Comparison Of Three Peritoneal Dialysis Catheter Complications And Efficacy

BackgroundChronic kidney disease (CKD) is the clinical collectively of vast majority of kidney disease (e.g, glomerulonephritis, occult glomerulonephritis, pyelonephritis, allergic purpura nephritis, lupus nephritis, IgA nephropathy, nephrotic syndrome, etc.), in addition to the acute nephritis with acute urinary tract infection (renal acute inflammatory diseases), other kidney disease can belong to the scope of CKD. Chronic kidney disease with high incidence, with high cardiovascular disease incidence, high case fatality rate and the low awareness of CKD from the whole society, low rate of prevention, low awareness of the characteristics of cardiovascular disease, at present,it has become one of the major diseases which threats public health. End stage renal diseases(ESRD), refers to all kinds of terminal stage of chronic kidney disease. ESRD refers to the irreversible decline of kidney function, only rely on patients with renal replacement therapy (i.e., kidney transplant and dialysis treatment) in order to maintain normal life need of pathological state. According to the national kidney foundation set by the K/DOQI clinical practice guidelines for CKD, the Glomerular filtration rate (GFR)<15ml/min/1.73m2is defined as the CKD5period. There is a total of1million～2million of patients with ESRD in China, ESRD incidence rate is as high as one over one hundred thousand. Treatment of ESRD is renal replacement therapy, including hemodialysis, peritoneal dialysis and kidney transplantation, to prolong patient survival and improve the patient’s quality of life. Peritoneal Dialysis (PD) is one treatment of ESRD,it use peritoneal dialysis membrane, dependent on the diffusion and ultrafiltration, in order to achieve the purpose to clear the body of excess water and toxins. Adult peritoneal area approximately2.2m2, peritoneum as a semipermeable membrane of a biological, has a good permeability, with good secretion, absorption, permeation, diffusion effects. Peritoneal dialysis system consists of the peritoneal dialysis catheter, in vitro ligation system, dialysate, or peritoneal dialysis machine (automated peritoneal dialysis, APD).Since peritoneal dialysis used in clinical,peritoneal dialysis catheter over a long period of development and improvement. Now, there are many types of peritoneal dialysis catheter in clinical. Currently used peritoneal dialysis catheter are Tenckhoff catheter (including straight and curled-type), swan-neck (including straight and curled-type), TWH tube column disk.The peritoneal dialysis catheter is generally non-toxic silicone hydrophobic material, tissue biocompatibility good catheter function designed by the catheter itself, intubation techniques, and cultural level of patients, patients operating proficiency and the medium was changed the configuration of the system a variety of factors.On which peritoneal dialysis catheter is better, at home and abroad of peritoneal dialysis center, there are many comparative studies, the conclusions are different. The Tenckhoff catheter and swan-neck catheter is the largest use of peritoneal dialysis catheter, about Curled Tenckhoff catheter, Straight Tenckhoff catheter, Straight swan-neck catheter of complications and efficacy comparison was rarely reported.By collecting the ESRD patient data during the past three years who got long-term follow-up, three kinds of peritoneal dialysis catheter were placement. Contrast three kinds of peritoneal dialysis catheter complications, three kinds of peritoneal dialysis catheter technical survival rate, patients survival rate and the efficiency of peritoneal dialysis, provides the theoretical basis of peritoneal dialysis catheter to choose appropriate for clinical.PurposeCompare complications, including non-infection complications and the infection complications, catheter survival rate and patients survival rate, the differences between the efficiency of peritoneal dialysis of three kinds of peritoneal dialysis catheter, ingclding curled Tenckhoff, straight Tenckhoff catheter, the straight swan-neck, provide theoretical basis to choose appropriate drain catheter for clinical.MethodsGathered data of157cases of ESRD patients who got a long-term follow-up from March2008to July2011in Zhujiang Hospital,Southern Medical University, Department of Nephrology. Time of all patients with peritoneal dialysiswere was more than three months. By peritoneal dialysis catheter form different in patients, we divided into three group:curled Tenckhoff catheter group (group A), straight Tenckhoff catheter group (group B) and the straight swan-neck catheter group (group C), three groups of catheter cases respectively:53cases,54cases and50cases. Record patients’ gender, age, primary