Reduction of infectious complications and costs using temporary subcutaneous implantation of PD catheters

A limited number of authors have demonstrated that temporary subcutaneous implantation of peritoneal dialysis catheters ("Moncrief") reduces infectious complications and increases catheter life expectancy. Two operations are required to use the Moncrief catheter as compared to only one operation when peritoneal dialysis catheters are exteriorized for immediate use ("Updike"). The questions arise, then, are these findings reproducible and which catheter is the most cost-effective? In an effort to support these premises, a retrospective review of 195 patients who received peritoneal dialysis catheters from 1991 to 1995 was undertaken. Demographics, complications, life expectancy analysis, and costs were compared between Moncrief and Updike catheters. There were no significant differences between the groups, and comparisons revealed a clinically evident and statistically significant decrease in the incidence of infections with Moncrief catheters. At both one- and two-year follow-up, Moncrief catheters demonstrated a significant increase in longevity as compared to the Updike catheters. Cost comparisons between the catheter systems revealed that if patients were not undergoing immediate dialysis, placement of a Moncrief catheter was more cost-effective. Conversely, if the patient was currently undergoing dialysis, placement of an Updike catheter was more cost-effective. However, sensitivity analysis revealed that shorter exteriorization times would make the Moncrief catheter the more cost-effective choice in this patient population. In conclusion, temporary subcutaneous implantation of peritoneal dialysis catheters significantly decreases the incidence of infectious complications, increases catheter life expectancy, and is the cost-effective choice for patients who will undergo peritoneal dialysis.