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Tipo de catéter y técnicas de colocación e inserción para la prevención de infecciones relacionadas con el catéter en pacientes en diálisis peritoneal crónica

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Referencias

Akcicek 1995 {published data only}

Akcicek F, Ok E, Tokut Y, Cirit M, Kursal A, Unsul A, et al. Comparison the effect of laparoscopic Moncrief‐Popovich technique (LMPT) and blind Trocar technique (BTT) on early CAPD complications [abstract]. Nephrology Dialysis Transplantation 1995;10(6):1037. [CENTRAL: CN‐00261138]CENTRAL

Akyol 1990 {published data only}

Akyol AM, Porteous C, Brown MW. A comparison of two types of catheters for continuous ambulatory peritoneal dialysis (CAPD). Peritoneal Dialysis International 1990;10(1):63‐6. [MEDLINE: 2085585]CENTRAL

Al‐Hwiesh 2016 {published data only}

Al‐Hwiesh A, Nasreldin M. The Saudi peritoneal dialysis catheter: Modified catheter and new technique: farewell to catheter migration [abstract no: SP456]. Nephrology Dialysis Transplantation 2016;31(Suppl 1):i244. [EMBASE: 72326558]CENTRAL
Al‐Hwiesh AK. A modified peritoneal dialysis catheter with a new technique: farewell to catheter migration. Saudi Journal of Kidney Diseases & Transplantation 2016;27(2):281‐9. [MEDLINE: 26997381]CENTRAL

Atapour 2011 {published data only}

Atapour A, Asadabadi HR, Karimi S, Eslami A, Beigi AA. Comparing the outcomes of open surgical procedure and percutaneously peritoneal dialysis catheter (PDC) insertion using laparoscopic needle: a two month follow‐up study. Journal of Research in Medical Sciences 2011;16(4):463‐8. [EMBASE: 2011292097]CENTRAL

Buijsen 1994 {published data only}

Buijsen JGM, Kox C, Boeschoten EW, Struijk DG. Randomized trial to compare single cuff (Sc) with double cuff (Dc) straight tenckhoff catheter (Tc) in CAPD patients (pt) [abstract]. Nephrology Dialysis Transplantation 1994;9(5):583. [CENTRAL: CN‐00444579]CENTRAL
Struijk DG, Kox C, vd Heijden‐Buijsen JG. Randomized trial of single cuff (sc) versus double cuff (dc) peritoneal dialysis catheter [abstract]. 35th Congress. European Renal Association. European Dialysis and Transplantation Association; 1998 Jun 6‐9; Rimini, Italy. 1998:315. [CENTRAL: CN‐00486056]CENTRAL

Chen 2014a {published data only}

Chen G, Liu H, Zhou L, Wang P, Peng Y, Liu FU. Greater omentum folding in open surgical placement of PD catheters: a randomized controlled study and systemic review [abstract no: FR‐PO965]. Journal of the American Society of Nephrology 2013;24:582A. CENTRAL
Chen G, Wang P, Liu H, Zhou L, Cheng M, Liu Y, et al. Greater omentum folding in the open surgical placement of peritoneal dialysis catheters: a randomized controlled study and systemic review. Nephrology Dialysis Transplantation 2014;29(3):687‐97. [MEDLINE: 24084323]CENTRAL

Danielsson 2002 {published data only}

Danielsson A, Blohme L, Tranaeus A, Hylander B. A prospective randomized study of the effect of a subcutaneously "buried" peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit‐site infection. Peritoneal Dialysis International 2002;22(2):211‐9. [MEDLINE: 11990406]CENTRAL
Danielsson A, Blohme L, Tranaeus A, Hylander B. Prospective randomized study of the impact a subcutaneous rest‐peroid of a PD‐catheter has on the incidence of peritonitis [abstract no: A0832]. Journal of the American Society of Nephrology 1997;8(Program & Abstracts):178A. [CENTRAL: CN‐00444979]CENTRAL

Dasgupta 1998 {published data only}

Dasgupta MK, Fox S, Card J, Maitland C, Perry D. Catheter survival is improved by the use of Moncrief‐Popovich catheters [abstract]. Journal of the American Society of Nephrology 1998;9(Program & Abstracts):190A. [CENTRAL: CN‐00444987]CENTRAL

Ejlersen 1990 {published data only}

Ejlersen E, Steven K, Lokkergaard H. Paramedian versus midline incision for the insertion of permanent peritoneal dialysis catheters. A randomized clinical trial. Scandinavian Journal of Urology & Nephrology 1990;24(2):151‐4. [MEDLINE: 2192446]CENTRAL

Eklund 1994 {published data only}

Eklund BH, Honkanen EO, Kala AR, Kyllonen LE. Catheter configuration and outcome in patients on continuous ambulatory peritoneal dialysis: a prospective comparison of two catheters. Peritoneal Dialysis International 1994;14(1):70‐4. [MEDLINE: 8312419]CENTRAL

Eklund 1995 {published data only}

Eklund BH, Honkanen EO, Kala AR, Kyllonen LE. Peritoneal dialysis access: prospective randomized comparison of the Swan neck and Tenckhoff catheters. Peritoneal Dialysis International 1995;15(8):353‐6. [MEDLINE: 8785234]CENTRAL

Eklund 1997 {published data only}

Eklund B, Honkanen E, Kyllonen L, Salmela K, Kala AR. Peritoneal dialysis access: prospective randomized comparison of single‐cuff and double‐cuff straight Tenckhoff catheters. Nephrology Dialysis Transplantation 1997;12(2):2664‐6. [MEDLINE: 9430868]CENTRAL

Gadallah 1999 {published data only}

Gadallah MF, Pervez A, El‐Shahawy M, Sorrells D, Zibari G, McDonald J, et al. Peritoneoscopic versus surgical placement of Tenckhoff catheters: a prospective study on outcome [abstract no: A0904]. Journal of the American Society of Nephrology 1996;7(9):1428. [CENTRAL: CN‐01658199]CENTRAL
Gadallah MF, Pervez A, el‐Shahawy MA, Sorrells D, Zibari G, McDonald J, et al. Peritoneoscopic versus surgical placement of peritoneal dialysis catheters: a prospective randomized study on outcome. American Journal of Kidney Diseases 1999;33(1):118‐22. [MEDLINE: 9915276]CENTRAL

Johnson 2006 {published data only}

Johnson DW, Wong J, Wiggins KJ, Kirwan R, Griffin A, Preston J, et al. A randomized controlled trial of coiled versus straight swan‐neck Tenckhoff catheters in peritoneal dialysis patients. American Journal of Kidney Diseases 2006;48(5):812‐21. [MEDLINE: 17060001]CENTRAL
Wong JS, Wiggins KJ, Campbell SB, Isbel NM, Mudge DW, Hawley CM, et al. A randomized, controlled trial of coiled versus straight swan neck tenckhoff catheters in peritoneal dialysis patients [abstract no: 1550]. Nephrology 2006;11(Suppl 2):A16. CENTRAL

Jwo 2010 {published data only}

Jwo SC, Chen KS, Lee CC, Chen HY. Prospective randomized study for comparison of open surgery with laparoscopic‐assisted placement of Tenckhoff peritoneal dialysis catheter‐‐a single center experience and literature review. Journal of Surgical Research 2010;159(1):489‐96. [MEDLINE: 19482306]CENTRAL

Li 2009e {published data only}

Li CL, Cui TG, Gan HB, Cheung K, Lio WI, Kuok UI. A randomized trial comparing conventional swan‐neck straight‐tip catheters to straight‐tip catheters with an artificial subcutaneous swan neck. Peritoneal Dialysis International 2009;29(3):278‐84. [MEDLINE: 19458299]CENTRAL

Lo 2003b {published data only}

Lo WK, Lui SL, Li FK, Choy BY, Lam MF, Tse KC, et al. A prospective randomized study on three different peritoneal dialysis catheters. Peritoneal Dialysis International 2003;23 Suppl 2:S127‐31. [MEDLINE: 17986531]CENTRAL

