LW CHAN, E TAN, P SIZELAND
Midland Regional Renal Services, Hamilton, Waikato, New Zealand
Aim: To analyse local clinical outcomes of Swan-neck Pre-sternal Peritoneal Dialysis Catheters (PPDCs).
Background: The PPDC, with its parasternal exit-site, is designed to reduce catheter-associated complications and prolong survival, especially for obese patients. With increasing use of such catheters, analysing their outcomes becomes important.
Methods: Single-centre data was retrospectively collected for PPDCs inserted in Waikato Hospital from 2002-2015, using electronic and hardcopy records. Demographic data included age, gender, Body Mass Index (BMI), ethnicity, primary kidney disease (PKD) and indications for PPDC. Catheter outcomes that were analysed included technique survival (TS), catheter-related mechanical and infective complications. TS outcomes were censored for death, transplant or elective modality change.
Results: 100 PPDCs were inserted in 89 patients. Patient demographics: mean age (59.3±0.9years), male/female ratio (34%:66%), mean BMI (35.4±0.5kg/m2), ethnicity (Maori/European/Others, 79%/16%/5%) and PKD (diabetes/glomerulonephritis/others, 66%/16%/18%). The major indication for PPDC was obesity (95%). Outcomes: mean TS (20.9±1.6months), longest TS (78 months) and 1-year TS (81.3%). 18 catheters were removed within one year, due to: obstruction (8), peritoneal-pleural leak (2), abdominal leak (1), tunnel/exit site infections (4) and peritonitis (3). Staphylococcus aureus (67%) was the commonest organism causing exit-site/tunnel infection. The peritonitis rate was 0.48 episodes/year; Coagulase-negative Staphylococcus (38%) was the commonest organism. 13% patients died within year one. None were transplanted.
Conclusions: PPDC is a feasible access option. Our 1-year TS meets current ISPD recommendations. PPDC patients were pre-dominantly female, obese, Maori and diabetic. Mechanical complications accounted for most (61%) 1-year catheter removals.
Discussion: Obesity and diabetes may have predisposed to higher mechanical/infection risk and subsequent PPDC failure. Future studies could incorporate longer term observations and matched-control comparisons with patients on haemodialysis or/and conventional abdominal peritoneal dialysis.