Retrospective Analysis of Peritoneal Dialysis Catheter Outcomes, Complications, and Surgical Techniques
Poster #: 105
Session/Time: B
Author:
Nicholas Edward Rouck, BA
Mentor:
Jessica Burgess, MD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Peritoneal dialysis (PD) is an increasingly popular modality of renal replacement therapy for patients with end-stage renal disease, but catheter obstruction or migration can compromise patency. Prophylactic techniques to decrease catheter malfunction such as catheter-pexy (CP) and omentopexy (suturing the catheter or omentum to the abdominal wall, respectively) have been described as possible adjuncts but have yet to be studied in a large cohort. Therefore, this study investigates whether prophylactic CP improves PD catheter patency over a 1-year period.
METHODS:
This retrospective cohort study includes adult patients who underwent PD catheter placement at Sentara Norfolk General Hospital from 1/1/2016 to 11/1/2023. Data were obtained via electronic medical records. The primary exposure was CP during PD catheter insertion. The primary outcome was 1-year patency, defined as the absence of revision or removal surgeries within 1 year of insertion. Covariates included age, sex, race, ethnicity, BMI, comorbidities, surgery length, and omentopexy during insertion. Mann-Whitney-U and chi-squared tests were used to compare baseline differences between CP and no-CP groups. Risk-adjusted multivariable logistic regression was employed to analyze the association of CP with 1-year catheter patency. P-values <0.05 were considered statistically significant.
RESULTS:
Of 202 patients, 157 (77.7%) had prophylactic CP and 45 (22.3%) did not. Baseline characteristics were similar between groups (p >0.05). Reoperation was required for 49 (31.2%) patients in the CP group, compared to 18 (40.0%) in the no-CP group (p=0.270). After multivariable logistic regression, CP was associated with a 55% decrease in reoperation within 1 year (OR 0.45, 95% CI [0.20-0.99]). The only other variable associated with reoperation was diabetes mellitus (OR 0.46, 95% CI [0.21-0.98]).
CONCLUSION:
These findings suggest that CP during PD catheter insertion is associated with superior 1-year patency rates. Surprisingly, diabetes mellitus was also associated with improved patency, which may be due to greater medical surveillance and follow-up. Although this study's sample is limited, future analysis will include an expanded cohort of 591 patients with additional covariates that will provide more robust evidence regarding the use of prophylactic CP.
Peritoneal dialysis (PD) is an increasingly popular modality of renal replacement therapy for patients with end-stage renal disease, but catheter obstruction or migration can compromise patency. Prophylactic techniques to decrease catheter malfunction such as catheter-pexy (CP) and omentopexy (suturing the catheter or omentum to the abdominal wall, respectively) have been described as possible adjuncts but have yet to be studied in a large cohort. Therefore, this study investigates whether prophylactic CP improves PD catheter patency over a 1-year period.
METHODS:
This retrospective cohort study includes adult patients who underwent PD catheter placement at Sentara Norfolk General Hospital from 1/1/2016 to 11/1/2023. Data were obtained via electronic medical records. The primary exposure was CP during PD catheter insertion. The primary outcome was 1-year patency, defined as the absence of revision or removal surgeries within 1 year of insertion. Covariates included age, sex, race, ethnicity, BMI, comorbidities, surgery length, and omentopexy during insertion. Mann-Whitney-U and chi-squared tests were used to compare baseline differences between CP and no-CP groups. Risk-adjusted multivariable logistic regression was employed to analyze the association of CP with 1-year catheter patency. P-values <0.05 were considered statistically significant.
RESULTS:
Of 202 patients, 157 (77.7%) had prophylactic CP and 45 (22.3%) did not. Baseline characteristics were similar between groups (p >0.05). Reoperation was required for 49 (31.2%) patients in the CP group, compared to 18 (40.0%) in the no-CP group (p=0.270). After multivariable logistic regression, CP was associated with a 55% decrease in reoperation within 1 year (OR 0.45, 95% CI [0.20-0.99]). The only other variable associated with reoperation was diabetes mellitus (OR 0.46, 95% CI [0.21-0.98]).
CONCLUSION:
These findings suggest that CP during PD catheter insertion is associated with superior 1-year patency rates. Surprisingly, diabetes mellitus was also associated with improved patency, which may be due to greater medical surveillance and follow-up. Although this study's sample is limited, future analysis will include an expanded cohort of 591 patients with additional covariates that will provide more robust evidence regarding the use of prophylactic CP.