Lye 1996 {published data only}

Lye WC, Kour NW, van der Straaten JC, Leong SO, Lee EJ. A prospective randomized comparison of the Swan neck, coiled, and straight Tenckhoff catheters in patients on CAPD. Peritoneal Dialysis International 1996;16 Suppl 1:S333‐5. [MEDLINE: 8728219]CENTRAL

Merrikhi 2014 {published data only}

Merrikhi A, Beigi AA, Raji Asadabadi H, Gheisari A, Karimi SH. The outcomes of percutaneously peritoneal dialysis catheter placement in comparison with open surgical method in children [abstract no: P177]. Iranian Journal of Kidney Diseases 2011;5(Suppl 1):37. [EMBASE: 70539682]CENTRAL
Merrikhi A, Raji Asadabadi H, Beigi AA, Marashi SM, Ghaheri H, Nasiri Zarch Z. Comparison of percutaneous versus open surgical techniques for placement of peritoneal dialysis catheter in children: a randomized clinical trial. Medical Journal of the Islamic Republic of Iran 2014;28:38. [MEDLINE: 25250279]CENTRAL

Moncrief 1998 {published data only}

Moncrief JW, Popovich PP. Subcutaneous buried versus standard peritoneal dialysis catheter [abstract]. XVIII Annual CAPD Conference; 1998 Feb 24; Nashville (TN). 1998. [CENTRAL: CN‐00776340]CENTRAL

Nielsen 1995 {published data only}

Nielsen PK, Hemmingsen C, Friis SU, Ladefoged J, Olgaard K. Comparison of straight and curled Tenckhoff peritoneal dialysis catheters implanted by percutaneous technique: a prospective randomized study. Peritoneal Dialysis International 1995;15(1):18‐21. [MEDLINE: 7734555]CENTRAL

Ouyang 2015 {published data only}

Ouyang CJ, Huang FX, Yang QQ, Jiang ZP, Chen W, Qiu Y, et al. Comparing the incidence of catheter‐related complications with straight and coiled tenckhoff catheters in peritoneal dialysis patients‐a single‐center prospective randomized trial. Peritoneal Dialysis International 2015;35(4):443‐9. [MEDLINE: 24584608]CENTRAL

Park 1998 {published data only}

Park MS, Yim AS, Chung SH, Lee EY, Cha MK, Kim JH, et al. Effect of prolonged subcutaneous implantation of peritoneal catheter on peritonitis rate during CAPD: a prospective randomized study. Blood Purification 1998;16(3):171‐8. [MEDLINE: 9681160]CENTRAL

Qian 2014 {published data only}

Qian X, Qi J. Preliminary report: cystoscopy‐assisted peritoneal dialysis catheter placement ‐ a direct, visual, safe, precise, easy, minimally invasive, and inexpensive technique. Clinical Nephrology 2014;81(4):247‐50. [MEDLINE: 24656314]CENTRAL

Rubin 1990 {published data only}

Rubin J, Didlake R, Raju S, Hsu H. A prospective randomized evaluation of chronic peritoneal catheters. Insertion site and intraperitoneal segment. ASAIO Transactions 1990;36(3):M497‐500. [MEDLINE: 2252732]CENTRAL

Sanchez‐Canel 2016 {published data only}

Sanchez‐Canel JJ, Garcia‐Perez H, Garcia‐Calvo R, Pascual MJ, Casado D. Prospective randomized study comparing a single‐cuff self‐locating catheter with a single‐cuff straight tenckhoff catheter in peritoneal dialysis. Peritoneal Dialysis International 2016;36(1):52‐9. [MEDLINE: 25185016]CENTRAL

Scott 1994 {published data only}

Scott PD, Bakran A, Pearson R, Riad H, Parrott N, Johnson RW, et al. Peritoneal dialysis access. Prospective randomized trial of 3 different peritoneal catheters‐‐preliminary report. Peritoneal Dialysis International 1994;14(3):289‐90. [MEDLINE: 7948247]CENTRAL

SIPROCE 1997 {published data only}

Pommer W. The efficiency of a silver ring to prevent exit‐site and other catheter‐related infections in PD‐patients‐final results of the SIPROCE study [abstract no: A0849]. Journal of the American Society of Nephrology 1997;8(Program & Abstracts):182A. [CENTRAL: CN‐00447255]CENTRAL
Pommer W, Brauner M, Westphale HJ, Brunkhorst R, Kramer R, Bundschu D, et al. Effect of a silver device in preventing catheter‐related infections in peritoneal dialysis patients: silver ring prophylaxis at the catheter exit study. American Journal of Kidney Diseases 1998;32(5):752‐60. [MEDLINE: 9820444]CENTRAL
SIPROCE Study Group. Efficiency of a silver ring in preventing exit‐site infections in adult PD patients: results of the SIPROCE Study. Silver ring Prophylaxis of the Catheter Exit Site. Advances in Peritoneal Dialysis 1997;13:227‐32. [MEDLINE: 9360688]CENTRAL

Stegmayr 2005a {published data only}

Stegmayr BG, Wikdahl AM, Bergström M, Nilsson C, Engman U, Arnerlöv C, et al. A randomized clinical trial comparing the function of straight and coiled Tenckhoff catheters for peritoneal dialysis. Peritoneal Dialysis International 2005;25(1):85–8. [MEDLINE: 15770930]CENTRAL

Stegmayr 2015 {published data only}

Stegmayr BG, Sperker W, Nilsson CH, Degerman C, Persson SE, Stenbaek J, et al. Few outflow problems with a self‐locating catheter for peritoneal dialysis: a randomized trial. Medicine 2015;94(48):e2083. [MEDLINE: 26632891]CENTRAL

Sun 2015a {published data only}

Sun C, Zhang M, Jiang C. Vertical tunnel‐based low‐site peritoneal dialysis catheter implantation decreases the incidence of catheter malfunction. American Surgeon 2015;81(11):1157‐62. [MEDLINE: 26672587]CENTRAL

Timely PD 2010 {published data only}

Ranganathan D, Baer R, Fassett RG, Williams N, Han T, Watson M, et al. Randomised controlled trial to determine the appropriate time to initiate peritoneal dialysis after insertion of catheter to minimise complications (Timely PD study). BMC Nephrology 2010;11:11. [MEDLINE: 20565984]CENTRAL
Ranganathan D, John GT, Yeoh E, Williams N, O'Loughlin B, Han T, et al. A randomized controlled trial to determine the appropriate time to initiate peritoneal dialysis after insertion of catheter (Timely PD Study). Peritoneal Dialysis International 2017;37(4):420‐8. [MEDLINE: 28408711]CENTRAL

Trooskin 1990 {published data only}

Trooskin SZ, Harvey RA, Lennard TW, Greco RS. Failure of demonstrated clinical efficacy of antibiotic‐bonded continuous ambulatory peritoneal dialysis (CAPD) catheters. Peritoneal Dialysis International 1990;10(1):57‐9. [MEDLINE: 2085584]CENTRAL

Tsimoyiannis 2000 {published data only}

Tsimoyiannis EC, Siakas P, Glantzounis G, Toli C, Sferopoulos G, Pappas M, et al. Laparoscopic placement of the Tenckhoff catheter for peritoneal dialysis. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 2000;10(4):218‐21. [MEDLINE: 10961749]CENTRAL

Turner 1992 {published data only}

Turner K, Edgar D, Hair M, Uttley L, Sternland R, Hunt L, et al. Does catheter immobilization reduce exit‐site infections in CAPD patients?. Advances in Peritoneal Dialysis 1992;8:265‐8. [MEDLINE: 1361803]CENTRAL

Voss 2012 {published data only}

Voss D. Prospective randomised trial of radiological and surgical tenckhoff catheter insertion [abstract no: 101]. Nephrology 2004;9(Suppl 1):A26. [CENTRAL: CN‐00509548]CENTRAL
Voss D, Hawkins S, Poole G, Marshall M. Radiological versus surgical implantation of first catheter for peritoneal dialysis: a randomized non‐inferiority trial. Nephrology Dialysis Transplantation 2012;27(11):4196–204. [MEDLINE: 22810376]CENTRAL

