A Randomized Controlled Trial of Coiled Versus Straight Swan-Neck Tenckhoff Catheters in Peritoneal Dialysis Patients

Background: Current clinical practice guidelines recommend that no particular type of peritoneal dialysis (PD) catheter has been proved superior to another. However, a recent Cochrane review recommended the need for a large, well-designed, randomized, controlled trial of straight versus coiled PD ca...

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Bibliographic Details
Published in:	American journal of kidney diseases Vol. 48; no. 5; pp. 812 - 821
Main Authors:	Johnson, David W., Wong, Jennifer, Wiggins, Kathryn J., Kirwan, Robyn, Griffin, Anthony, Preston, John, Wall, Daryl, Campbell, Scott B., Isbel, Nicole M., Mudge, David W., Hawley, Carmel M., Nicol, David L.
Format:	Journal Article
Language:	English
Published:	Orlando, FL Elsevier Inc 01-11-2006 Elsevier
Subjects:	Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Catheterization - adverse effects Coiled Tenckhoff catheter Drainage - instrumentation Emergency and intensive care: renal failure. Dialysis management Equipment Design Equipment Failure exit-site infections Female Humans Intensive care medicine kidney failure, chronic Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Peritoneal Dialysis - adverse effects Peritoneal Dialysis - instrumentation peritonitis Proportional Hazards Models Prospective Studies Renal failure straight Tenckhoff catheter technique survival Time Factors Treatment Failure tunnel infections kidney failure, chronic tunnel infections peritonitis straight Tenckhoff catheter technique survival Coiled Tenckhoff catheter exit-site infections Kidney disease Human Site Nephrology Urinary system disease chronic; peritonitis; straight Tenckhoff catheter; technique survival; tunnel infections Catheter Survival Peritoneal dialysis Urology Coil Infection Extrarenal dialysis Chronic Abdominal disease Renal failure Randomised controlled trial Neck Technique Comparative study Peritonitis Tunnels Coiled Tenckhoff catheter; exit-site infections; kidney failure
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Summary:	Background: Current clinical practice guidelines recommend that no particular type of peritoneal dialysis (PD) catheter has been proved superior to another. However, a recent Cochrane review recommended the need for a large, well-designed, randomized, controlled trial of straight versus coiled PD catheters because of the paucity and suboptimal quality of previously performed trials. Methods: A randomized controlled trial was undertaken at 2 metropolitan teaching hospitals comparing the effects of straight versus coiled PD catheters on time to catheter malposition (primary outcome), catheter-associated infection, technique failure, and all-cause mortality. Results: One hundred thirty-two PD patients were enrolled and randomly assigned to insertion of a coiled (n = 62) or straight catheter (n = 70). There was no significant difference in time to laparoscopic reposition between the 2 cohorts (log-rank score, 0.41; P = 0.52). However, median technique survival was significantly worse for coiled catheters (1.5 years; 95% confidence interval [CI], 1.2 to 1.8) compared with straight catheters (2.1 years; 95% CI, 1.8 to 2.5; P < 0.05), primarily because of increased risk for inadequate dialytic clearance with the former. On univariate Cox proportional hazards model analysis, insertion of a coiled PD catheter was associated significantly with a greater risk for technique failure (unadjusted hazard ratio, 1.86; 95% CI, 1.03 to 3.36). No difference was observed between the 2 groups with respect to catheter-associated infections or overall patient survival. Conclusion: Coiled catheters do not influence the risk for drainage failure caused by catheter malposition compared with straight catheters, but are associated with significantly increased risk for PD technique failure, primarily because of inadequate dialytic clearance.
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ISSN:	0272-6386 1523-6838
DOI:	10.1053/j.ajkd.2006.08.010