132 (53.9%) diabetics and 113 (46.1%) non-diabetics in the cohort. ♦ RESULTS: The mean break-in period for the percutaneous group was 2.68 ± 2.6 days. There were significantly more males among the diabetics (103 [78%] vs 66 [58.4%], p = 0.001). Diabetics had a significantly higher body mass index (BMI) (23.9 ± 3.7 kg/m2vs 22.2 ± 4 kg/m2, p < 0.001) and lower serum albumin (33.1 ± 6.3 g/L vs 37 ± 6 g/L, p < 0.001) compared with non-diabetics. Poor catheter outflow was present in 6 (4.5%) diabetics and 16 (14.2%) non-diabetics (p = 0.009). Catheter migration was also significantly more common in the non-diabetic group (11 [9.7%] vs 2 [1.5%], p = 0.004). Primary catheter non-function was present in 17(15%) of the non-diabetics and in 7(5.3%) of the diabetics (p = 0.01). There were no mortality or major non-procedural complications during the catheter insertions. Among patients with 1 year of follow-up data, catheter survival (93/102 [91.2%] vs 71/82 [86.6%], p = 0.32) and technique survival (93/102 [91.2%] vs 70/82 [85.4%], p = 0.22) at 1 year was comparable between diabetics and non-diabetics, respectively. ♦ CONCLUSIONS: Percutaneous catheter insertion by practicing nephrologists provides a short break-in period with very low mechanical and infective complications. Non-diabetic status emerged as a significant risk factor for primary catheter non-function presumed to be due to more patients with lower BMI and thus smaller abdominal cavities. This is the first report that systematically compares diabetic and non-diabetic patients.
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, India.
authors.forename: Ninoo
authors.initials: N
authors.lastname: George
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, India suceena@gmail.com.
authors.forename: Suceena
authors.initials: S
authors.lastname: Alexander
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, India.
authors.forename: Vinoi George
authors.initials: VG
authors.lastname: David
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, India.
authors.forename: Gopal
authors.initials: G
authors.lastname: Basu
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, India.
authors.forename: Anjali
authors.initials: A
authors.lastname: Mohapatra
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, India.
authors.forename: Anna T
authors.initials: AT
authors.lastname: Valson
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, India.
authors.forename: Shibu
authors.initials: S
authors.lastname: Jacob
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, India.
authors.forename: Harish K
authors.initials: HK
authors.lastname: Pathak
authors.affiliation: Department of Urology, Christian Medical College, Vellore, India.
authors.forename: Antony
authors.initials: A
authors.lastname: Devasia
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, India.
authors.forename: Veerasamy
authors.initials: V
authors.lastname: Tamilarasi
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, India.
authors.forename: Santosh
authors.initials: S
authors.lastname: Varughese
mesh_terms: D000328:Adult; D000367:Age Factors; D055499:Catheter-Related Infections / Q000382:microbiology / Q000401:mortality*; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D002423:Cause of Death; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Peritoneal dialysis; catheters; mechanical processes; methods; mortality; peritonitis