Winch 2000 {published data only}

Winch P, Saltissi D, McGiffin C, Nathanson L, O'Loughlin B. Comparison between swan‐neck (SN) and straight curled (SC) double‐cuff catheters on peritoneal dialysis (PD) catheter‐related complications [abstract no: 29]. Nephrology 2000;5(1‐2 Suppl):A10. [CENTRAL: CN‐01657505]CENTRAL

Wright 1999 {published data only}

Sellars L, Bel'eed K, Stoves J, Eadington D, Johnson B, Wright M, et al. Randomized trial of conventional vs laparoscopically assisted peritoneal catheter insertion techniques (interim report) [abstract]. Journal of the American Society of Nephrology 1997;8(Program & Abstracts):182A. [CENTRAL: CN‐00447669]CENTRAL
Wright MJ, Bel'eed K, Johnson BF, Eadington DW, Sellars L, Farr MJ. Randomized prospective comparison of laparoscopic and open peritoneal dialysis catheter insertion. Peritoneal Dialysis International 1999;19(4):372‐5. [MEDLINE: 10507820]CENTRAL

Xie 2011a {published data only}

Xie J, Kiryluk K, Ren H, Zhu P, Huang X, Shen P, et al. Coiled versus straight peritoneal dialysis catheters: a randomized controlled trial and meta‐analysis. American Journal of Kidney Diseases 2011;58(6):946‐55. [MEDLINE: 21872978]CENTRAL

Yip 2010 {published data only}

Yip T, Lui SL, Tse KC, Xu H, Ng FS, Cheng SW, et al. A prospective randomized study comparing Tenckhoff catheters inserted using the triple incision method with standard swan neck catheters. Peritoneal Dialysis International 2010;30(1):56‐62. [MEDLINE: 20056980]CENTRAL

Zhang 2016 {published data only}

Zhang Q, Jiang C, Zhu W, Sun C, Xia Y, Tang T, et al. Peritoneal catheter fixation combined with straight upward tunnel and low implant position to prevent catheter malfunction. Nephrology 2016;23(3):247‐52. [MEDLINE: 27862718]CENTRAL

Zhu 2015 {published data only}

Zhu W, Jiang C, Zheng X, Zhang M, Guo H, Yan X. The placement of peritoneal dialysis catheters: a prospective randomized comparison of open surgery versus "Mini‐Perc" technique. International Urology & Nephrology 2015;47(2):377‐82. [MEDLINE: 25395078]CENTRAL

Crabtree 2003 {published data only}

Crabtree JH, Burchette RJ, Siddiqi RA, Huen IT, Hadnott LL, Fishman A. The efficacy of silver‐ion implanted catheters in reducing peritoneal dialysis‐related infections. Peritoneal Dialysis International 2003;23(4):368‐74. [MEDLINE: 12968845]CENTRAL

ISRCTN87054124 {published data only}

Sudhindran S. Prospective randomised trial of laparoscopic versus closed insertion of tenckhoff catheters for peritoneal dialysis access. www.controlled‐trials.com/ISRCTN87054124 (first received 12 September 2003). CENTRAL

Moncrief 1994 {published data only}

Moncrief JW, Popovich RP. Moncrief‐Popovich catheter: implantation technique and clinical results. Peritoneal Dialysis International 1994;14 Suppl 3:S56‐8. [MEDLINE: 7948277]CENTRAL

N0547061060 {published data only}

Rhodes M. Prospective randomised trial of laparoscopic sutured versus blind (conventional) insertion of tenckhoff peritoneal dialysis catheters. www.nihr.ac.uk/Profile/Pages/NRRResults.aspx?publication_id=N0547061060(last accessed July 2004). CENTRAL

O'Dwyer 2005 {published data only}

O'Dwyer H, Fotheringham T, O'Kelly P, Doyle S, Haslam P, McGrath F, et al. A prospective comparison of two types of tunneled hemodialysis catheters: the Ash Split versus the PermCath. Cardiovascular & Interventional Radiology 2005;28(1):23‐9. [MEDLINE: 15602643]CENTRAL

Williams 1989 {published data only}

Williams AJ, Boletis I, Johnson BF, Raftery AT, Cohen GL, Moorhead PJ, et al. Tenckhoff catheter replacement or intraperitoneal urokinase: a randomised trial in the management of recurrent continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Peritoneal Dialysis International 1989;9(1):65‐7. [MEDLINE: 2488185]CENTRAL

Referencias de los estudios en espera de evaluación

Ir a:

Ahmad 2010 {published data only}

Ahmad SF, Liu WJ, Mohd Y, Kandasami ND, Hooi LS, Gunn KB. Randomized controlled trial of peritoneoscopic vs open surgical placement of peritoneal dialysis catheters [abstract]. Peritoneal Dialysis International 2010;30(Suppl 2):S95. [EMBASE: 71928045]CENTRAL

LOCI 2011 {published data only}

Hagen SM, van Alphen AM, Ijzermans JN, Dor FJ. Laparoscopic versus open peritoneal dialysis catheter insertion, the LOCI‐trial: a study protocol. BMC Surgery 2011;11:35. [MEDLINE: 22185091]CENTRAL
Lafranca JA, Hagen SM, Akkersdijk GP, Wever JJ, Kimenai HJ, Wabbijn M, et al. Laparoscopic vs open peritoneal dialysis catheter insertion, the LOCI‐trial [abstract]. European Surgical Research 2014;52(3‐4):139. [EMBASE: 71493264]CENTRAL

Wong 2004b {published data only}

Wong FS, Chau S, Chow N, Ho JC, Cheng Y, Yu AW. Effect of changing transfer set on relapse of bacterial peritonitis. Hong Kong Journal of Nephrology 2004;6(2):87‐91. [EMBASE: 2004491078]CENTRAL

NCT01023191 {published data only}

Chetter IC. Open versus percutaneous insertion of CAPD catheters. www.clinicaltrials.gov/ct2/show/NCT01023191 (date first received 2 December 2009). CENTRAL

NCT02479295 {published data only}

Chow KM. Straight versus coiled peritoneal dialysis catheter for peritoneal dialysis patients. www.clinicaltrials.gov/ct2/show/NCT02479295 (date first received 24 June 2015). CENTRAL

Barraclough 2010

Barraclough K, Hawley CM, McDonald SP, Brown FG, Rosman JB, Wiggins KJ, et al. Polymicrobial peritonitis in peritoneal dialysis patients in Australia: predictors, treatment, and outcomes. American Journal of Kidney Diseases 2010;55(1):121‐31. [MEDLINE: 19932543]

Boudville 2012

Boudville N, Kemp A, Clayton P, Lim W, Badve SV, Hawley CM, et al. Recent peritonitis associates with mortality among patients treated with peritoneal dialysis. Journal of the American Society of Nephrology 2012;23(8):1398–405. [MEDLINE: 22626818]

Campbell 2016

Campbell DJ, Craig JC, Mudge DW, Brown FG, Wong G, Tong A. Patients' perspectives on the prevention and treatment of peritonitis in peritoneal dialysis: a semi‐structured interview study. Peritoneal Dialysis International 2016;36(6):631‐9. [MEDLINE: 27680766]

Chow 2005

Chow KM, Szeto CC, Leung CB, Kwan BC, Law MC, Li PK. A risk analysis of continuous ambulatory peritoneal dialysis‐related peritonitis. Peritoneal Dialysis International 2005;25(4):374–9. [MEDLINE: 16022095]

CONSORT 2001

Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel‐group randomised trials. Lancet 2001;357(9263):1191‐4. [MEDLINE: 11323066]

Edey 2010

Edey M, Hawley CM, McDonald SP, Brown FG, Rosman JB, Wiggins KJ, et al. Enterococcal peritonitis in Australian peritoneal dialysis patients: predictors, treatment and outcomes in 116 cases. Nephrology Dialysis Transplantation 2010;25(4):1272‐8. [MEDLINE: 19948875]

Egger 1997

Egger M, Davey‐Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple graphical test. BMJ 1997;315(7109):629‐34. [MEDLINE: 9210563]

