1
|
Zhang Y, He P, He L. Body surface area and treatment failure in peritoneal dialysis-associated peritonitis. Ther Apher Dial 2023; 27:926-936. [PMID: 37381103 DOI: 10.1111/1744-9987.14026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/28/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION This study mainly discussed the relationship between body surface area (BSA) and treatment failure of peritoneal dialysis-associated peritonitis (PDAP). METHODS The exposures were BSA grouped by the tertiles of BSA levels. The association between BSA and the risk of treatment failure in PDAP, defined as the temporary or permanent switch to hemodialysis and kidney transplantation, was evaluated in Cox proportional hazards models. RESULTS A total of 483 episodes in 285 patients were recorded in our center. As a three-level categorical variable, in reference to G3, the G1 of BSA displayed a 4.054-fold increased venture of treatment failure in a fully adjusted model. In sensitivity analysis, a lower value of BSA (G1) was identified as an independent risk factor for peritonitis episodes (odds ratio = 2.433, 95% confidence interval: 1.184-4.999, p = 0.015). CONCLUSION A lower level of body surface area was remarkably associated with a higher incidence of treatment failure among peritoneal dialysis-associated peritonitis episodes.
Collapse
Affiliation(s)
- Yuting Zhang
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Peng He
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lijie He
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| |
Collapse
|
2
|
Nawaz S, Chinnadurai R, Al Chalabi S, Evans P, Kalra PA, Syed AA, Sinha S. Obesity and Chronic Kidney Disease A Current Review. Obes Sci Pract 2022; 9:61-74. [PMID: 37034567 PMCID: PMC10073820 DOI: 10.1002/osp4.629] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/02/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022] Open
Abstract
Background Obesity poses significant challenges to healthcare globally, particularly through its bi-directional relationship with co-morbid metabolic conditions such as type 2 diabetes and hypertension. There is also emerging evidence of an association between obesity and chronic kidney disease (CKD) which is less well characterized. Methods A literature search of electronic libraries was conducted to identify and present a narrative review of the interplay between obesity and CKD. Findings Obesity may predispose to CKD directly as it is linked to the histopathological finding of obesity-related glomerulopathy and indirectly through its widely recognized complications such as atherosclerosis, hypertension, and type 2 diabetes. The biochemical and endocrine products of adipose tissue contribute to pathophysiological processes such as inflammation, oxidative stress, endothelial dysfunction, and proteinuria. The prevention and management of obesity may prove critical in counteracting both the development and advancement of CKD. Moreover, measures of abdominal adiposity such as waist circumference, are generally associated with worse morbidity and mortality in individuals receiving maintenance hemodialysis. Conclusion Obesity is a risk factor for the onset and progression of CKD and should be recognized as a potential target for a preventative public health approach to reduce CKD rates within the general population. Future research should focus on the use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors in patients with CKD and obesity due to their multi-faceted actions on major outcomes.
Collapse
Affiliation(s)
- Saira Nawaz
- Faculty of Biology Medicine and Health University of Manchester Manchester UK
| | - Rajkumar Chinnadurai
- Faculty of Biology Medicine and Health University of Manchester Manchester UK
- Department of Renal Medicine Salford Royal Hospital Northern Care Alliance NHS Foundation Trust Salford UK
| | - Saif Al Chalabi
- Faculty of Biology Medicine and Health University of Manchester Manchester UK
- Department of Renal Medicine Salford Royal Hospital Northern Care Alliance NHS Foundation Trust Salford UK
| | - Philip Evans
- Department of Renal Medicine Liverpool University Hospitals NHS Foundation Trust Liverpool UK
| | - Philip A Kalra
- Faculty of Biology Medicine and Health University of Manchester Manchester UK
- Department of Renal Medicine Salford Royal Hospital Northern Care Alliance NHS Foundation Trust Salford UK
| | - Akheel A. Syed
- Faculty of Biology Medicine and Health University of Manchester Manchester UK
