Sahu Krishna M, Walele Aziz, Liakopoulos Vasilis, Bargman Joanne M
Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Adv Perit Dial. 2003;19:252-4.
Many studies have examined the survival of the first peritoneal dialysis (PD) catheter. However, data are scarce about the factors that influence the function and survival time of a second PD catheter. The purpose of the present study was to calculate the survival time of the second PD catheter and to examine factors that predict removal of that catheter. We conducted a retrospective study of second PD catheters inserted at our institution over a 10-year period from May 1992 to April 2002. The endpoint consisted of removal of the second catheter. Voluntary change to hemodialysis, kidney transplantation, transfer to another center, and death with a functioning catheter were censored observations. Catheter survival was analyzed by the Kaplan-Meier method. During the study period, 106 patients (59 men, 47 women) received a second catheter. The mean age of the patients was 55 +/- 14.9 years. One third of the patients had diabetes. The reasons for removal of the first catheter and insertion of the second one were peritonitis (n = 50), catheter malfunction (n = 20), catheter leak (n = 11), exit site or tunnel infection (n = 21), and failed kidney transplantation with resumption of PD (n = 4). The median survival of the second catheter was 48 months (95% confidence interval: 38 months to 59 months). On univariate analysis, increasing patient age and peritonitis as cause for removal of the first catheter were associated with an increased risk of removal of the second catheter. However, on multivariate analysis, only increasing patient age was associated with a greater risk to survival of the second catheter.
许多研究已对首次腹膜透析（PD）导管的留存情况进行了考察。然而，关于影响第二次PD导管功能及留存时间的因素，相关数据却很匮乏。本研究的目的是计算第二次PD导管的留存时间，并探究预测该导管拔除的因素。我们对1992年5月至2002年4月这10年间在本机构插入的第二次PD导管进行了一项回顾性研究。终点指标为第二次导管的拔除。自愿转为血液透析、肾移植、转至另一中心以及导管仍在发挥功能时患者死亡等情况均作为删失观察值。采用Kaplan-Meier法分析导管留存情况。在研究期间，106例患者（59例男性，47例女性）接受了第二次导管插入。患者的平均年龄为55±14.9岁。三分之一的患者患有糖尿病。拔除首次导管并插入第二次导管的原因包括腹膜炎（n = 50）、导管功能障碍（n = 20）、导管渗漏（n = 11）、出口部位或隧道感染（n = 21）以及肾移植失败后恢复腹膜透析（n = 4）。第二次导管的中位留存时间为48个月（95%置信区间：38个月至59个月）。单因素分析显示，患者年龄增加以及首次导管因腹膜炎拔除与第二次导管拔除风险增加相关。然而，多因素分析表明，只有患者年龄增加与第二次导管留存风险增大相关。