GRADE 2008

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924‐6. [MEDLINE: 18436948]

GRADE 2011

Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction‐GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383‐94. [MEDLINE: 21195583]

Hagen 2014

Hagen SM, Lafranca JA, Ijzermans JN, Dor FJ. A systematic review and meta‐analysis of the influence of peritoneal dialysis catheter type on complication rate and catheter survival. Kidney International 2014;85(4):920–32. [MEDLINE: 24088961]

Higgins 2003

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. [MEDLINE: 12958120]

Higgins 2011

Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Htay 2017

Htay H, Cho Y, Pascoe EM, Darssan D, Nadeau‐Fredette AC, Hawley C, et al. Multicenter registry analysis of center characteristics associated with technique failure in patients on incident peritoneal dialysis. Clinical Journal of The American Society of Nephrology: CJASN 2017;12(7):1090‐9. [MEDLINE: 28637862]

Htay 2018

Htay H, Cho Y, Pascoe EM, Darssan D, Nadeau‐Fredette AC, Hawley C, et al. Center effects and peritoneal dialysis peritonitis outcomes: analysis of a national registry. American Journal of Kidney Diseases 2018;74(6):814‐21. [MEDLINE: 29289475]

Jegatheesan 2018

Jegatheesan D, Johnson DW, Cho Y, Pascoe EM, Darssan D, Htay H, et al. The relationship between body mass index and organism‐specific peritonitis. Peritoneal Dialysis International 2018;38(3):206‐14. [MEDLINE: 29848600]

Kolesnyk 2010

Kolesnyk I, Dekker FW, Boeschoten EW, Krediet RT. Time‐dependent reasons for peritoneal dialysis technique failure and mortality. Peritoneal Dialysis International 2010;30(2):170‐7. [MEDLINE: 20124193]

Kotsanas 2007

Kotsanas D, Polkinghorne KR, Korman TM, Atkins RC, Brown F. Risk factors for peritoneal dialysis‐related peritonitis: can we reduce the incidence and improve patient selection?. Nephrology 2007;12(3):239–45. [MEDLINE: 17498118]

Li 2016

Li PK, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, et al. ISPD peritonitis recommendations: 2016 update on prevention and treatment. Peritoneal Dialysis International 2016;36(5):481–508. [MEDLINE: 27282851]

Li 2017

Li PK, Chow KM, Van de Luijtgaarden MW, Johnson DW, Jager KJ, Mehrotra R, et al. Changes in the worldwide epidemiology of peritoneal dialysis. Nature Reviews Nephrology 2017;13(2):90‐103. [MEDLINE: 28029154]

Lim 2011

Lim WH, Boudville N, McDonald SP, Gorham G, Johnson DW, Jose M. Remote indigenous peritoneal dialysis patients have higher risk of peritonitis, technique failure, all‐cause and peritonitis‐related mortality. Nephrology Dialysis Transplantation 2011;26(10):3366–72. [MEDLINE: 21382988]

Lindblad 1988

Lindblad AS, Hamilton RW, Nolph KD, Novak JW. A retrospective analysis of catheter configuration and cuff type: a National CAPD Registry report. Peritoneal Dialysis International 1988;8(2):129–33. [EMBASE: 18252569]

McDonald 2004

McDonald SP, Collins JF, Rumpsfeld M, Johnson DW. Obesity is a risk factor for peritonitis in the Australian and New Zealand peritoneal dialysis patient populations. Peritoneal Dialysis International 2004;24(4):340–6. [MEDLINE: 15335147]

Mehrotra 2016

Mehrotra R, Devuyst O, Davies SJ, Johnson DW. The current state of peritoneal dialysis. Journal of the American Society of Nephrology 2016;27(11):3238‐52. [MEDLINE: 27339663]

Ong 2016

Ong LM, Ch'ng CC, Wee HC, Supramaniam P, Zainal H, Goh BL, et al. Risk of peritoneal dialysis‐related peritonitis in a multi‐racial Asian population. Peritoneal Dialysis International 2017;37(1):35‐43. [MEDLINE: 27147287]

Piraino 2002

Piraino B. Peritonitis as a complication of peritoneal dialysis. Journal of the American Society of Nephrology 2002;9(10):1956‐64. [MEDLINE: 9773798]

Schaefer 2003

Schaefer F. Management of peritonitis in children receiving chronic peritoneal dialysis. Paediatric Drugs 2003;5(5):315‐25. [MEDLINE: 12716218]

Schünemann 2011a

Schünemann HJ, Oxman AD, Higgins JP, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and 'Summary of findings' tables. In: Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Schünemann 2011b

Schünemann HJ, Oxman AD, Higgins JP, Deeks JJ, Glasziou P, Guyatt GH. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Shen 2013

Shen JI, Mitani AA, Saxena AB, Goldstein BA, Winkelmayer WC. Determinants of peritoneal dialysis technique failure in incident US patients. Peritoneal Dialysis International 2013;33(2):155‐66. [MEDLINE: 23032086]

Spence 1985

Spence PA, Mathews RE, Khanna R, Oreopoulos DG. Improved results with a paramedian technique for the insertion of peritoneal dialysis catheters. Surgery, Gynecology & Obstetrics 1985;161(6):585‐7. [MEDLINE: 4071373]

Strippoli 2004a

Strippoli GF, Tong A, Johnson D, Schena FP, Craig JC. Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients. Cochrane Database of Systematic Reviews 2004, Issue 4. [DOI: 10.1002/14651858.CD004679.pub2]

Szeto 2017

Szeto CC, Li PK, Johnson DW, Bernardini J, Dong J, Figueiredo AE, et al. ISPD catheter‐related infection recommendations: 2017 update. Peritoneal Dialysis International 2017;37(2):141‐54. [MEDLINE: 28360365]

Wu 2013

Wu HH, Li IJ, Weng CH, Lee CC, Chen YC, Chang MY, et al. Prophylactic antibiotics for endoscopy‐associated peritonitis in peritoneal dialysis patients. PLoS ONE [Electronic Resource] 2013;8(8):e71532. [MEDLINE: 23936514]

Xu 2009

Xu G, Tu W, Xu C. Mupirocin for preventing exit‐site infection and peritonitis in patients undergoing peritoneal dialysis. Nephrology Dialysis Transplantation 2010;25(2):587–92. [MEDLINE: 19679557]

Referencias de otras versiones publicadas de esta revisión

Ir a:

Strippoli 2003

Strippoli GF, Tong A, Johnson D, Schena FP, Craig JC. Catheter type, placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients. Cochrane Database of Systematic Reviews 2003, Issue 3. [DOI: 10.1002/14651858.CD004680]

Strippoli 2004

Strippoli GF, Tong A, Johnson D, Schena FP, Craig JC. Catheter type, placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients. Cochrane Database of Systematic Reviews 2004, Issue 4. [DOI: 10.1002/14651858.CD004680.pub2]

Strippoli 2004b

Strippoli GF, Tong A, Johnson D, Schena FP, Craig JC. Catheter‐related interventions to prevent peritonitis in peritoneal dialysis: a systematic review of randomized, controlled trials. Journal of the American Society of Nephrology 2004;15(10):2735‐46. [MEDLINE: 15466279]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

Akcicek 1995

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: not reported

  • Follow‐up period: not reported

Participants

  • Country: Turkey

  • Setting: single centre

  • Patients undergoing PD catheter insertion

  • Number: treatment group (10); control group (12)

  • Mean age ± SD (years): treatment group (45.6 ± 12.8); control group (48.7 ± 12.5)

  • Sex (M/F): not reported

  • Diabetes: not reported

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Laparoscopic Moncrief‐Popovich technique

Control group

  • Blind Trocar technique

Outcomes

  • Exit‐site infection

  • Peritonitis

  • Catheter tip migration

Notes

  • Abstract‐only publication

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Selective reporting (reporting bias)

High risk

Not all the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Akyol 1990

Methods

  • Study design: parallel RCT; randomly allocated at time of surgery

  • Study time frame/recruitment period: October 1986 to July 1987

  • Follow‐up period: 72 weeks

Participants

  • Country: Scotland

  • Setting: single centre

  • Consecutive patients for CAPD

  • Number (catheters/patients): treatment group (20/20); control group (20/19)

