A Randomized Clinical Trial Comparing the Function of Straight and Coiled Tenckhoff Catheters for Peritoneal Dialysis

Stegmayr, Bernd; Wikdahl, Ann Marie; Bergström, Monica; Nilsson, Christina; Engman, U; Arnerlöv, Conny; Petersen, Erling N.

doi:10.1177/089686080502500115

Cited by 31 publications

(26 citation statements)

References 11 publications

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“…Coiled tip catheters were noted to be associated with a higher risk of catheter migration 31.2% vs 8.7% (P .02), 32 and drainage dysfunction due to malposition, (47% vs 0% P < .05), requiring frequent interventions, (41% vs 7%, P < .05). 33 A meta-analysis of randomized controlled trials comparing straight vs coiled tip catheters found an increased risk of catheter tip migration with catheter dysfunction, (HR 2.08, P = .002, and overall higher catheter failure rate (HR 1.77, P .03). 34 In a recent RCT Li et.al reported drainage failure in 5.8% and 0.7% of patients receiving a coiled catheter or a straight catheter respectively, with 5.1% (95% CI, 1.2%-9.1%; P = .02) lower risk of catheter dysfunction in straight catheters.…”

Section: Discussionmentioning

confidence: 99%

Predictors of technique failure and mortality on peritoneal dialysis: An analysis of New Zealand peritoneal dialysis registry data

Hayat

Saweirs

2020

Nephrology

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Aim: Technique failure is a major disadvantage associated with peritoneal dialysis (PD). This study aimed to analyse the demographic and risk predictors of technique failure and mortality in patients on PD.Methods: All incidental PD patients registered on the New Zealand Peritoneal dialysis registry (NZPDR) from January 1995 to December 2014 were included in the study. The primary outcomes were time to technique failure and its specific causes, while as the secondary outcome was time to death. Risk predictors of technique failure and mortality were analysed using multivariate Cox proportional hazards (PH) regression model. Besides, competitive risk regression analysis was undertaken to analyse the effect of death as a competing event to technique failure.Results: Of 6379 patients, there were 2993 (46.9%) episodes of technique failure and 2684 (42%) deaths. The crude technique failure and mortality rates were 165 ± 5.90 and 147.9 ± 5.50 (mean ± SD)/1000 patient-years, respectively. Hazards of technique failure were lower in older individuals above 60 years, HR 0.72 (95% CI 0.67-0.79), larger centres, HR 0.89 (95% CI 0.79-1.00) and higher with coiled catheters, HR 1.26 (95% CI 1.16-1.37). Early nephrology referral, continuous ambulatory peritoneal dialysis (CAPD) and Asian ethnicities were associated with better technique survival. Infections were the major cause of technique failure (58.4%) with peritonitis being the leading cause (30.2%). Conclusion:There are multiple factors associated with risk of technique failure, therefore it is persuasive to construct a mathematical model for early prediction, for a planned transition to HD. K E Y W O R D Sclinical nephrology, dialysis, end-stage kidney disease Peritoneal dialysis (PD) is equivalent to haemodialysis (HD) as a treatment option in patients with end-stage kidney disease (ESKD). The major advantages of PD include preservation of residual kidney functions, treatment-related flexibility, superior patient satisfaction and a reduced risk of transmission of blood-borne infections. PD is also cost-effective with an annual cost savings of up to 40% compared to in-centre HD. [1][2][3][4] Despite these advantages, the major concerns with PD are progressive attrition in patient numbers due to technique failure, resulting in significant patient risks and health care costs. 5,6 There are inconsistencies among various studies regarding the definition and timing of PD technique failure resulting in significant variability in the outcomes. 7 A comprehensive registry-based study from Australia

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Section: Discussionmentioning

confidence: 99%

Predictors of technique failure and mortality on peritoneal dialysis: An analysis of New Zealand peritoneal dialysis registry data

Hayat

Saweirs

2020

Nephrology

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“…We had previously established the benefit using a straight double cuff Tenckhoff before a coiled catheter. 4 Thereafter, at our hospital, insertions were performed using either a straight or a self-locating Wolfram catheter. To clarify if there was a benefit using one or the other we decided to perform a systematic quality assessment study using randomization.…”

Section: Methodsmentioning

confidence: 99%

“…Although the use of a swan neck catheter versus a straight outer part of the Tenckhoff catheter does not differ, 3 the use of a coiled inner part causes more complications than when using a straight inner part. 4 – 7 The coiled catheters are more frequently caught by the omentum and dislocated.…”

Section: Introductionmentioning

confidence: 99%

Few Outflow Problems With a Self-locating Catheter for Peritoneal Dialysis

et al. 2015

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We developed a technique for direct start of peritoneal dialysis. Using a coiled or straight Tenckhoff catheter often results in obstruction of flow. A self-locating Wolfram catheter is on the market. It is not clarified if this results in a benefit.The primary aim of this study was to perform a randomized investigation to clarify if the use of a self-locating peritoneal dialysis (PD) catheter would result in different flow problems than a straight Tenckhoff catheter.A total of 61 insertions were made who were randomized and received either a straight Tenckhoff (n = 32) or a self-locating Wolfram catheter (n = 29).A previously described operation technique allowed immediate postoperative start of dialysis. Seven straight Tenckhoff catheters had to be changed into self-locating catheters, and none vice versa, due to flow problems (P = 0.011). An early leakage resulted in temporarily postponed PD in 4 patients.This study showed that using the present operation technique the self-locating PD-catheter causes fewer obstruction episodes than a straight Tenckhoff catheter. This facilitates immediate postoperative start of PD.

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“…Rationale: The Cochrane Review did not find any advantage for straight versus coiled catheters, single or double cuff, median or lateral incision (21). However, a RCT reported improved primary catheter function (22) and improved PD technique survival for straight versus coiled catheters (23). A further RCT reported that coiled catheters might have higher migration rates than straight catheters (24).…”

Section: Full Clinical Practice Guidelines For Peritoneal Dialysis Accessmentioning

confidence: 99%

Clinical Practice Guidelines for Peritoneal Access

et al. 2010

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A Randomized Clinical Trial Comparing the Function of Straight and Coiled Tenckhoff Catheters for Peritoneal Dialysis

Cited by 31 publications

References 11 publications

Predictors of technique failure and mortality on peritoneal dialysis: An analysis of New Zealand peritoneal dialysis registry data

Predictors of technique failure and mortality on peritoneal dialysis: An analysis of New Zealand peritoneal dialysis registry data

Few Outflow Problems With a Self-locating Catheter for Peritoneal Dialysis

Clinical Practice Guidelines for Peritoneal Access

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