Straight Versus Coiled Peritoneal Dialysis Catheters: A Randomized Controlled Trial

Area of Science:

• Nephrology
• Medical Devices
• Surgical Outcomes

Background:

• The optimal design for peritoneal dialysis (PD) catheters remains debated, with prior meta-analyses suggesting benefits for straight catheters.
• Uncertainty persists regarding the comparative clinical advantages of straight versus coiled double-cuffed PD catheters.

Purpose of the Study:

• To compare complication rates between straight and coiled double-cuffed PD catheters.
• To evaluate the incidence of catheter dysfunction requiring surgical intervention as a primary outcome.

Main Methods:

• A multicenter, open-label, randomized controlled trial was conducted.
• 308 adult patients undergoing continuous ambulatory PD were randomized to receive either straight (n=153) or coiled (n=155) catheters.
• Follow-up averaged 21 months, assessing outcomes including dysfunction, migration, pain, peritonitis, and technique failure.

Main Results:

• Catheter dysfunction occurred in 0.7% of patients with straight catheters versus 5.8% with coiled catheters (P=0.02).
• Straight catheters demonstrated a 5.1% lower risk of dysfunction requiring intervention.
• Coiled catheters showed a significantly higher hazard ratio for dysfunction (HR=8.69, P=0.04) and were associated with increased infusion pain.

Conclusions:

• Straight Tenckhoff catheters are associated with a reduced rate of catheter dysfunction requiring surgical intervention compared to coiled catheters.
• The findings suggest that straight PD catheters may be preferable for minimizing complications and improving PD outcomes.