  • Mean age, range (years): treatment group (49, 22 to 70); control group (45, 19 to 73)

  • Sex (M/F): treatment group (15/5); control group (8/11)

  • Diabetes: treatment group (3/20); control group (2/19)

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Straight tip

Control group

  • Coiled tip

Other information

  • All catheters were double‐cuff Tenckhoff with 4 cm (curled) and 5 cm (straight) between cuffs

  • 1g vancomycin by IV infusion preoperatively on day of surgery. Catheters inserted in an operating theatre with general or local anaesthetic

Outcomes

  • Exit‐site, wound and tunnel infection: defined as isolation of a pathogenic organism on culture in the presence of local signs of inflammation or infection i.e. swelling, redness, pain or discharge of any nature

  • Peritonitis: defined as either a positive culture form dialysis effluent or a WCC > 100/mm³ in the effluent associated with clinical evidence of peritonitis

  • Mechanical complications

Notes

  • Follow‐up terminated at the date of catheter removal or at the last clinic visit before the analysis

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote " Neither the patients nor the staff supervising their care thereafter were aware of the type of catheter used."

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

5% dropout (2/40)

Selective reporting (reporting bias)

High risk

Not all the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Al‐Hwiesh 2016

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: December 2012 to June 2014

  • Follow‐up period: 18 months

Participants

  • Country: Saudi Arabia

  • Setting: single centre

  • Incident PD patient followed up in the study unit

  • Number: treatment group (36); control group (37)

  • Median age, IQR (years): treatment group (54, 42 to 63); control group (50, 45 to 61)

  • Sex (M/F): treatment group (11/25); control group (11/26)

  • Diabetes: treatment group (21/36); control group (23/37)

  • Exclusion criteria: previous abdominal or pelvic surgery; history of peritonitis; pregnancy

Interventions

Treatment group

  • Triple cuff

Control group

  • Double cuff

Other information

  • Antibiotic prophylaxis with first generation cephalosporin was given IV prior to the procedure. APD was instituted 14 days after PD catheter insertion

Outcomes

  • Exit‐site, wound and tunnel infection

  • Peritonitis

  • Mechanical complications: bowel perforation, haemorrhage, poor drainage, omental wrapping, catheter migration, early leak, catheter replacement

  • Technique survival

Notes

  • Additional data requested from authors: yes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomised using adaptive randomisation method

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts

Selective reporting (reporting bias)

Low risk

Most outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Atapour 2011

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: 2009 to 2010

  • Follow‐up period: 2 months

Participants

  • Country: Iran

  • Setting: single centre

  • Aged ≥ 18 years; CKD stage 5 which needed RRT; self‐care ability; patient’s consent and having family support of choosing CAPD as a choice of RRT

  • Number: treatment group (31); control group (30)

  • Mean age ± SD (years): treatment group (58.5 ± 14.7); control group (51.5 ± 19.2)

  • Sex (M/F): treatment group (21/10); control group (12/18)

  • Diabetes: treatment group (14/31); control group (14/30)

  • Exclusion criteria: morbid obesity (BMI > 35kg/m2); ventral or inguinal hernia or any history of abdominal surgery

Interventions

Treatment group

  • Percutaneously inserted catheter

Control group

  • Surgically inserted catheter

Outcomes

  • Exit‐site infection

  • Peritonitis

  • Mechanical complications: outflow failure, leak, haemoperitoneum, hollow viscous perforation, incisional site hernia

Notes

  • 3 patients from percutaneous group were excluded post intervention due to cardiac death

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random allocation software

Allocation concealment (selection bias)

Low risk

Random allocation software

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts

Selective reporting (reporting bias)

High risk

The incidence of infection was reported for the first two weeks only, did not report infection at the end of study

Other bias

Unclear risk

No information was provided for who performed the procedures for both groups
Buijsen 1994

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: 1991 to 1993

  • Follow‐up period: not reported

Participants

  • Country: Netherlands

  • Setting: single centre

  • Patients newly starting on CAPD

  • Number: treatment group (25); control group (24)

  • Mean age ± SD (years): not reported

  • Sex (M/F): not reported

  • Diabetes: not reported

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Single cuff straight Tenckhoff catheter

Control group

  • Double cuff straight Tenckhoff catheter

Outcomes

  • Technique failure

  • Exit‐site/tunnel infection

Notes

  • Implantation via a laparotomy was performed, if there was a history of abdominal surgery, the catheter was inserted by needlescope

  • Abstract‐only publication

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Selective reporting (reporting bias)

High risk

Not all the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Chen 2014a

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: March 2008 to December 2012

  • Follow‐up period: mean follow‐up days were 487 in open surgery group (control) and 522 in omental folding group (treatment)

Participants

  • Country: China

  • Setting: single centre

  • Aged 18 to 80 years; initiation of PD; presence of greater omentum below the abdominal incision (accessible through the incision)

  • Number: treatment group (34); control group (33)

  • Mean age ± SD (years): treatment group (51 ± 13); control group (50 ± 14)

  • Sex (M/F): treatment group (16/18); control group (17/16)

  • Diabetes: treatment group (7/34); control group (7/33)

  • Exclusion criteria: previous open abdominal surgery history; history of psychological illness or condition that interfered with the ability to understand or comply with requirements of the study

Interventions

Treatment group

  • Open insertion of PD catheter with omentum folding (where a 2 cm incision was made in the peritoneum and the greater omentum was gently drawn out of the abdominal cavity. The distal corners of the greater omentum were fixed to the proximal (gastrocolic) parts of the omentum with three stitches of 2‐0 silk suture)

Control group

  • Regular open insertion of PD catheter

Outcomes

  • Catheter tip migration with drainage failure

  • Irreversible catheter dysfunction

  • All‐cause catheter failure: defined as necessary to remove or reposition the catheter by surgical methods

  • First catheter‐related infections including peritonitis, exit‐site infection, and tunnel infection

  • Technique survival: defined as time to permanent transfer to HD or kidney transplant

Notes

  • Additional data requested from authors: yes

  • Funding source: " This work was supported in part by the Research Award Fund for Young Teachers in Central South University (2011QNZT165) to G.C. and the National Natural Science Foundation of China (No. 81070610) to F.L"

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts

Selective reporting (reporting bias)

Low risk

All the outcomes are reported

Other bias

High risk

Assessment of presence of greater omentum was only possible during operation hence it is unclear randomisation was occurred after surgical incision was made

Danielsson 2002

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: September 1992 to October 1995

  • Follow‐up period: 0.4 to 44 months

Participants

  • Country: Sweden

  • Setting: multicentre (2 sites)

  • ESKD patients scheduled for PD and judged not to need PD for at least 6 weeks after catheter insertion

  • Number: treatment group (30); control group (30)

  • Median age, range (years): treatment group 54.6, 32 to 80(); control group (60.8, 31 to 76)

  • Sex (M/F): treatment group (18/12); control group (16/14)

  • Diabetes: treatment group (8/30); control group (9/30)

  • Exclusion criteria: required PD shortly after catheter insertion

Interventions

Treatment group

  • Buried catheter

  • The tip of the catheter was buried in the subcutaneous tissue. Prior to PD the tip was exteriorised through an exit site

Control group

  • Non‐buried catheter

  • Moncrief‐Popvich catheter used in both groups

Other information

  • All patients were given IV infusion of 2g cloxacillin followed by 1g flucloxacillin orally, twice/day for 5 days

  • Procedures performed by one experience nephrologist at HS and one senior surgeon to KS

Outcomes

  • Death

  • Peritonitis rate: peritonitis defined as any combination of abdominal pain, turbid dialysate, and a dialysate leukocyte count > 100 x 109/L

  • Exit‐site/tunnel infection rate: exit‐site infection defined as peri‐catheter erythema and/or exudation from the exit site

  • Technique failure

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

1.5% dropout (1/60)

Selective reporting (reporting bias)

