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논문분류	춘계학술대회 초록집
제목	Implanting PD Catheter Exit-site Facing an Upward Direction
저자	Masato Ikeda
출판정보	2024; 2024(1):
키워드
초록	① Current status of Japanese Interventional Nephrology. Main managers of all 4 procedures (VA, VAIVT, PD access and kidney biopsy) were nephrologists in Japan. All procedure volume increased as nephrologists become more involved. Acquisition of one specific procedure by nephrologists associated with increase in not only this specific procedure volume, but also the other procedure volumes. ② Implanting PD Catheter Exit-site Facing an Upward Direction Background Upward directed exit-site has been believed to be the worst for frequent exit-site infection (ESI) by an old retrospective study using straight catheter. And no comparison study of 3 exit-site directions using swan-neck catheter has been performed regarding which direction is the best for our endpoints, Easy-to-see the backside area of exit-site: ESBE, Easy-to-disinfect the backside area of exit-site: EDBE, reduction of both ESI, symptomatic catheter dislocation and peritonitis. Method We assessed relationship of exit-site direction with our endpoints in a quantitative cross-sectional, multicentered questionnaire survey. Results The numbers (percentage) of directions were upward 79 (26.0), lateralward 108 (37.5) and downward 105 (36.5). Cochran-Armitage analysis showed a significant step-ladder increase in the prevalence of ESI as the direction changed from upward to lateralward to downward (0.15±0.41, 0.25±0.54, 0.38±0.69 episodes/patient-year, p=0.03). Multivariable regression analysis revealed the upward catheter independently associates with both higher frequency of ESBE (OR 5.55, 95%CI: 2.23-16.45, p <0.01) and reduction of prevalence of ESI (OR 0.55, 95%CI: 0.27-0.98, p =0.04). Positive association between the prevalence of symptomatic catheter dislocation and ESI (OR 2.84, 95%CI: 1.27-7.82, p =0.01), and inverse association between EDBE and either prevalence of symptomatic catheter dislocation (OR 0.27, 95%CI: 0.11-0.72) or peritonitis (OR 0.48, 95%CI: 0.23-0.99) observed. Conclusion Upward-directed swan-neck catheter exit-site may be the best for both ESBE and prevention of ESI. EDBE may reduce catheter dislocation and peritonitis. Symptomatic catheter dislocation may predict ESI.
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