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Evidence summaries

Catheter-Related Interventions for Preventing Peritonitis in Peritoneal Dialysis

There is probably no major benefit from any catheter-related interventions which have been purported to reduce the risk of peritonitis in peritoneal dialysis patients. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 42 studies with a total of 3 144 subjects (18 studies of surgical strategies of catheter insertion, 22 of catheter types). The methodological quality was suboptimal.

The main complications studied included peritonitis rate, exit-site/tunnel infection and catheter removal/replacement. There were no significant differences with laparoscopy compared with laparotomy; standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying; midline compared to lateral insertion; between straight versus coiled intraperitoneal portion catheters; single versus double cuffed catheters; or immobilisation versus no immobilisation of the PD catheter.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by limitations in study quality (inadequate or unclear allocation concealment, lack of blinding, inadequate intention-to-treat adherence).

References

  • Htay H, Johnson DW, Craig JC et al. Catheter type, placement and insertion techniques for preventing catheter-related infections in chronic peritoneal dialysis patients. Cochrane Database Syst Rev 2019;(5):CD004680.[PubMed]

Primary/Secondary Keywords