Oki Rikako, Hamasaki Yoshifumi, Komaru Yohei, Miyamoto Yoshihisa, Matsuura Ryo, Yamada Daisuke, Iwagami Masao, Doi Kent, Kume Haruki, Nangaku Masaomi
Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan.
Department of Urology, University of Tokyo Hospital, Tokyo, Japan.
Kidney Int Rep. 2020 Dec 7;6(2):325-332. doi: 10.1016/j.ekir.2020.11.030. eCollection 2021 Feb.
Catheter-related infections such as exit site infection (ESI) and tunnel infection (TI) are major causes of peritoneal dialysis (PD) discontinuation. For ESI/TI treatment, catheter diversion procedure (CDP) with exit-site renewal for catheter salvage presents an alternative to catheter removal. Nevertheless, CDP capability of improving PD catheter survival remains unclear.
We retrospectively reviewed our hospital patients who started PD during 2001-2019 (=148): 33 treated for ESI/TI by CDP (CDP group) and 115 treated for ESI/TI using conservative therapy or none (non-CDP group). A "virtual discontinuation group" was designated for patients in the CDP group who had received PD catheter removal instead of CDP and who had stopped PD. Kaplan-Meier analysis and log-rank test PD were used for intergroup catheter survival comparison. Associations between clinical factors and PD discontinuation or death were examined using Cox proportional hazards regression analyses.
For patients (76% male, mean age of 61.7±13.0 years), 40 CDP were performed for 33 CDP group patients. Infection-free rates at 30 and 90 days after CDP were, respectively, 90% and 67%. The CDP group PD catheter survival rate was significantly higher than that of virtual discontinuation group ( < .01) and higher than that of the non-CDP group ( = .03). Multivariate analysis revealed independent association of serum albumin concentration (hazard ratio 0.33, 95% confidence interval 0.17-0.67), PD+HD combination therapy (hazard ratio 0.29, 95% confidence interval 0.17-0.49), and CDP (hazard ratio 0.44, 95% confidence interval 0.24-0.80) with PD discontinuation or death.
Results show that CDP may improve PD catheter survival as an effective and less-invasive surgical treatment for ESI/TI to avoid withdrawal of PD.
导管相关感染，如出口部位感染（ESI）和隧道感染（TI）是腹膜透析（PD）中断的主要原因。对于ESI/TI的治疗，采用出口部位更新的导管转流术（CDP）来挽救导管是一种替代导管拔除的方法。然而，CDP提高PD导管生存率的能力仍不明确。
我们回顾性分析了2001年至2019年期间在我院开始进行PD治疗的患者（n = 148）：33例接受CDP治疗ESI/TI（CDP组），115例采用保守治疗或未治疗ESI/TI（非CDP组）。为CDP组中接受PD导管拔除而非CDP且停止PD的患者指定一个“虚拟中断组”。采用Kaplan-Meier分析和对数秩检验比较组间导管生存率。使用Cox比例风险回归分析检查临床因素与PD中断或死亡之间的关联。
对于患者（76%为男性，平均年龄61.7±13.0岁），33例CDP组患者共进行了40次CDP。CDP后30天和90天的无感染率分别为90%和67%。CDP组的PD导管生存率显著高于虚拟中断组（P <.01），且高于非CDP组（P =.03）。多变量分析显示血清白蛋白浓度（风险比0.33，95%置信区间0.17 - 0.67）、PD + HD联合治疗（风险比0.29，95%置信区间0.17 - 0.49）和CDP（风险比）0.44，95%置信区间0.24 - 0.80）与PD中断或死亡独立相关。
结果表明，CDP作为一种有效且侵入性较小的ESI/TI手术治疗方法，可提高PD导管生存率，避免PD中断。
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