- Department of Diabetes Endocrinology and Obesity Medicine Salford Royal Hospital Northern Care Alliance NHS Foundation Trust Salford UK
| | - Smeeta Sinha
- Faculty of Biology Medicine and Health University of Manchester Manchester UK
- Department of Renal Medicine Salford Royal Hospital Northern Care Alliance NHS Foundation Trust Salford UK
| |
Collapse
|
3
|
Lambie M, Zhao J, McCullough K, Davies SJ, Kawanishi H, Johnson DW, Sloand JA, Sanabria M, Kanjanabuch T, Kim YL, Shen JI, Pisoni RL, Robinson BM, Perl J. Variation in Peritoneal Dialysis Time on Therapy by Country: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study. Clin J Am Soc Nephrol 2022; 17:861-871. [PMID: 35641246 PMCID: PMC9269666 DOI: 10.2215/cjn.16341221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Quantifying contemporary peritoneal dialysis time on therapy is important for patients and providers. We describe time on peritoneal dialysis in the context of outcomes of hemodialysis transfer, death, and kidney transplantation on the basis of the multinational, observational Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) from 2014 to 2017. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among 218 randomly selected peritoneal dialysis facilities (7121 patients) in the PDOPPS from Australia/New Zealand, Canada, Japan, Thailand, the United Kingdom, and the United States, we calculated the cumulative incidence from peritoneal dialysis start to hemodialysis transfer, death, or kidney transplantation over 5 years and adjusted hazard ratios for patient and facility factors associated with death and hemodialysis transfer. RESULTS Median time on peritoneal dialysis ranged from 1.7 (interquartile range, 0.8-2.9; the United Kingdom) to 3.2 (interquartile range, 1.5-6.0; Japan) years and was longer with lower kidney transplantation rates (range: 32% [the United Kingdom] to 2% [Japan and Thailand] over 3 years). Adjusted hemodialysis transfer risk was lowest in Thailand, but death risk was higher in Thailand and the United States compared with most countries. Infection was the leading cause of hemodialysis transfer, with higher hemodialysis transfer risks seen in patients having psychiatric disorder history or elevated body mass index. The proportion of patients with total weekly Kt/V ≥1.7 at a facility was not associated with death or hemodialysis transfer. CONCLUSIONS Countries in the PDOPPS with higher rates of kidney transplantation tended to have shorter median times on peritoneal dialysis. Identification of infection as a leading cause of hemodialysis transfer and patient and facility factors associated with the risk of hemodialysis transfer can facilitate interventions to reduce these events. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_05_31_CJN16341221.mp3.
Collapse
Affiliation(s)
- Mark Lambie
- Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Simon J Davies
- Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | | | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - James A Sloand
- JAS Renaissance, Chicago, Illinois.,George Washington University, Washington, DC
| | | | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong-Lim Kim
- School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jenny I Shen
- The Lundquist Institute at Harbor-University of California, Los Angeles Medical Center, Torrance, California
| | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Jeffrey Perl
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | |
Collapse
|
4
|
Bonenkamp AA, Vonk S, Abrahams AC, Vermeeren YM, van Eck van der Sluijs A, Hoekstra T, van Ittersum FJ, van Jaarsveld BC, Korte MR, Cnossen TT, Jaarsveld BC, Krepel HP, Dam MAGJ, Doorenbos CJ, Özyilmaz A, Boereboom FTJ, Esch S, Breda GF, Hoorn EJ, Severs D, Boonstra AH, Nette RW, Vermeeren YM, Thang HD, Hommes NH, Buren M, Hofstra JM, Diepeveen SHA, Boorsma S, Rotmans JI, Sande F, Litjens EJR, Brink HS, Wijering R, Hagen EC, Penne EL, Fijter CWH, Brulez HFH, Hamersvelt HW, Huisman SJ, Douma CE, Abrahams AC, Luik AJ, Klaassen RJL, Weenink AG, Krekels MME. Comorbidity is not associated with dialysis modality choice in patients with end‐stage kidney disease. Nephrology (Carlton) 2022; 27:510-518. [PMID: 35244316 PMCID: PMC9315144 DOI: 10.1111/nep.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Anna A. Bonenkamp
- Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam Research institute Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Sanne Vonk
- Department of Nephrology and Hypertension University Medical Centre Utrecht Utrecht the Netherlands
