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Kidney Week

Abstract: SA-PO637

Does Final Peritoneal Dialysis Catheter Tip Position Predict Early Catheter Dysfunction?

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Mcgrath, Susan, London Health Sciences Centre, London, Ontario, Canada
  • Clark, David, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
  • Ashour, Omar Talal, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
  • Jain, Arsh, London Health Sciences Centre, London, Ontario, Canada
Background

It is believed that, for a functioning peritoneal dialysis (PD) catheter, the inserter needs to place the catheter in an optimal position. Exact tip position within the pelvis in relation to the pubic symphysis can be determined at time of placement for fluoroscopically guided PD catheters.

Methods

A retrospective cohort of adult PD patients in London, Ontario, who underwent percutaneous PD catheter insertion using fluoroscopy from 2013 to 2017 were reviewed. The distance between the top of the pubic symphysis and the bottom of the catheter coil was measured using Citrix software of stored images. Univariate and multivariate backward stepwise logistic regression analyses were conducted for the outcome of early catheter flow dysfunction versus each of final catheter tip position and baseline covariables included age, sex, race, body mass index (BMI), cause of Kidney Failure and number of prior abdominal surgeries with P-value <0.2 for variable inclusion in stepwise regression. Early catheter flow dysfunction was defined as the failure to achieve sufficient inflow/outflow to maintain any modality of PD, refractory to non-procedural interventions, and necessitating a repositioning procedure within 3 months of PD start.

Results

286 patients who underwent fluoroscopic catheter insertion during the study period had a trial of PD. Of 35 patients who experienced early catheter dysfunction, 31/35 underwent a repositioning procedure.

There was no difference between final catheter tip position of catheters that did or did not experience early flow dysfunction [catheter-tip to pubis symphysis median distance (Q1-Q3) 37 (29-53) vs 38 (26-50) mm, p=0.62]. In univariate analyses, no variable was associated with a significant difference in frequency of catheter dysfunction. Backward stepwise multivariate analyses of catheter dysfunction retained BMI, age and cause of Kidney Failure with only BMI significantly associated with frequency of early catheter flow dysfunction (OR 1.07 ± 0.04, p=0.04).

Conclusion

Final pelvic PD catheter tip position, relative to the pubic symphysis at time of fluoroscopic insertion, was not predictive of early catheter flow dysfunction. In light of this, the frequent focus of inserters on “optimal” placement may be unwarranted.