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Catheter Event Rates in Medical Compared to Surgical Peritoneal Dialysis Catheter Insertion

Fotheringham, James; Solis-Trapala, Ivonne; Briggs, Victoria; Lambie, Mark; McCullough, Keith; Dunn, Louese; Rawdin, Andrew; Hill, Harry; Wailloo, Allan; Davies, Simon; Wilkie, Martin

Authors

James Fotheringham

Victoria Briggs

Mark Lambie

Keith McCullough

Louese Dunn

Andrew Rawdin

Harry Hill

Allan Wailloo

Martin Wilkie



Abstract

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. [Abstract copyright: © 2023 International Society of Nephrology. Published by Elsevier Inc.]

Journal Article Type Article
Acceptance Date Sep 11, 2023
Online Publication Date Sep 17, 2023
Publication Date 2023-09
Deposit Date Oct 23, 2023
Journal Kidney International Reports
Print ISSN 2468-0249
Electronic ISSN 2468-0249
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 8
Issue 12
Pages 2635-2645
DOI https://doi.org/10.1016/j.ekir.2023.09.015
Keywords peritoneal dialysis, dialysis access, catheter insertion