Fotheringham James, Solis-Trapala Ivonne, Briggs Victoria, Lambie Mark, McCullough Keith, Dunn Louese, Rawdin Andrew, Hill Harry, Wailloo Allan, Davies Simon, Wilkie Martin
Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
School of Health and Related Research, University of Sheffield, Sheffield, UK.
Kidney Int Rep. 2023 Sep 17;8(12):2635-2645. doi: 10.1016/j.ekir.2023.09.015. eCollection 2023 Dec.
How patient, center, and insertion technique factors interact needs to be understood when designing peritoneal dialysis (PD) catheter insertion pathways.
We undertook a prospective cohort study in 44 UK centers enrolling participants planned for first catheter insertion. Sequences of regressions were used to describe the associations linking patient and dialysis unit-level characteristics with catheter insertion technique and their impact on the occurrence of catheter-related events in the first year (catheter-related infection, hospitalization, and removal). Factors associated with catheter events were incorporated into a multistate model comparing the rates of catheter events between medical and surgical insertion alongside treatment modality transitions and mortality.
Of 784 first catheter insertions, 466 (59%) had a catheter event in the first year and 61.2% of transitions onto hemodialysis (HD) were immediately preceded by a catheter event. Catheter malfunction was less but infection was more common with surgical compared with medical insertions. Participants at centers with fewer late presenters and more new dialysis patients starting PD, had a lower probability of a catheter event. Adjusting for these factors, the hazard ratio for a catheter event following insertion (medical vs. surgical) was 0.70 (95% confidence interval [CI] 0.43 to 1.13), and once established on PD 0.77 (0.62 to 0.96).
Offering both medical and surgical techniques is associated with lower catheter event rates and keeps people on PD for longer.
在设计腹膜透析（PD）导管插入路径时，需要了解患者、中心和插入技术因素是如何相互作用的。
我们在英国的44个中心进行了一项前瞻性队列研究，纳入计划首次插入导管的参与者。采用回归序列来描述将患者和透析单位层面的特征与导管插入技术联系起来的关联，以及它们对第一年导管相关事件（导管相关感染、住院和拔除）发生的影响。将与导管事件相关的因素纳入多状态模型，比较内科和外科插入导管后导管事件的发生率，以及治疗方式转换和死亡率。
在784例首次导管插入中，466例（59%）在第一年发生了导管事件，61.2%的血液透析（HD）转换之前紧接着发生了导管事件。与内科插入相比，外科插入的导管故障较少，但感染更为常见。在晚期就诊者较少且开始腹膜透析的新透析患者较多的中心，参与者发生导管事件的概率较低。调整这些因素后，插入导管后发生导管事件的风险比（内科与外科）为0.70（95%置信区间[CI]0.43至1.13），一旦开始腹膜透析则为0.77（0.62至0.96）。
同时提供内科和外科技术与较低的导管事件发生率相关，并能使患者接受腹膜透析的时间更长。