Low risk

Most outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Dasgupta 1998

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: not reported

  • Follow‐up period: 14.3 months for Moncrief‐Popovich catheter group and 15.8 months for Tenckhoff catheter group

Participants

  • Country: Canada

  • Setting: Single centre

  • PD patients

  • Number: treatment group (19); control group (20)

  • Mean age ± SD (years): not reported

  • Sex (M/F): not reported

  • Diabetes: not reported

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Moncrief‐Popovich catheter

Control group

  • Tenckhoff catheter

Outcomes

  • Catheter survival

Notes

  • Unable to contact author for additional data

  • Abstract‐only publication

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Selective reporting (reporting bias)

High risk

Reported few outcomes

Other bias

Unclear risk

Insufficient information to permit judgement
Ejlersen 1990

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: 1 June 1986 to 1 April 1988

  • Follow‐up period: 450 days

Participants

  • Country: Denmark

  • Setting: Single centre

  • All patients with chronic uraemia requiring the insertion of a permanent PD catheter for future CAPD

  • Number: treatment group (16); control group (21)

  • Median, range (years): treatment group (57, 28 to 74); control group (58, 28 to 75)

  • Sex (M/F): treatment group (9/7); control group (10/11)

  • Diabetes: not reported

  • Exclusion criteria: no prior history of extensive peritoneal adherences requiring laparotomy

Interventions

Treatment group

  • Lateral insertion

Control group

  • Midline insertion

Other information

  • Catheter insertions performed by a senior registrar in urology.

  • Right‐angled modified Tenckhoff catheter, single‐cuff L‐catheter

  • Local anaesthetic used for both techniques

  • IV antibiotic prophylaxis just prior to procedure using 2g ampicillin or 2g cefalothin if penicillin allergy suspected

  • CAPD was not initiated until at least 2 weeks after insertion. Patients placed on intermittent PD or HD

Outcomes

  • Death

  • Peritonitis

  • Tunnel infection

  • Surgical/mechanical failure

Notes

  • Stop/end‐points: surgical or mechanical catheter failure requiring catheter removal: incurable peri‐catheter leakage, irreversible displacement and malfunction, peri‐catheter herniation

  • Funding source: The statistical support from the Danish Medical Research Council is acknowledged (J.no. 5.52.16.90.)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts

Selective reporting (reporting bias)

Low risk

Most outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Eklund 1994

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: August 1987 to February 1989

  • Follow‐up period: 5 years (31 October 1992)

Participants

  • Country: Finland

  • Setting: single centre

  • Consecutive patients selected for CAPD

  • Number: treatment group (20); control group (20)

  • Mean age, range (years): treatment group (42.8, 19.5 to 61.0); control group (49.0, 28.5 to 65.3)

  • Sex (M/F): treatment group (9/11); control group (12/8)

  • Diabetes: treatment group (3/20); control group (10/20)

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Single‐cuff, straight Tenckhoff catheter

Control group

  • One‐bubble, slanted flange, single‐cuff Swan neck catheter

Other information

  • Catheters inserted surgically by the same surgeon, spinal anaesthesia was the preferred choice

  • Prior to insertion catheter was soaked in vancomycin 500 mg/10 mL saline solution and rest of antibiotic injected into rectus muscle

  • After implantation peritoneal cavity flushed with 1 to 3, 1L exchanges until effluent clear. Catheter was then filled with 2 mL saline and 1 mL heparin (5000 U)

  • CAPD training and treatment was started 10‐14 days after implantation

Outcomes

  • Peritonitis: diagnosed when 2 of the following criteria were fulfilled: abdominal pain; cloudy dialysate with leucocytes > 50/mm³; positive microbiological culture from dialysate)

  • Peritonitis rate

  • Exit‐site infection: erythema with or without skin induration and/or purulent discharge from exit site)

  • Exit‐site infection rate

  • Catheter removal or replacement

  • Death

Notes

  • Dropout definitions: catheter removal due to successful transplantation, elective transfer to HD or death from concurrent disease were regarded as lost to follow‐up

  • Funding source: "This study was supported by the Sigrid Juselius Foundation"

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Low risk

Sequentially numbered sealed envelopes containing catheter configurations in random order

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts

Selective reporting (reporting bias)

Low risk

All outcomes were reported

Other bias

High risk

Definition of peritonitis was different from the ISPD guidelines
Eklund 1995

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: March 1990 to September 1991

  • Follow‐up period: to 30 September 1994

Participants

  • Country: Finland

  • Setting: Single centre

  • 40 consecutive patients selected for CAPD

  • Number: treatment group (20); control group (20)

  • Mean age, range (years): treatment group (48.5, 26 to 68); control group (43.7, 23 to 66)

  • Sex (M/F): treatment group (11/9); control group (11/9)

  • Diabetes: treatment group (6/20); control group (10/20)

  • Exclusion criteria: not reported

Interventions

Treatment group

  • 2 cuff straight Tenckhoff catheter (straight intraperitoneal segment)

Control group

  • 2 cuff Swan neck catheter (straight intraperitoneal segment)

Other information

  • Catheters inserted surgically, spinal anaesthesia was used in all instances

  • Prior to insertion catheter was soaked in vancomycin 500 mg/10 mL saline solution and rest of antibiotic injected into rectus muscle

Outcomes

  • Peritonitis: diagnosed when 2 of the following criteria were fulfilled: abdominal pain; cloudy dialysate with leucocyte count of 100 cells/mm³ or more with 50% polymorphonuclear cells; positive microbiological culture from dialysate

  • Peritonitis rate

  • Exit‐site infection: erythema with or without skin induration and/or purulent discharge from exit site

  • Exit‐site infection rate

  • Catheter removal or replacement

  • Death

Notes

  • Dropout definitions: catheter removal due to successful transplantation, elective transfer to HD or death from concurrent disease with functioning catheter were censored at the time of the event

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Low risk

Sequentially numbered sealed envelopes containing catheter configurations in random order

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

High risk

High dropout (14/40, transferred to HD or death)

Selective reporting (reporting bias)

Low risk

All outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Eklund 1997

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: October 1991 to June 1993

  • Follow‐up period: 1841 days

Participants

  • Country: Finland

  • Setting: single centre

  • Consecutive patients selected for CAPD

  • Number: treatment group (30); control group (30)

  • Mean age, range (years): treatment group (42.8, 22 to 67); control group (45.1, 25 to 64)

  • Sex (M/F): treatment group (20/10); control group (20/10)

  • Diabetes: treatment group (6/30); control group (10/30)

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Single‐cuff Tenckhoff, straight tip

Control group

  • Double‐cuff Tenckhoff, straight tip

Other information

  • Spinal anaesthesia used for all patients

Outcomes

  • Peritonitis: 2 of the following criteria ‐ abdominal pain, cloudy dialysate with leucocytes > 100/mm³ with > 50% polymorphonuclear cells, or positive dialysate culture

  • Exit‐site infection: erythema with or without skin induration and/or purulent discharge for the exit site

  • Death

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Low risk

Sealed envelopes

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts

Selective reporting (reporting bias)

Low risk

Unclear, unable to totally exclude reporting bias

Other bias

Unclear risk

Insufficient information to permit judgement
Gadallah 1999

Methods

  • Study design: parallel quasi‐RCT

  • Study time frame/recruitment period: October 1992 to October 1995

  • Follow‐up period: 3 years

Participants

  • Country: USA

  • Setting: single centre

  • Patients undergoing PD catheter placement (no further details)

  • Number: treatment group (76); control group (72)

  • Mean age ± SD (years): treatment group (45.0 ± 1.8); control group (47.2 ± 2.4)

  • Sex (M/F): treatment group (37/39); control group (22/34)

  • Diabetes: not reported

  • Race (White/Black/Latino): treatment group (25/50/1); control group (17/55/0)

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Peritoneoscopic placement

  • Performed by the same 3 nephrologists in a special procedure room under local anaesthesia and sterile conditions

Control group

  • Surgical placement

  • Performed by the same 3 surgeons in the operating room under general anaesthetic

