G LOW1, J KOH2, G LOW3, S PANG1,H HTAY1, M FOO1, T CHONG1, C TAN1
1Singapore General Hospital, Singapore, Singapore, 2Nanyang Technological University, Singapore, Singapore, 3National University of Singapore, Singapore, Singapore
Tenckhoff catheter longevity remains one of the leading challenges for long-term peritoneal dialysis. This study aims to report catheter outcomes and predictors of mortality within our center.
A single-center retrospective study was performed for patients who had Tenckhoff catheter inserted between January 2011 and January 2016, with patients followed up until 1st January 2017. Cox regression analysis was performed to investigate factors affecting patient survival and catheter survival. Catheter failure is defined as any catheter-related complication necessitating removal.
470 Tenckhoff catheters were inserted in total. Mean age of the study population was 61.6±14.3 years, 49.8% Male, 75.5% Chinese/18.9% Malay/4.9% Indian with median BMI of 24.0kg/m2. Diabetes Mellitus(DM)(58.5%), Hypertension(87.2%) and Ischemic Heart Disease(IHD)(41.1%) were the 3 most common patient comorbidities.
Median follow-up period was 29.2 months(IQR 16.7-49.7 months). All-cause mortality during follow-up was 37.0%(174/470), with only 18.4%(32/174) of deaths resulting from catheter failure. Significant associations with patient survival on multivariate analysis include age(HR=1.04, 95%CI 1.02-1.05), DM(HR=2.04, 95%CI 1.36-3.07), IHD(HR=1.80, 95%CI 1.28-2.52) and serum albumin before catheter insertion(HR=0.94, 95%CI 0.92-0.97). No significant association was observed between patient survival and gender, BMI, hypertensive status, previous cerebrovascular accident, PD modality, hemodialysis before catheter insertion or presence of infection during follow-up.
Catheter failure rate was 27.7%(130/470) during the follow-up period, with mean catheter survival of 50.1±1.4 months. The only significant association with catheter survival was presence of infection during follow-up(p<0.001, HR=3.51, 95%CI 2.16-5.71).
DM, IHD, older age and lower baseline serum albumin were associated with poorer survival and should be considerations when selecting patients within our population. Patients without any infectious episodes during follow-up experienced longer catheter survival in our study, suggesting infection prevention remains essential to prolonging catheter survival.
Gerard Low is a Medical Student enrolled in Yong Loo Lin School of Medicine, National University of Singapore.