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Am J Kidney Dis. 2019 Aug 21. pii: S0272-6386(19)30846-7. doi: 10.1053/j.ajkd.2019.05.024. [Epub ahead of print]

Straight Versus Coiled Peritoneal Dialysis Catheters: A Randomized Controlled Trial.

Author information

1
Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. Electronic address: chow_kai_ming@alumni.cuhk.net.
2
Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong.
3
Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.

Abstract

RATIONALE & OBJECTIVE:

Despite a recent meta-analysis favoring straight catheters, the clinical benefits of straight versus coiled peritoneal dialysis catheters remain uncertain. We conducted a randomized controlled study to compare the complication rates associated with these 2 types of double-cuffed peritoneal dialysis catheters.

STUDY DESIGN:

Multicenter, open-label, randomized, controlled trial.

SETTING & PARTICIPANTS:

308 adult continuous ambulatory peritoneal dialysis patients.

INTERVENTION:

Participants were randomly assigned to receive either straight or coiled catheters.

OUTCOMES:

The primary outcome was the incidence of catheter dysfunction requiring surgical intervention. Secondary outcomes included time to catheter dysfunction requiring intervention, catheter migration with dysfunction, infusion pain measured using a visual analogue scale, peritonitis, technique failure, and peritoneal catheter survival.

RESULTS:

153 patients were randomly assigned to straight catheters; and 155, to coiled catheters. Among randomly assigned patients who underwent peritoneal dialysis, during a mean follow-up of 21 months, the primary outcome of catheter dysfunction or drainage failure occurred in 9 (5.8%) patients who received a coiled catheter and 1 (0.7%) patient who received a straight catheter. Straight catheters had 5.1% lower risk for catheter dysfunction (95% CI, 1.2%-9.1%; P=0.02). The HR of the primary outcome for coiled versus straight catheters was 8.69 (95% CI, 1.10-68.6; P=0.04). Patients who received a coiled catheter had similar risk for peritonitis but reported higher infusion pain scores than those who received straight catheters.

LIMITATIONS:

Generalizability to other peritoneal dialysis centers with lower volumes and other races and nationalities.

CONCLUSIONS:

Use of straight Tenckhoff catheters compared with coiled catheters reduced the rate of catheter dysfunction requiring surgical intervention.

FUNDING:

Funded by the Chinese University of Hong Kong.

TRIAL REGISTRATION:

Registered at ClinicalTrials.gov with study number NCT02479295.

KEYWORDS:

Tenckhoff catheter; catheter dysfunction; catheter survival; coiled; continuous ambulatory peritoneal dialysis (CAPD); drainage failure; end-stage renal disease (ESRD); infusion pain; kidney failure; outcomes; peritoneal dialysis (PD); peritonitis; randomized controlled trial (RCT); straight

PMID:
31445925
DOI:
10.1053/j.ajkd.2019.05.024

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