| | - Alferso C. Abrahams
- Department of Nephrology and Hypertension University Medical Centre Utrecht Utrecht the Netherlands
| | | | | | - T. Hoekstra
- Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam Research institute Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Frans J. van Ittersum
- Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam Research institute Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Brigit C. van Jaarsveld
- Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam Research institute Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Bennett PN, Bohm C, Harasemiw O, Brown L, Gabrys I, Jegatheesan D, Johnson DW, Lambert K, Lightfoot CJ, MacRae J, Meade A, Parker K, Scholes-Robertson N, Stewart K, Tarca B, Verdin N, Wang AYM, Warren M, West M, Zimmerman D, Li PKT, Thompson S. Physical activity and exercise in peritoneal dialysis: International Society for Peritoneal Dialysis and the Global Renal Exercise Network practice recommendations. Perit Dial Int 2021; 42:8-24. [PMID: 34743628 DOI: 10.1177/08968608211055290] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Life participation requiring physical activity and physical function is a key patient-reported outcome for people receiving peritoneal dialysis (PD). Clinician guidance is required from multidisciplinary sources regarding exercise and activity advice to address the specific needs of this group. From August 2020 through to June 2021, the Global Renal Exercise Network and the International Society for Peritoneal Dialysis reviewed the published literature and international clinical experience to develop a set of clinical practice points. A set of questions relevant to physical activity and exercise were developed from the perspective of a person receiving PD and were the basis for the practice point development. The GRADE framework was used to evaluate the quality of evidence and to guide clinical practice points. The review of the literature found sparse quality evidence, and thus the clinical practice points are generally based on the expert consensus of people receiving PD, PD exercise expert clinicians and experienced PD exercise researchers. Clinical practice points address timing of exercise and activity (post-catheter insertion, peritoneal space empty or full), the uptake of specific activities (work, sex, swimming, core exercise), potential adverse outcomes related to activity and exercise (exit site care, perspiration, cardiovascular compromise, fatigue, intra-abdominal pressure), the effect of exercise and activity on conditions of interest (mental health, obesity, frailty, low fitness) and exercise nutrition.
Collapse
Affiliation(s)
- Paul N Bennett
- Clinical Health Sciences, University of South Australia, Australia.,Satellite Healthcare, USA
| | - Clara Bohm
- Chronic Disease Innovation Centre, Canada.,University of Manitoba, Canada
| | - Oksana Harasemiw
- Chronic Disease Innovation Centre, Canada.,University of Manitoba, Canada
| | | | | | - Dev Jegatheesan
- Princess Alexandra Hospital, Australia.,The University Queensland, Australia
| | - David W Johnson
- Princess Alexandra Hospital, Australia.,The University Queensland, Australia
| | | | | | | | | | | | | | | | - Brett Tarca
- Clinical Health Sciences, University of South Australia, Australia
| | - Nancy Verdin
- The Global Renal Exercise Network Patient Engagement Council, AB, USA
| | | | - Madeleine Warren
- The Global Renal Exercise Network Patient Engagement Council, AB, USA.,Warren-Charnock Associates, UK
| | | | | | - Philip Kam-Tao Li
- Prince of Wales Hospital, Hong Kong.,Chinese University of Hong Kong
| | | |
Collapse
|
6
|
Choudhury D, Yalamanchili HB, Hasan A. Dialysis of the Obese Patient: Meeting Needs for a Growing Epidemic. Semin Nephrol 2021; 41:371-379. [PMID: 34715966 DOI: 10.1016/j.semnephrol.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Increasing population obesity and associated metabolic consequences has led to increased number of obese patients with chronic kidney disease and end-stage renal disease. While obesity is associated with increased cardiovascular morbidity and mortality, obese dialysis patients present a seeming paradox for survival benefit, given other acute intervening illnesses for those on dialysis with loss of lean body mass overtime. Challenges remain in providing adequate renal replacement options and therapy for this growing segment of obese patients on dialysis which are discussed in this article.
