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Patterns of peritoneal dialysis catheter practices and technique failure in peritoneal dialysis: A nationwide cohort study.

ABSTRACT: INTRODUCTION:Our objective was to assess whether clusters of centers with similar peritoneal dialysis (PD) catheter related practices were associated with differences in the risk of technique failure. METHODS:Patients on incident PD in French centers contributing to the French Language PD Registry from 2012 to 2016 were included in a retrospective analysis of prospectively collected data. Centers with similar catheter cares practices were gathered in clusters in a hierarchical analysis. Clusters of centers associated with technique failure were evaluated using Cox and Fine and Gray models. A mixed effect Cox model was used to assess the influence of a center effect, as explained by the clusters. RESULTS:Data from 2727 catheters placed in 64 centers in France were analyzed. Five clusters of centers were identified. After adjustment for patient-level characteristics, the fourth cluster was associated with a lower risk of technique failure (cause specific-HR 0.70, 95%CI 0.54-0.90. The variance of the center effect decreased by 5% after adjusting for patient characteristics and by 26% after adjusting for patient characteristics and clusters of centers in the mixed effect Cox model. Favorable outcomes were observed in clusters with a greater proportion of community hospitals, where catheters were placed via open surgery, first dressing done 6 to 15 days after catheter placement, and local prophylactic antibiotics was applied on exit-site. CONCLUSION:Several patterns of PD catheter related practices have been identified in France, associated with differences in the risk of technique failure. Combinations of favorable practices are suggested in this study.

SUBMITTER: Lanot A

PROVIDER: S-EPMC6586404 | biostudies-other | 2019

REPOSITORIES: biostudies-other

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Patterns of peritoneal dialysis catheter practices and technique failure in peritoneal dialysis: A nationwide cohort study.

Lanot Antoine A Bechade Clemence C Verger Christian C Fabre Emmanuel E Vernier Isabelle I Lobbedez Thierry T

PloS one 20190620 6

<h4>Introduction</h4>Our objective was to assess whether clusters of centers with similar peritoneal dialysis (PD) catheter related practices were associated with differences in the risk of technique failure.<h4>Methods</h4>Patients on incident PD in French centers contributing to the French Language PD Registry from 2012 to 2016 were included in a retrospective analysis of prospectively collected data. Centers with similar catheter cares practices were gathered in clusters in a hierarchical ana ...[more]

PMID: 31220171

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Project description:Rationale & objectiveTechnique failure in peritoneal dialysis (PD) remains one of the most critical challenges of this therapy and is associated with a significant increase in costs and morbidity. Our objective was to estimate the frequency of PD technique failure and identify factors associated with technique failure.Study designA retrospective multicenter observational cohort study.Setting & participantsAll adult patients initiating PD between January 1, 2010, and December 31, 2015, with follow-up until December 31, 2018, at the Renal Therapy Services network in Colombia.Exposure & predictorsPD modality (continuous ambulatory PD and automated PD) and demographic and clinical characteristics.OutcomesTechnique failure, defined as a switch to hemodialysis lasting at least 30 days.Analytical approachSociodemographic and clinical characteristics of all patients were summarized descriptively according to modality. We estimated the cumulative incidence of technique failure, and a flexible parametric survival model with competing risks was used to evaluate factors associated with this outcome.ResultsAmong 6,452 patients meeting inclusion criteria, 67% were treated with continuous ambulatory PD. The cumulative incidence of technique failure within 1 year of PD initiation adjusting for competing risks was 6.9% (95% CI, 6.3%-7.6%); within 2 years, technique failure was 13.5% (95% CI, 12.6%-14.4%); and within 3 years, 19.6% (95% CI, 18.5%-20.7%). Female sex, larger center size, and higher Kt/V were associated with lower risk for modality change, whereas diabetes, history of major abdominal surgery, catheter implant technique (laparotomy and percutaneous techniques), obesity, and peritonitis were associated with a higher likelihood of technique failure.LimitationsVariables of distance to the center, use of icodextrin, and measures of outcomes reported by patients were not included.ConclusionsTechnique failure is relatively uncommon in Colombia; catheter-related problems are the most frequent cause of technique failure. Best practices in catheter insertion could minimize the risk for this outcome.

Dataset Information

Patterns of peritoneal dialysis catheter practices and technique failure in peritoneal dialysis: A nationwide cohort study.

Publications

Patterns of peritoneal dialysis catheter practices and technique failure in peritoneal dialysis: A nationwide cohort study.

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