Other information

  • Both groups received 1g vancomycin IV preoperatively

  • Postoperatively both groups had daily irrigation with 200 ml 1.5% dianeal and dialysis was not study until 1 week from the date of surgery

Outcomes

  • Early complications

  • Late complications

  • Catheter failure

  • Death

  • Peritonitis

  • Exit site/tunnel infection

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Randomisation method was by alternate months, quasi‐RCT

Allocation concealment (selection bias)

High risk

Alternate months

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

3% dropout (5/148)

Selective reporting (reporting bias)

Low risk

All outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Johnson 2006

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: February 2003 to February 2006

  • Follow‐up period: All patients were followed up until death, kidney transplantation, completion of PD therapy, or the end of the study on 24 March 2006, whichever came first

Participants

  • Country: Australia

  • Setting: multicentre (2 sites)

  • Adults patients with ESKD (stage 5 CKD) who required insertion of a Tenckhoff catheter for PD

  • Number: treatment group (70); control group (62)

  • Mean age ± SD (years): treatment group (56.3 ± 15.7); control group (57.6 ± 15.7)

  • Sex (M/F): treatment group (40/30); control group (42/30)

  • Diabetes: treatment group (29/70); control group (19/62)

  • Exclusion criteria: history of psychological illness or condition that interfered with the ability to understand or comply with requirements of the study

Interventions

Treatment group

  • Straight Tenckhoff catheter

Control group

  • Coiled Tenckhoff catheter

Outcomes

  • Catheter malposition

  • Catheter associated infection (peritonitis, exit‐site infection)

  • Technique failure

  • Death (all causes)

Notes

  • Stop of end points: all patients were followed up until death, kidney transplantation, completion of PD therapy, or the end of the study on March 24, 2006, whichever came first

  • Funding source: none

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated random number list with randomisation blocks of 20

Allocation concealment (selection bias)

Low risk

Random number with randomisation blocks of 20

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts

Selective reporting (reporting bias)

Low risk

Low risk, most outcomes were reported

Other bias

High risk

Unequal baseline characteristics
Jwo 2010

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: December 2002 to October 2006

  • Follow‐up period: not reported

Participants

  • Country: Taiwan

  • Setting: single centre

  • All incident PD patients

  • Number: treatment group (37); control group (40)

  • Mean age ± SD (years): treatment group (56.7 ± 13.4); control group (54.4 ± 16.5)

  • Sex (M/F): treatment group (12/25); control group (18/22)

  • Diabetes: treatment group (17/37); control group (13/40)

  • Exclusion criteria: intolerant to spinal/general anaesthesia; unwilling to participate

Interventions

Treatment group

  • Laparoscopic insertion of catheter

  • 500 mg of cefazolin, a prophylactic antibiotic, was given IV before anaesthesia.

  • Laparoscopic adhesiolysis was performed for those who had peritoneal adhesion due

  • to previous abdominal surgery or pelvic inflammatory disease.

  • The postoperative care of the laparoscopic group was identical to that of the open group.

Control group

  • Open surgical method of catheter insertion

  • 500 mg of cefazolin, a prophylactic antibiotic, was given IV before anaesthesia

  • No additional surgery such as omentectomy or salpingectomy was performed. PD was started at 7 d postoperatively

Outcomes

  • Patient survival

  • Catheter dropout

  • Early catheter‐related complication including catheter migration, leak, bleeding

  • Late catheter‐related complication including catheter migration, leak, exit‐site infection, peritonitis, hernia

Notes

  • Additional data requested from authors

  • Funding source:

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Insufficient information to permit judgement, significantly high number of cirrhosis patients in laparoscopic group

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No loss of follow‐up

Selective reporting (reporting bias)

Low risk

All the outcomes were reported

Other bias

High risk

Different baseline characteristic between the two groups
Li 2009e

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: May 2005 to January 2006

  • Follow‐up period: 31.8 patient‐year for treatment group and 20.7 patient‐year for control group

Participants

  • Country: China

  • Setting: single centre

  • All PD patients entering the PD program

  • Number: treatment group (20); control group (19)

  • Mean age ± SD (years): treatment group (57.8 ± 15.7); control group (61.0 ± 19.4)

  • Sex (M/F): treatment group (10/10); control group (11/8)

  • Diabetes: not reported

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Double‐cuff straight‐tip Tenckhoff catheter with an artificial subcutaneous swan‐neck

Control group

  • Conventional double‐cuff straight‐tip swan‐neck catheter

Outcomes

  • Exit‐site infection rate

  • Peritonitis

  • Catheter‐related complication including catheter migration, outflow failure, surgery ‐related bleeding

Notes

  • Funding source: none

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated randomising chart

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

All patients were followed up and analysed

Selective reporting (reporting bias)

Low risk

All outcomes were reported

Other bias

High risk

Procedures were performed by 3 nephrologists; the study was terminated earlier than planned as they ran out of catheters

Lo 2003b

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: August 1997 to January 2001

  • Follow‐up period: The study endpoint was the removal of the catheter of 31 January 2002 (1 year after the last patient recruitment)

Participants

  • Country: Hong Kong

  • Setting: single centre

  • All incident PD patients

  • Number: treatment group 1 (23); treatment group 2 (22); control group (48)

  • Mean age ± SD (years): treatment groups (62.6 ± 42.6); control group (60.8 ± 13.6)

  • Sex (M/F): treatment group 1 (10/13); treatment group 2 (11/11); control group (24/24)

  • Diabetes: not reported

  • Exclusion criteria: not reported

Interventions

Treatment group 1

  • Swan‐neck straight tip catheter

Treatment group 2

  • swan‐neck curled tip catheter

Control group

  • Conventional straight double‐cuffed Tenckhoff catheter

Other information

  • All catheter implantations were performed by the same group of four trained nephrologists using minilaparotomy

  • Cefazolin 1 g was given intravenously as a prophylactic antibiotic just before the operation.

  • Twice‐weekly IPD was started immediately after implantation in almost all cases. Training for CAPD was conducted at about 6 weeks after catheter implantation

  • Povidone iodine as the standard antiseptic solution for daily exit‐site care but chlorhexidine and saline, were also used. Prophylactic mupirocin was not applied to the exit site

Outcomes

  • Exit‐site infection rate: defined according to the classification by Twardowski and Prowant

  • Peritonitis

  • Catheter‐related complication including catheter migration, outflow failure, surgery‐related bleeding

  • Catheter survival

Notes

  • Based on power analysis to show a clinical significance of reducing ESI episodes by one third in the SN group, the original study was designed with a sample size of 60 patients. Because of a failure to show any significant difference in outcome by the time 60 patients had been recruited, the study was extended to recruit 50% more patients

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No loss to follow‐up

Selective reporting (reporting bias)

High risk

Not all of the outcomes were reported

Other bias

Unclear risk

Despite calculate power before the study, no significant difference in the outcomes was observed after complete the recruitment and finally the number of recruitment was increased by 50%

Lye 1996

Methods

  • Study design: quasi‐RCT

  • Study time frame/recruitment period: January 1993 to June 1994

  • Follow‐up period: 1 year

Participants

  • Country: Singapore

  • Setting: single centre

  • Consecutive patients who were commencing CAPD for the first time

  • Number: treatment group (20); control group (20)

  • Mean age ± SD (years): treatment group (64.2 ± 9.8); control group (64.4 ± 10.3)

  • Sex (M/F): not reported

  • Diabetes: treatment group (14/20); control group (10/20)

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Conventional, double‐cuff, straight Tenckhoff

Control group

  • Double‐cuff, Swan neck coiled catheter

Other information

  • All catheters inserted under local anaesthetic by the same surgeon and immediately post‐surgery position of tip was checked by abdominal radiography

  • Catheters were flushed using 1 L exchanges until effluent was clear. Catheter was then filled with a heparin/saline solution and rested for at least 2 weeks until patient commenced CAPD

  • If the patient required RRT HD was used unless contraindicated where intermittent PD was performed

Outcomes

  • Peritonitis rate

  • Exit‐site infections

  • Mechanical complications

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Alternate randomisation

Allocation concealment (selection bias)

