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Perit Dial Int 26(6): 677-683 2006
© 2006 International Society for Peritoneal Dialysis
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Clinical

PROSPECTIVE COMPARISON OF DOWNWARD AND LATERAL PERITONEAL DIALYSIS CATHETER TUNNEL-TRACT AND EXIT-SITE DIRECTIONS

John H. Crabtree1 and Raoul J. Burchette2

1 Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower; 2 Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, California, USA

Correspondence to: J.H. Crabtree, Department of Surgery, Module 4400, Kaiser Permanente Bellflower Medical Center, 9400 E. Rosecrans Avenue, Bellflower, California 90706 USA.
John.H.Crabtree{at}kp.org

{diamondsuit} Objective: Guidelines for optimal peritoneal dialysis access support both downward and lateral exit-site directions. Numerous clinical reports support the superiority of downward exit sites but none substantiate lateral configurations.

{diamondsuit} Methods: This prospective study compared infectious and mechanical complications between 85 catheters with a preformed arcuate bend to produce a downward exit site and 93 catheters with a straight intercuff segment configured to create a lateral exit site.

{diamondsuit} Results: Kaplan-Meier survivals were not different for time to first exit-site infection (p = 0.62), tunnel infection (p = 0.89), or peritonitis (p = 0.38) for downward and lateral exit-site directions. Poisson regression showed no differences in rates (episodes/patient-year) of exit-site infection (0.26 vs 0.27, p = 0.86), tunnel infection (0.02 vs 0.03, p = 0.79), peritonitis (0.42 vs 0.43, p = 0.87), or catheter loss (0.06 vs 0.09, p = 0.29) for downward and lateral exit sites. Kaplan-Meier analyses of antibiotic-free intervals for exit-site (p = 0.94) and peritonitis infections (p = 0.72) were not different for the two groups. There was one case of catheter tip displacement with flow dysfunction in each group. There were no pericatheter hernias or spontaneous cuff extrusions. Catheter survival between groups was not different (p = 0.20).

{diamondsuit} Conclusions: Catheter types employing downward and lateral tunnel-tract and exit-site configurations produce equivalent outcomes for infectious and mechanical complications.

KEY WORDS: Tenckhoff catheter; swan neck catheter; exit-site infection; tunnel infection; peritonitis; cuff extrusion; catheter tip migration; catheter survival.

Received 21 February 2006; accepted 19 April 2006.






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