Factores asociados con el cambio temprano de catéter de diálisis peritoneal en Veracruz, México / Factors associated with early peritoneal dialysis catheter replacement in Veracruz, Mexico

Antecedentes: Las complicaciones asociadas con el catéter en diálisis peritoneal causan disminución en su eficacia e interrupción de ésta, conversión a hemodiálisis, hospitalizaciones y necesidad de cirugía para cambiar el catéter. Objetivos: Determinar factores de riesgo para la disfunción temprana del catéter que hace necesario su cambio. Métodos: Se incluyeron 235 catéteres colocados con técnica quirúrgica abierta en línea media infraumbilical. Dentro de los posibles factores de riesgo se incluyó: edad, género, índice de masa corporal, área de superficie corporal, diabetes, enfermedad poliquística renal, cirugía previa, tiempo quirúrgico, omentectomía, omentopexia, infección de la herida y hernia posincisional. Resultados: El cambio del catéter por disfuncionalidad ocurrió en 47 pacientes (20%) durante el primer año. La complicación más frecuente fue: migración del catéter y peritonitis (4,3% en ambos casos), además de obstrucción por el omento (3,7%). En el análisis univariado, los pacientes que presentaron disfunción del catéter/cambio eran jóvenes con índice de masa corporal y área de superficie corporal bajos (p < 0,05). La infección de la herida y la hernia posincisional estaban asociados significativamente con el cambio de catéter. La omentectomía fue asociada a baja incidencia de disfunción de catéter/cambio en el análisis univariado y regresión logística (razón de momios: 0,275, intervalo de confianza: 95%, 0,101-0,751, p < 0,012). Conclusiones: Nuestra técnica de inserción de catéter ofrece bajas tasas de complicaciones y buenos resultados el primer año posquirúrgico. Además de la omentectomía, en nuestro estudio no se encontró un factor de riesgo para cambio de catéter en nuestra población. La omentectomía tuvo un efecto protector en términos de cambio de catéter (AU)

Introduction: Catheter-related complications in patients on peritoneal dialysis lead to decreased effectiveness and discontinuation of the technique, conversion to haemodialysis, hospitalisation, and surgical interventions to replace the catheter. Objectives: Determine risk factors for early catheter dysfunction that result in the need for replacement. Methods: We analysed 235 catheters placed by open surgery using an infra-umbilical midline incision. Possible risk factors included the following: age, sex, body mass index, body surface area, diabetes, polycystic kidney disease, previous surgery, time of surgical procedure, omentectomy, omentopexy, wound infection and postoperative incisional hernia. Results: During the first year, 47 patients (20%) required a catheter replacement due to poor function. The most common complications were catheter migration and peritonitis (4.3% in both cases), followed by obstruction from omental wrapping (3.7%). Univariate analysis showed that patients with catheter dysfunction or requiring catheter replacement were younger, with a lower body mass index and body surface area (P<.05). There was a significant association of wound infection and post-operative incisional hernia with catheter replacement. Omentectomy was associated with a low incidence rate of catheter dysfunction/replacement in the univariate and logistical regression analyses (odds ratio: 0.275; 95% confidence interval: 0.101-0.751; P<.012). Conclusions: Our catheter placement technique offers a low complication rate and good results in the first year after surgery. Except for omentectomy, we did not discover any risk factors for catheter replacement in our study population. Omentectomy had a protective effect in terms of catheter replacement (AU)

Factors associated with early peritoneal dialysis catheter replacement in Veracruz, Mexico.

INTRODUCTION: Catheter-related complications in patients on peritoneal dialysis lead to decreased effectiveness and discontinuation of the technique, conversion to haemodialysis, hospitalisation, and surgical interventions to replace the catheter. OBJECTIVES: Determine risk factors for early catheter dysfunction that result in the need for replacement. METHODS: We analysed 235 catheters placed by open surgery using an infra-umbilical midline incision. Possible risk factors included the following: age, sex, body mass index, body surface area, diabetes, polycystic kidney disease, previous surgery, time of surgical procedure, omentectomy, omentopexy, wound infection and postoperative incisional hernia. RESULTS: During the first year, 47 patients (20%) required a catheter replacement due to poor function. The most common complications were catheter migration and peritonitis (4.3% in both cases), followed by obstruction from omental wrapping (3.7%). Univariate analysis showed that patients with catheter dysfunction or requiring catheter replacement were younger, with a lower body mass index and body surface area (P<.05). There was a significant association of wound infection and post-operative incisional hernia with catheter replacement. Omentectomy was associated with a low incidence rate of catheter dysfunction/replacement in the univariate and logistical regression analyses (odds ratio: 0.275; 95% confidence interval: 0.101-0.751; P<.012). CONCLUSIONS: Our catheter placement technique offers a low complication rate and good results in the first year after surgery. Except for omentectomy, we did not discover any risk factors for catheter replacement in our study population. Omentectomy had a protective effect in terms of catheter replacement.