Singh Namita, Davidson Ingemar, Minhajuddin Abu, Gieser Steven, Nurenberg Michael, Saxena Ramesh
Department of Internal Medicine, Division of Nephrology, UT Southwestern Medical Center, Dallas, Texas 75390-8856, USA.
J Vasc Access. 2010 Oct-Dec;11(4):316-22. doi: 10.5301/jva.2010.5774.
To review the peritoneal dialysis (PD) catheter outcomes at our center and assess factors affecting catheter survival.
We carried out a retrospective study on 315 patients who had their first PD catheter placed between January 2001 and September 2009 at the UT Southwestern/DaVita Peritoneal Dialysis Clinic at Dallas, Texas. Medical records were reviewed for demographic and clinical information of the patients. The primary end point of the study was PD catheter failure, defined as removal of a dysfunctional PD catheter due to catheter-related complications. Catheter survival was estimated using the Kaplan-Meier method. Cox proportional hazard regression model was used to identify factors that are independently associated with catheter survival.
The mean age of the patients was 49.7 ± 29 yrs. The study population included 54.6% females, 42.5% African American, 27.9% Caucasian and 22.9% Hispanic patients. Diabetes was the primary etiology of end-stage renal disease in 43.2% of patients. More than 90% of patients had one or more co-morbidities, and 57.5% had previous abdominal surgery. The mean BMI for the group was 28.6 ± 13.8 kg/m2. Less than a quarter of the patients (24.1%) had non-infectious/mechanical catheter problems. Overall PD catheter survival rates over 12, 24 and 36 months were 92.9%, 91.9% and 91.1%, respectively. PD catheter-related non-infectious problem was the only independent variable that was significantly associated with catheter survival (hazard ratio 22.467; 95% CI 6.665-75.732). No significant association was observed between the PD catheter survival and other risk factors including age, body mass index (BMI), diabetic status, co-morbidities, previous abdominal surgeries or infections.
Our study shows an excellent 3-yr PD catheter survival (91.1%). Only PD catheter-related non-infectious problems are significantly associated with catheter failure. Other factors such as age, gender, race, BMI, diabetic status, co-morbidities, previous abdominal surgeries, peritoneal infections or exit site/tunnel infections were not found to affect the PD catheter survival and should not be considered barriers to PD initiation.
回顾我们中心腹膜透析（PD）导管的使用结果，并评估影响导管存活的因素。
我们对2001年1月至2009年9月期间在德克萨斯州达拉斯市的UT西南医学中心/达维塔腹膜透析诊所首次置入PD导管的315例患者进行了一项回顾性研究。查阅病历以获取患者的人口统计学和临床信息。该研究的主要终点是PD导管失败，定义为因导管相关并发症而拔除功能失调的PD导管。使用Kaplan-Meier方法估计导管存活率。采用Cox比例风险回归模型来确定与导管存活独立相关的因素。
患者的平均年龄为49.7±29岁。研究人群包括54.6%的女性、42.5%的非裔美国人、27.9%的白种人和22.9%的西班牙裔患者。43.2%的患者终末期肾病的主要病因是糖尿病。超过90%的患者有一种或多种合并症，57.5%的患者曾接受过腹部手术。该组的平均体重指数为28.6±13.8kg/m²。不到四分之一的患者（24.1%）存在非感染性/机械性导管问题。12个月、24个月和36个月时的总体PD导管存活率分别为92.9%、91.9%和91.1%。PD导管相关的非感染性问题是唯一与导管存活显著相关（风险比22.467；95%置信区间6.665-75.732）的独立变量。未观察到PD导管存活与其他风险因素之间存在显著关联，这些因素包括年龄、体重指数（BMI）、糖尿病状态、合并症、既往腹部手术或感染。
我们的研究显示3年PD导管存活率极佳（91.1%）。只有PD导管相关的非感染性问题与导管失败显著相关。未发现年龄、性别、种族、BMI、糖尿病状态、合并症、既往腹部手术、腹膜感染或出口部位/隧道感染等其他因素会影响PD导管存活，不应将其视为开始PD治疗的障碍。
