Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea.
Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea.
Nephrology (Carlton). 2020 May;25(5):413-420. doi: 10.1111/nep.13627. Epub 2019 Jul 21.
Catheter migration is an important cause of catheter malfunction in peritoneal dialysis (PD). The purpose of this study was to investigate the effect of early detection of catheter migration on clinical outcomes.
A retrospective review of 135 consecutive patients initiating PD immediately following catheter insertion from 2002 to 2017 was undertaken. In order to detect catheter migration without malfunction early, serial abdominal-pelvic radiographic examinations were performed according to a predefined protocol. Conservative management with rigorous catharsis was undertaken to correct catheter migration. A Kaplan-Meier method was used to calculate survival rate.
Mean follow-up period was 42.8 ± 34.9 months. Catheter migration occurred in 62.4%. Among them, 85.9% occurred within the first 2 weeks after catheter insertion. There were no significant associations between catheter migration and variables such as gender, obesity, DM and type of catheter. Success rate of conservative management with rigorous catharsis was 91.1%. Catheter survival at 1 and 5 years were 91.5% and 64.6% in the migration group and 81.2% and 69.9% in the non-migration group, respectively (Log-rank test, P = 0.915). Patient survival at 1 and 5 years were 96.8% and 85.8% in the migration group and 91.9% and 82.3% in the non-migration group, respectively (P = 0.792).
Early detection of PD catheter migration allowed the migrated tip to be easily corrected with conservative management. Once the migrated catheter tip was restored, catheter migration itself did not affect catheter survival. These findings suggest that early detection and correction of catheter migration is important for improving clinical outcomes.
导管迁移是腹膜透析（PD）中导管功能障碍的一个重要原因。本研究旨在探讨早期发现导管迁移对临床结局的影响。
回顾性分析了 2002 年至 2017 年期间 135 例连续接受 PD 治疗的患者。为了在没有功能障碍的情况下早期发现导管迁移，根据预设方案进行了连续的腹部-盆腔放射影像学检查。采用严格的灌肠进行保守治疗以纠正导管迁移。采用 Kaplan-Meier 方法计算生存率。
平均随访时间为 42.8±34.9 个月。导管迁移发生率为 62.4%。其中，85.9%发生在导管插入后 2 周内。导管迁移与性别、肥胖、DM 和导管类型等变量之间无显著相关性。严格灌肠的保守治疗成功率为 91.1%。迁移组和非迁移组的导管 1 年和 5 年生存率分别为 91.5%和 64.6%、81.2%和 69.9%（Log-rank 检验，P=0.915）。迁移组和非迁移组的患者 1 年和 5 年生存率分别为 96.8%和 85.8%、91.9%和 82.3%（P=0.792）。
早期发现 PD 导管迁移可使移位尖端易于通过保守治疗进行纠正。一旦恢复了移位的导管尖端，导管迁移本身并不影响导管的存活率。这些发现表明，早期发现和纠正导管迁移对于改善临床结局非常重要。
