Dogra P M, Hooda A K, Shanmugraj G, Pramanik S K
Department of Nephrology, Command Hospital, Kolkata, West Bengal, India.
Department of Medicine, Command Hospital, Kolkata, West Bengal, India.
Indian J Nephrol. 2018 Jul-Aug;28(4):291-297. doi: 10.4103/ijn.IJN_144_17.
Continuous ambulatory peritoneal dialysis (CAPD) is a standard renal replacement therapy, but there is a lack of consensus for catheter insertion method and type of catheter used. We retrospectively analyzed 140 peritoneal dialysis catheters (PDC) inserted in 139 CAPD patients by two methods; percutaneous (Group "P," = 47) and surgical mini laparotomy (Group "S," = 93) technique over a 39-month period, with cumulative experience of 2415 catheter-months: 745 catheter-months for Group "P" and 1670 catheter-months for Group "S." Break-in period was shorter in Group "P" ( = 0.002) whereas primary nonfunction rate was comparable ( = 0.9). The mean catheter survival was better in Group "S" (17.95 ± 10.96 months vs. 15.85 ± 9.41 months in "P" group, = 0.05) whereas the death-censored and overall catheter survival was comparable in both groups. PDC removal due to refractory peritonitis was also comparable. Mechanical complications were more in "P" group ( = 0.049), leading to higher catheter removal ( = 0.033). The peritonitis rates were higher in "P" group (1 episode per 24.8 catheter-months vs. 1 episode per 34.8 catheter-months in "S" group, = 0.026) and related to a higher number of rural patients in the group ( = 0.04). Patient survival was comparable. There was no effect on episodes of peritonitis in those CAPD patients who had diabetic etiology or prior hemodialysis catheter-related sepsis, age, and PDC insertion method.
持续非卧床腹膜透析（CAPD）是一种标准的肾脏替代疗法，但对于导管插入方法和所用导管类型缺乏共识。我们回顾性分析了139例CAPD患者在39个月期间通过两种方法插入的140根腹膜透析导管（PDC）：经皮穿刺法（“P”组，n = 47）和外科小切口剖腹术（“S”组，n = 93）技术，累积导管使用月数为2415个：“P”组745个导管月，“S”组1670个导管月。“P”组的初始透析期较短（P = 0.002），而初次无功能率相当（P = 0.9）。“S”组的导管平均存活时间更好（“S”组为17.95±10.96个月，“P”组为15.85±9.41个月，P = 0.05），而两组的死亡校正导管存活时间和总体导管存活时间相当。因难治性腹膜炎导致的PDC拔除率也相当。“P”组的机械并发症更多（P = 0.049），导致更高的导管拔除率（P = 0.033）。“P”组的腹膜炎发生率更高（每24.8个导管月1次，“S”组为每34.8个导管月1次，P = 0.026），且与该组中较多的农村患者有关（P = 0.04）。患者生存率相当。对于患有糖尿病病因或既往有血液透析导管相关败血症、年龄以及PDC插入方法的CAPD患者，腹膜炎发作情况不受影响。