Collapse
Affiliation(s)
- Devasmita Choudhury
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA; Department of Medicine, Division of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Division of Nephrology, University of Virginia School of Medicine, Charlottesville, VA.
| | - Hima Bindu Yalamanchili
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA; Department of Medicine, Division of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Alia Hasan
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA
| |
Collapse
|
7
|
Wu H, Ye H, Huang R, Yi C, Wu J, Yu X, Yang X. Incidence and risk factors of peritoneal dialysis-related peritonitis in elderly patients: A retrospective clinical study. Perit Dial Int 2021; 40:26-33. [PMID: 32063144 DOI: 10.1177/0896860819879868] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study was to analyze the incidence, risk factors, and clinical outcomes of peritonitis in elderly continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS Incident patients undergone CAPD from 1 January 2006 to 30 June 2015 in our center were enrolled and divided into aged < 65 years and ≥ 65 years groups. Risk factors were evaluated using a logistic regression model, and outcome comparison was evaluated using a Cox proportional model. RESULTS Among 1953 patients, 111(33.2%) in elderly (n = 334) and 470 (29.0%) in younger (n = 1619) developed at least one episode of peritonitis. Comparing with younger patients, elderly ones had a higher peritonitis rate (0.203 vs. 0.145 episodes/patient-year, p < 0.05). The multivariate Cox regression showed that advanced age (hazard ratio (HR) = 1.06, 95% confidence interval (CI) = 1.01-1.11, p = 0.015), assistant-assisted peritoneal dialysis (PD; HR = 2.64, 95% CI = 1.23-5.64, p = 0.012), higher body mass index (BMI; HR = 1.11, 95% CI = 1.02-1.20, p = 0.010), and low serum albumin level (HR = 0.94, 95% CI = 0.90-0.98, p = 0.004) were associated with increased peritonitis risk in elderly patients. Compared with younger ones with peritonitis, elderly patients had an approximately fourfold increased risk of peritonitis-related mortality (odd ratio (OR) = 3.57, 95% CI = 1.38-9.28, p = 0.009). During the cohort, peritonitis was the risk factor associated with technique failure (HR = 3.19, 95% CI = 2.33-4.39, p < 0.001) in younger patient but not in the elderly population (HR = 1.82, 95% CI = 0.84-3.94, p = 0.132). CONCLUSIONS Elderly PD patients had higher prevalence for peritonitis and peritonitis-related mortality. Advanced age, assistant-assisted PD, a higher BMI, and lower serum albumin level were independently associated with the first episode of peritonitis in elderly patients. However, peritonitis was not the predictor of death-censored technique failure in elderly ones.
Collapse
Affiliation(s)
- Haishan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Rong Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Juan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| |
Collapse
|
8
|
Htay H, Johnson DW, Craig JC, Schena FP, Strippoli GFM, Tong A, Cho Y. Catheter type, placement and insertion techniques for preventing catheter-related infections in chronic peritoneal dialysis patients. Cochrane Database Syst Rev 2019; 5:CD004680. [PMID: 31149735 PMCID: PMC6543877 DOI: 10.1002/14651858.cd004680.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Peritonitis is one of the limiting factors for the growth of peritoneal dialysis (PD) worldwide and is a major cause of technique failure. Several studies have examined the effectiveness of various catheter-related interventions for lowering the risk of PD-related peritonitis. This is an update of a review first published in 2004. OBJECTIVES To evaluate the role of different catheter implantation techniques and catheter types in lowering the risk of PD-related peritonitis in PD patients. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 15 January 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA Studies comparing different catheter insertion techniques, catheter types, use of immobilisation techniques and different break-in periods were included. Studies of different PD sets were excluded. