Catheter Diversion Procedure With Exit-Site Renewal Promotes Peritoneal Dialysis Catheter Survival

Rikako Oki; Yoshifumi Hamasaki; Yohei Komaru; Yoshihisa Miyamoto; Ryo Matsuura; Daisuke Yamada; Masao Iwagami; Kent Doi; Haruki Kume; Masaomi Nangaku

Kidney International Reports (Feb 2021)

Catheter Diversion Procedure With Exit-Site Renewal Promotes Peritoneal Dialysis Catheter Survival

Rikako Oki,
Yoshifumi Hamasaki,
Yohei Komaru,
Yoshihisa Miyamoto,
Ryo Matsuura,
Daisuke Yamada,
Masao Iwagami,
Kent Doi,
Haruki Kume,
Masaomi Nangaku

Affiliations

Rikako Oki: Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
Yoshifumi Hamasaki: Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan; Correspondence: Yoshifumi Hamasaki, Department of Hemodialysis and Apheresis, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Yohei Komaru: Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
Yoshihisa Miyamoto: Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
Ryo Matsuura: Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
Daisuke Yamada: Department of Urology, University of Tokyo Hospital, Tokyo, Japan
Masao Iwagami: Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tokyo, Japan
Kent Doi: Department of Acute Medicine, University of Tokyo Hospital, Tokyo, Japan
Haruki Kume: Department of Urology, University of Tokyo Hospital, Tokyo, Japan
Masaomi Nangaku: Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan

Journal volume & issue: Vol. 6, no. 2
pp. 325 – 332

Abstract

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Introduction: Catheter-related infections such as exit site infection (ESI) and tunnel infection (TI) are major causes of peritoneal dialysis (PD) discontinuation. For ESI/TI treatment, catheter diversion procedure (CDP) with exit-site renewal for catheter salvage presents an alternative to catheter removal. Nevertheless, CDP capability of improving PD catheter survival remains unclear. Methods: We retrospectively reviewed our hospital patients who started PD during 2001–2019 (n=148): 33 treated for ESI/TI by CDP (CDP group) and 115 treated for ESI/TI using conservative therapy or none (non-CDP group). A “virtual discontinuation group” was designated for patients in the CDP group who had received PD catheter removal instead of CDP and who had stopped PD. Kaplan-Meier analysis and log-rank test PD were used for intergroup catheter survival comparison. Associations between clinical factors and PD discontinuation or death were examined using Cox proportional hazards regression analyses. Results: For patients (76% male, mean age of 61.7±13.0 years), 40 CDP were performed for 33 CDP group patients. Infection-free rates at 30 and 90 days after CDP were, respectively, 90% and 67%. The CDP group PD catheter survival rate was significantly higher than that of virtual discontinuation group (P < .01) and higher than that of the non-CDP group (P = .03). Multivariate analysis revealed independent association of serum albumin concentration (hazard ratio 0.33, 95% confidence interval 0.17–0.67), PD+HD combination therapy (hazard ratio 0.29, 95% confidence interval 0.17–0.49), and CDP (hazard ratio 0.44, 95% confidence interval 0.24–0.80) with PD discontinuation or death. Conclusion: Results show that CDP may improve PD catheter survival as an effective and less-invasive surgical treatment for ESI/TI to avoid withdrawal of PD.

Published in Kidney International Reports

ISSN: 2468-0249 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the genitourinary system. Urology
Website: http://www.journals.elsevier.com/kidney-international-reports/

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