Peritoneal dialysis access outcomes reported in randomized controlled trials: A systematic review

Abstract

Background: Functional peritoneal dialysis (PD) access is critical to the success of PD therapy. The aim of this review is to describe the spectrum of definitions and methods employed in the measurement of unique outcomes across PD access trials particularly focusing on the outcomes of PD access flow restriction and operative-related outcomes. Methods: Using Cochrane CENTRAL registry, MEDLINE, and EMBASE, we searched for studies restricted to randomized controlled trials (RCTs) involving interventions related to PD access without restrictions on age, language, or publication year. Studies were screened and data abstracted by two independent reviewers. Definitions, outcome measures, and time points of measurements were captured and documented separately. Unique combinations of these variables resulted in reporting the different ways of measurements. Results: Of the 1768 screened studies, 47 RCTs were included among which 817 PD access outcomes were grouped into 7 broad categories. Interventions evaluated in the RCTs were catheter type/configuration ( n = 17), insertion technique ( n = 15), multiple interventions ( n = 3), and other (6 interventions, n = 12). PD access flow restriction (a subcategory of mechanical outcomes) and operative-related outcomes were reported in 91% and 58% of the included trials, respectively. Tip migration was the most frequently reported flow restriction outcome (59% of RCTs) followed by catheter dysfunction (23% of RCTs). Of the components utilized in definition of flow restriction, description of the impaired flow was reported in 37% of RCTs, need for intervention in 42% of RCTs, and presumed etiology of flow restriction in 60% of RCTs. Conclusion: Variability exists in the definitions, reporting methods, choice of outcomes, and analysis of the PD access outcomes across RCTs. Operative-related outcomes remain underreported across RCTs. Outcomes relating to PD access flow restriction were the most common complications reported in the included RCTs but were reported heterogeneously with variability in reporting of the three key components of its definition including description and severity of the flow restriction, the need for intervention and etiology of flow restriction. In the future, defining PD access flow restriction should include all of these components to better evaluate the comparative effect of various PD access interventions.

A Nationwide Comparative Analysis of Peritoneoscopic and Laparoscopic Techniques for Peritoneal Dialysis Catheter Insertion in Brunei Darussalam

“…To enable comparisons across future studies, we have adopted the recently proposed definitions. 3 Entry point for time on PD therapy is taken from first day of PD training. For those who converted to HD, the first day of HD is taken as the exit point.…”

“…To the best of our knowledge, no previous studies have reported comparisons of the two techniques using the proposed standardized outcomes. 3 Future studies need to use standardized definitions to enable comparisons across jurisdictions and to allow identification of potentially modifiable risk factors.…”

“…To enable comparisons across future studies, we have adopted the recently proposed definitions. 3 As an important core outcome, definition of flow restriction should be standardized in achieving a better understanding of the effectiveness of different interventions and to enable assessment of the comparative effects of these interventions across future studies. The three components of flow restriction are ( 1 ) nature, severity, and direction of the impaired flow; ( 2 ) the need for intervention to restore flow; and ( 3 ) the presumed etiology of the flow restriction.…”

“…To the best of our knowledge, this is the first study to adopt the definitions of outcomes as recently proposed. 3…”

Optimizing peritoneal dialysis catheter placement

“…of PD technique failure are due to mechanical catheter complications (4)(5)(6). Additionally, there is in the definitions, reporting methods, choice of outcomes, and analysis of PD access outcomes which hampers the determination of best practices for PD catheter placement (7).…”