The Association of Intra-Abdominal Adhesions with Peritoneal Dialysis Catheter-Related Complications

被引：7

作者：

Qureshi, Mohammad Azfar ^{[1
]}

Maierean, Serban ^{[2
]}

Crabtree, John H. ^{[3
]}

Clarke, Alix ^{[4
]}

Armstrong, Sean ^{[5
]}

Fissell, Rachel ^{[6
]}

Jain, Arsh K. ^{[7
]}

Jassal, Sarbjit V. ^{[8
]}

Hu, Susie L. ^{[9
]}

Kennealey, Peter ^{[10
]}

Liebman, Scott ^{[11
]}

Mccormick, Brendan ^{[12
]}

Momciu, Bogdan ^{[13
]}

Pauly, Robert P. ^{[14
]}

Pellegrino, Beth ^{[15
]}

Perl, Jeffrey ^{[16
]}

Pirkle, James L. ^{[17
]}

Plumb, Troy J. ^{[18
]}

Seshasai, Rebecca ^{[19
]}

Shah, Ankur ^{[9
]}

Shah, Nikhil ^{[20
]}

Shen, Jenny ^{[21
]}

Singh, Gurmukteshwar ^{[22
]}

Tennankore, Karthik ^{[23
,24
]}

Uribarri, Jaime ^{[25
]}

Vasilevsky, Murray ^{[26
]}

Yang, Robert ^{[27
]}

Quinn, Robert R. ^{[28
,29
]}

Nadler, Ashlie ^{[30
]}

Oliver, Matthew J. ^{[31
]}

机构：

[1] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med, Div Nephrol, Toronto, ON, Canada

[2] Univ Toronto, Dept Med, Toronto, ON, Canada

[3] Harbor Univ Calif Los Angeles, Div Nephrol & Hypertens, Med Ctr, Torrance, CA USA

[4] Univ Calgary, Cumming Sch Med, Calgary, AB, Canada

[5] Univ Manitoba, Coll Hlth Sci, Winnipeg, MB, Canada

[6] Vanderbilt Univ, Med Ctr, Dept Med, Div Nephrol & Hypertens, Nashville, TN USA

[7] Western Univ, Dept Med, Dept Epidemiol & Biostat, London, ON, Canada

[8] Univ Toronto, Div Nephrol, Univ Hlth Network, Toronto, ON, Canada

[9] Brown Univ, Dept Internal Med, Warren Alpert Med Sch, Providence, RI 02912 USA

[10] Univ Colorado, Sch Med, Dept Med, Aurora, CO USA

[11] Univ Rochester, Dept Med, Div Nephrol, Rochester, NY USA

[12] Univ Ottawa, Dept Med, Div Nephrol, Ottawa, ON, Canada

[13] Queens Univ, Dept Med, Div Nephrol, Kingston, ON, Canada

[14] Univ Alberta, Dept Med, Div Nephrol, Edmonton, AB, Canada

[15] West Virginia Univ, Sch Med, Div Nephrol, Morgantown, WV USA

[16] Univ Toronto, St Michaels Hosp, Dept Med, Div Nephrol,Dept Med, Toronto, ON, Canada

[17] Wake Forest Sch Med, Winston Salem, NC 27101 USA

[18] Univ Nebraska Med Ctr, Dept Internal Med, Div Nephrol, Omaha, NE USA

[19] Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA

[20] Univ Alberta, Fac Med, Div Nephrol, Edmonton, AB, Canada

[21] Harbor UCLA Med Ctr, Lundquist Inst, Los Angeles, CA USA

[22] Geisinger Hlth, Kidney Hlth Res Inst, Danville, PA USA

[23] Dalhousie Univ, Dept Med, Div Nephrol, Halifax, NS, Canada

[24] Nova Scotia Hlth, Halifax, NS, Canada

[25] Icahn Sch Med Mt Sinai, Dept Med, Div Nephrol, New York, NY 10029 USA

[26] McGill Univ Hlth Ctr, Div Nephrol, Montreal, PQ, Canada

[27] McMaster Univ, Dept Med, Div Nephrol, Hamilton, ON, Canada

[28] Univ Calgary, Cumming Sch Med, Dept Med, Calgary, AB, Canada

[29] Univ Calgary, Cumming Sch Med, Dept Community Hlth Sci, Calgary, AB, Canada

[30] Univ Toronto, Dept Surg, Toronto, ON, Canada

[31] Univ Toronto, Dept Med, Div Nephrol, Toronto, ON, Canada

来源：

CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2024年 / 19卷 / 04期

基金：

加拿大健康研究院;

关键词：

LAPAROSCOPIC PLACEMENT; ABDOMINAL-SURGERY; MANIPULATION; MALFUNCTION; SURVIVAL; ACCESS;

D O I：

10.2215/CJN.0000000000000404

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background This study investigated the association of intra-abdominal adhesions with the risk of peritoneal dialysis (PD) catheter complications. Methods Individuals undergoing laparoscopic PD catheter insertion were prospectively enrolled from eight centers in Canada and the United States. Patients were grouped based on the presence of adhesions observed during catheter insertion. The primary outcome was the composite of PD never starting, termination of PD, or the need for an invasive procedure caused by flow restriction or abdominal pain. Results Seven hundred and fifty-eight individuals were enrolled, of whom 201 (27%) had adhesions during laparoscopic PD catheter insertion. The risk of the primary outcome occurred in 35 (17%) in the adhesion group compared with 58 (10%) in the no adhesion group (adjusted HR, 1.64; 95% confidence interval [CI], 1.05 to 2.55) within 6 months of insertion. Lower abdominal or pelvic adhesions had an adjusted HR of 1.80 (95% CI, 1.09 to 2.98) compared with the no adhesion group. Invasive procedures were required in 26 (13%) and 47 (8%) of the adhesion and no adhesion groups, respectively (unadjusted HR, 1.60: 95% CI, 1.04 to 2.47) within 6 months of insertion. The adjusted odds ratio for adhesions for women was 1.65 (95% CI, 1.12 to 2.41), for body mass index per 5 kg/m2 was 1.16 (95% CI, 1.003 to 1.34), and for prior abdominal surgery was 8.34 (95% CI, 5.5 to 12.34). Common abnormalities found during invasive procedures included PD catheter tip migration, occlusion of the lumen with fibrin, omental wrapping, adherence to the bowel, and the development of new adhesions. Conclusions People with intra-abdominal adhesions undergoing PD catheter insertion were at higher risk for abdominal pain or flow restriction preventing PD from starting, PD termination, or requiring an invasive procedure. However, most patients, with or without adhesions, did not experience complications, and most complications did not lead to the termination of PD therapy.

引用

页码：472 / 482

页数：11

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