Yaxley Julian, Scott Tahira, Hakim Harris, Wilkinson Catherine, Mantha Murty
Department of Nephrology, Cairns Hospital, Cairns, QLD, Australia.
Torres and Cape Hospital and Health Service, Cairns, QLD, Australia.
J Vasc Access. 2024 Sep 5:11297298241277861. doi: 10.1177/11297298241277861.
The preferred techniques for peritoneal dialysis catheterization are uncertain. Catheter implantation with formation of an inferiorly-directed tunnel and exit site is widely recommended to reduce the risk of infective complications. We aimed to compare percutaneous peritoneal dialysis catheter insertion using an upwardly-directed tract to catheter insertion using a downwardly-directed tract.
A retrospective cohort study was performed on consecutive peritoneal dialysis catheterizations over a 10-year period at a single centre. Participants were classified into two groups: catheter insertion with an upward tunnel and exit site versus insertion with a downward tunnel and exit site. The primary outcome was peritoneal dialysis catheter survival.
There were 247 peritoneal dialysis catheters inserted during the study period. The median catheter survival was 18 months, with no difference between the two groups ( = 0.23). The 12-month catheter patency rates were 76% for catheters with an upward tract and 79% for catheters with a downward tract ( = 0.15). Multivariate analysis identified no clinical factors predictive of catheter survival. A downward catheter tunnel and exit site was associated with an increased incidence of peritonitis (0.23 vs 0.11 episodes per year; ⩽ 0.01).
In this study, percutaneous peritoneal dialysis catheter insertion with an upward tunnel and exit site demonstrated similar catheter survival to insertion with a downward tunnel and exit site and was not associated with increased infections.
腹膜透析置管的首选技术尚不确定。广泛推荐植入带有向下定向隧道和出口部位的导管以降低感染并发症的风险。我们旨在比较使用向上定向路径进行经皮腹膜透析导管插入与使用向下定向路径进行导管插入的情况。
在一个中心对连续10年的腹膜透析置管进行了一项回顾性队列研究。参与者被分为两组：向上隧道和出口部位的导管插入组与向下隧道和出口部位的导管插入组。主要结局是腹膜透析导管的存活情况。
研究期间共插入247根腹膜透析导管。导管的中位存活时间为18个月，两组之间无差异（P = 0.23）。向上路径导管的12个月导管通畅率为76%，向下路径导管的为79%（P = 0.15）。多因素分析未发现预测导管存活的临床因素。向下的导管隧道和出口部位与腹膜炎发生率增加相关（每年0.23次 vs 0.11次发作；P⩽0.01）。
在本研究中，使用向上隧道和出口部位进行经皮腹膜透析导管插入与使用向下隧道和出口部位进行插入相比，导管存活情况相似，且与感染增加无关。