disease, catheter time, routine blood (including the proportion of blood WBC, neutrophil, hemoglobin, red blood cell pressure, platelet deposition), blood biochemistry, including potassium, sodium, calcium, serum creatinine, blood urea nitrogen, blood albumin, total protein, phosphorus, etc.), blood triglycerides, total cholesterol, etc before catheter placement. Generally, observe dysfunction (tunnel tube distortion, catheter displacement, greater omentum package, fibrin clot blocked drain tube), exit infection, tunnel infection, peritoneal dialysis related peritonitis occurred, catheter survival rate, the difference of patient survival rates, the peritoneal dialysis catheter technology outcome (death, turn to dialysis, kidney transplantation patients with giving up treatment, etc.), the impact on efficiency of peritoneal dialysis (including dialysis three months for the first time after the KT/V test results, peritoneal equilibrium test, anemia, biochemical and lipid metabolic differences) of the three groups of catheter.ResultSince March1,2008to July30,2011, the study enrolled157patients with end-stage renal disease patients, male95cases (60.51%) and62females (39.49%), aged15to87years old. Curled Tenckhoff catheter group (A) of the53cases (33.76%), Straight Tenckhoff catheter group (B)54cases (34.39%), Swan-neck straight catheter group (C)50cases (31.85%). Three groups of patients with gender, age, primary disease, no significant difference in catheterization laboratory tests before indicators,1. non-infectious complications:(1) catheter dysfunction:A total of tunnel distortion catheter of three sets was1case,1case (1.89%) in group A, group B and group C were0cases, there was no statistically significant difference (P=1.00) among the comparison groups; Catheter displacement:8cases (15.09%) in group A,4cases (7.40%) in group B,2cases (4%) in group C,The three groups of catheter displacement difference was statistically significant (P=0.034); A total of greater omentum package of three sets was3cases,2cases in group A (3.77%) and1case (1.85%)in group B,0cases in group C, there was no statistically significant difference (P=0.069); A total of fibrin clot blocked drain tube of three group was2cases,0cases in group A and2cases (3.70%) in group B,0cases in group C, there was no statistically significant difference (P=0.057)among the comparison groups;(2) There was no statistically significant difference in the noninfection complications of hernia, abdominal fluid leakage, subcutaneous polyester sets out, hemorrhagic to drain fluid, abdominal pain, breast-peritoneal fistula, etc.2. There are12cases15times of total exit infection,3cases (5.66%),5times in group A,7cases (12.96%),7 times in group B,2cases3(4%) times in group C, There was no statistical significance (P=0.185) of three groups of comparative differences; A total of10cases of tunnel infection of three group, twice times,2cases (3.77%) in group A,5cases(9.26%) six times in group B,3(6%) cases4times in group C, there was no statistically significant difference (P=0.217) of three sets of comparison; A total of peritoneal dialysis related peritonitis was42cases.19cases (35.85%)29times in group A,10cases(18.52%)12times in group B,13cases (26%)15times in C group, three group of comparison difference had no statistical significance (P=0.129);3, Curled Tenckhoff catheter of technology survival rate was94.33%, Straight Tenckhoff catheter technique survival rate was96.29%, Swan-neck neck straight catheter technique survival rate was98%, three kinds of catheter technique survival difference was not statistically significant (P>0.05);5patients died in Curled Tenckhoff catheter, three cases turned hemodialysis patients, two cases of transfer kidney transplant patients, to give up the treatment of patients with1cases, Straight Tenckhoff catheter group:4patients died, three cases turned hemodialysis patients, turned kidney transplant patientsabandon the treatment of patients with0cases, Straight Swan-neck catheter:three patients died, one cases turned hemodialysis patients, to turn renal transplant patients with one case, One patient give up treatment, r patient survival rate of three group difference was not statistically significant (P>0.05); The difference of first KT/V test, peritoneal equilibrium test, anemia, biochemical and lipid metabolism, blood creatinine reduction rate after Peritoneal dialysis was no statistically significant (P>0.05).ConclusionSwan-neck straight catheter can reduce the incidence of catheter dysfunction compared with Curled Tenckhoff catheter and Straight Tenckhoff catheter,There is no difference in terms of the three catheter infection complications, catheter technique survival rate, patient survival rate and the impact on the efficiency of peritoneal dialysis.