Straight Versus Coiled Peritoneal Dialysis Catheters: A Randomized Controlled Trial.

RATIONALE &

OBJECTIVE

Despite a recent meta-analysis favoring straight catheters, the clinical benefits of straight versus coiled peritoneal dialysis catheters remain uncertain. We conducted a randomized controlled study to compare the complication rates associated with these 2 types of double-cuffed peritoneal dialysis catheters.

STUDY

DESIGN

Multicenter, open-label, randomized, controlled trial.

SETTING &

PARTICIPANTS

308 adult continuous ambulatory peritoneal dialysis patients.

INTERVENTION: Participants were randomly assigned to receive either straight or coiled catheters.

OUTCOMES: The primary outcome was the incidence of catheter dysfunction requiring surgical intervention. Secondary outcomes included time to catheter dysfunction requiring intervention, catheter migration with dysfunction, infusion pain measured using a visual analogue scale, peritonitis, technique failure, and peritoneal catheter survival.

RESULTS

153 patients were randomly assigned to straight catheters; and 155, to coiled catheters. Among randomly assigned patients who underwent peritoneal dialysis, during a mean follow-up of 21 months, the primary outcome of catheter dysfunction or drainage failure occurred in 9 (5.8%) patients who received a coiled catheter and 1 (0.7%) patient who received a straight catheter. Straight catheters had 5.1% lower risk for catheter dysfunction (95% CI, 1.2%-9.1%; P=0.02). The HR of the primary outcome for coiled versus straight catheters was 8.69 (95% CI, 1.10-68.6; P=0.04). Patients who received a coiled catheter had similar risk for peritonitis but reported higher infusion pain scores than those who received straight catheters.

LIMITATIONS: Generalizability to other peritoneal dialysis centers with lower volumes and other races and nationalities.

CONCLUSIONS

Use of straight Tenckhoff catheters compared with coiled catheters reduced the rate of catheter dysfunction requiring surgical intervention.

FUNDING: Funded by the Chinese University of Hong Kong.

TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT02479295.