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality and extracted data. Statistical analyses were performed using a random effects model and the results expressed as risk ratio (RR) with 95% confidence intervals (CI). MAIN RESULTS Forty-two studies (3144 participants) were included: 18 evaluated techniques of catheter implantation, 22 examined catheter types, one assessed an immobiliser device, and one examined break-in period. In general, study quality was variable and almost all aspects of study design did not fulfil CONSORT standards for reporting.Catheter insertion by laparoscopy compared with laparotomy probably makes little or no difference to the risks of peritonitis (RR 0.90, 95% CI 0.59 to 1.35; moderate certainty evidence), exit-site/tunnel infection (RR 1.00, 95% CI 0.43 to 2.31; low certainty evidence), catheter removal/replacement (RR 1.20, 95% CI 0.77 to 1.86; low certainty evidence), technique failure (RR 0.71, 95% CI 0.47 to 1.08; low certainty evidence), and death (all causes) (RR 1.26, 95% CI 0.72 to 2.20; moderate certainty evidence). It is uncertain whether subcutaneous burying of catheter increases peritonitis (RR 1.16, 95% CI 0.37 to 3.60; very low certainty evidence). Midline insertion compared to lateral insertion probably makes little or no difference to the risks of peritonitis (RR 0.65, 95% CI 0.32 to 1.33; moderate certainty evidence) and may make little or no difference to exit-site/tunnel infection (RR 0.56, 95% CI 0.12 to 2.58; low certainty evidence). Percutaneous insertion compared with open surgery probably makes little or no difference to the exit-site/tunnel infection (RR 0.16, 95% CI 0.02 to 1.30; moderate certainty evidence).Straight catheters probably make little or no difference to the risk of peritonitis (RR 1.04, 95% CI 0.82 to 1.31; moderate certainty evidence), peritonitis rate (RR 0.91, 95% CI 0.68 to 1.21; moderate certainty evidence), risk of exit-site infection (RR 1.12, 95% CI 0.94 to 1.34; moderate certainty evidence), and exit-site infection rate (RR 1.05, 95% CI 0.77 to 1.43; moderate certainty evidence) compared to coiled catheter. It is uncertain whether straight catheters prevent catheter removal or replacement (RR 1.11, 95% CI 0.73 to 1.66; very low certainty evidence) but straight catheters probably make little or no difference to technique failure (RR 0.82, 95% CI 0.51 to 1.31; moderate certainty evidence) and death (all causes) (RR 0.95, 95% CI 0.62 to 1.46; low certainty evidence) compared to coiled catheter. Tenckhoff catheter with artificial curve at subcutaneous tract compared with swan-neck catheter may make little or no difference to peritonitis (RR 1.29, 95% CI 0.85 to 1.96; low certainty evidence) and incidence of exit-site/tunnel infection (RR 0.96, 95% CI 0.77 to 1.21; low certainty evidence) but may slightly improve exit-site infection rate (RR 0.67, 95% CI 0.50 to 0.90; low certainty evidence). AUTHORS' CONCLUSIONS There is no strong evidence that any catheter-related intervention, including the use of different catheter types or different insertion techniques, reduces the risks of PD peritonitis or other PD-related infections, technique failure or death (all causes). However, the numbers and sizes of studies were generally small and the methodological quality of available studies was suboptimal, such that the possibility that a particular catheter-related intervention might have a beneficial effect cannot be completely ruled out with confidence.
Collapse
Affiliation(s)
- Htay Htay
- Singapore General HospitalDepartment of Renal Medicine20 College StreetSingaporeSingapore169856
| | - David W Johnson
- Princess Alexandra HospitalDepartment of NephrologyIpswich RoadWoolloongabbaQueenslandAustralia4102
- University of QueenslandBrisbaneAustralia
| | - Jonathan C Craig
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
- Flinders UniversityCollege of Medicine and Public HealthAdelaideSAAustralia5001
| | - Francesco Paolo Schena
- University of BariDepartment of Emergency and Organ TransplantationPoliclinicoPiazza Giulio Cesare 11BariItaly70124
| | - Giovanni FM Strippoli
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
- University of BariDepartment of Emergency and Organ TransplantationPoliclinicoPiazza Giulio Cesare 11BariItaly70124
- DiaverumMedical Scientific OfficeLundSweden
- The University of SydneySydney School of Public HealthSydneyAustralia
| | - Allison Tong
- The University of SydneySydney School of Public HealthSydneyAustralia
- The Children's Hospital at WestmeadCentre for Kidney ResearchLocked Bag 4001WestmeadNSWAustralia2145
| | - Yeoungjee Cho
- Princess Alexandra HospitalDepartment of NephrologyIpswich RoadWoolloongabbaQueenslandAustralia4102
- University of QueenslandBrisbaneAustralia
| | | |
Collapse
|