High risk

Alternate randomisation

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

7% lost to follow‐up (3/40)

Selective reporting (reporting bias)

High risk

Not all the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Merrikhi 2014

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: 2010 to 2011

  • Follow‐up period: 2 months

Participants

  • Country: Iran

  • Setting: single centre

  • Patients < 15 years who will be receiving PD and have family support

  • Number: treatment group (18); control group (17)

  • Mean age ± SD (years): treatment group (6.77 ± 4.87); control group (6.38 ± 4.91)

  • Sex (M/F): treatment group (9/9); control group (12/5)

  • Diabetes: not reported

  • Exclusion criteria: history of prior major abdominal surgery; ventral or inguinal hernia; BMI ≥ 35 kg/m2

Interventions

Treatment group

  • Percutaneous placement by 1 cm transverse incision on the skin just below the umbilicus

Control group

  • Open placement by making a left 3to 4 cm paramedian incision approximately 1 to 2 cm superior to the umbilicus

Outcomes

  • Catheter‐related infection: peritonitis, exit‐site infection

  • Mechanical complication of catheter

  • Outflow failure of catheter

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No loss to follow‐up

Selective reporting (reporting bias)

Low risk

Study was registered with Iranian Registry of clinical trials

Other bias

Unclear risk

Insufficient information to permit judgement
Moncrief 1998

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: not reported

  • Follow‐up period: not reported

Participants

  • Country: not reported

  • Setting: not reported

  • Number: 113 patients; no data available on number per group

  • Mean age ± SD (years): not reported

  • Sex (M/F): not reported

  • Diabetes: not reported

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Midline insertion

Control group

  • Lateral insertion

Outcomes

  • No outcomes reported

Notes

  • Conference proceedings/CARI guidelines report. Unable to confirm data with authors

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Selective reporting (reporting bias)

High risk

Outcomes were not reported

Other bias

Unclear risk

Insufficient information to permit judgement
Nielsen 1995

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: April 1992 to July 1993

  • Follow‐up period: 15 months

Participants

  • Country: Denmark

  • Setting: single centre

  • Consecutive patients selected for CAPD programme

  • Number: treatment group (38); control group (34)

  • Mean age, range (years): treatment group (50, 18 to 79); control group (55, 29 to 78)

  • Sex (M/F): treatment group (20/18); control group (20/14)

  • Diabetes: treatment group (7/38); control group (6/34)

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Straight single cuff Tenckhoff

Control group

  • Coiled single cuff Tenckhoff

Other information

  • Catheters inserted by 5 nephrologists. All patients received premedication of a minor tranquillizer and morphine. Local anaesthesia used in all cases (lidocaine 1% containing norepinephrine)

  • Immediately after implantation, low volume (1 L) supine intermittent PD was initiated for 24 h (60 L) and continued 1 day/week for the first 3 to 4 weeks after implantation

  • All patients started on a disconnect CAPD system

Outcomes

  • Drainage failure

  • Tunnel or exit‐site infection: defined clinically as an inflammation with or without discharge

  • Peritonitis: two of four of the following: cloudy effluent; abdominal pain; leucocyte count > 100 x 106/L (> 50% neutrophils); positive culture

Notes

  • Stop or end points: results analyses after 60 patients and due to significant difference in catheter outcome, the study was terminated after the inclusion of 72 patients

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Study described as randomised; method of randomisation not reported

Allocation concealment (selection bias)

Low risk

Sequentially number sealed envelopes with catheter type in random order

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Both participants and personnel are blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

High dropout rate (32/72)

Selective reporting (reporting bias)

High risk

Not all the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Ouyang 2015

Methods

  • Study design: parallel RT

  • Study time frame/recruitment period: November 2007 to August 2008

  • Follow‐up period: 24 months

Participants

  • Country: China

  • Setting: single centre

  • All ESKD patients ≥ 18 years who underwent a first PD catheter placement

  • Number: treatment group (90); control group (99)

  • Mean age ± SD (years): treatment group (50.3 ± 14.1); control group (49.1 ± 15.6)

  • Sex (M/F): treatment group (49/41); control group (54/45)

  • Diabetes: not reported

  • Exclusion criteria: AKI; referral for kidney transplantation evaluation within 3 months; acute heart failure; acute MI within 3 months; acute respiratory distress syndrome at the time of enrolment; malignant disease; psychiatric disease

Interventions

Treatment group

  • Coiled tip Tenckhoff Catheter

Control group

  • Straight tip Tenckhoff catheter

Other information

  • All placements were performed by one of two designated experienced nephrologists

  • A prophylactic 2nd or 3rd‐generation cephalosporin was administered intravenously 1 hour before the catheter placement procedure

  • Patients underwent PD therapy immediately after the successful catheter placement and transited to continuous ambulatory PD 7 days later

Outcomes

  • 1‐year and 2‐year catheter survival

  • Death, transfer to HD, kidney transplantation, refusal of PD therapy, or recovery of kidney function

  • Catheter dysfunction

  • Peritonitis diagnosed when two of the following conditions were present: abdominal pain; cloudy effluent with an effluent white cell count of more than 100/μL (≥ 50% polymorphonuclear neutrophils); or a positive effluent culture

  • Exit‐site infection: defined as erythema with or without skin induration and purulent discharge from the exit site

Notes

  • Additional data requested from authors

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

22% dropout (43/189)

Selective reporting (reporting bias)

Low risk

All the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Park 1998

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: April 1991 to January 1995

  • Follow‐up period: 2 years

Participants

  • Country: Korea

  • Setting: single centre

  • Patients commencing CAPD

  • Number: treatment group (30); control group (29)

  • Mean age, range (years): treatment group (47.8, 16 to 69); control group (46.2, 27 to 71)

  • Sex (M/F): treatment group (19/11); control group (17/12)

  • Diabetes: treatment group (13/30); control group (13/29)

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Buried catheter

  • Catheter tip buried for 6 weeks before being exteriorised. Bag exchange commenced the same day

Control group

  • Non‐buried catheter

  • Tip was brought to the surface at the time of surgery and 6 weeks were allowed for wound healing before bag exchange

Other information

  • Double cuff Swan neck bent catheter was used in all patients

Outcomes

  • Peritonitis: defined as turbid peritoneal effluent with leukocyte count > 100/mm3

  • Exit‐site infection, total number: defined as skin over the tunnel red, war, tender and/or if purulent discharge was observed

  • Peritonitis rate

  • Exit‐site infection rate

  • Death

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

2% dropout (1/60)

Selective reporting (reporting bias)

High risk

Not all the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Qian 2014

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: March 2009 to November 2012

  • Follow‐up period: not reported

Participants

  • Country: China

  • Setting: single centre

  • ESKD patients

  • Number: treatment group (14); control group (15)

  • Mean age ± SD (years): treatment group (60.2 ± 5.7); control group (62.7 ± 8.6)

  • Sex (M/F): treatment group (6/8); control group (7/8)

  • Diabetes: not reported

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Cystoscopy‐assisted PD catheter insertion

Control group

  • Open surgery

Outcomes

  • Exit‐site infection or tunnel tract

  • Peritonitis

  • Peritoneal fluid leak

  • Catheter migration, catheter obstruction, hernia

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Selective reporting (reporting bias)

High risk

Not all the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Rubin 1990

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: May 1987 to September 1989

  • Follow‐up period: 2 years

Participants

  • Country: USA

  • Setting: single centre

  • All patients undergoing placement of initial PD catheters

  • Number: treatment group (50); control group (35)

  • Mean age ± SD (years): treatment group (47 ± 18); control group (51 ± 17)

  • Sex (M/F): 40/45

  • Diabetes: not reported

  • Exclusion criteria: previous abdominal surgery that precluded randomisation of catheter insertion site

Interventions

Treatment group (groups 1 and 3)

  • Midline insertion, straight catheter/lateral insertion, straight catheter

Control group (groups 2 and 4)

  • Midline insertion, spiral catheter/lateral insertion, spiral catheter

Other information

  • All procedures performed in an operating room environment

  • Dialysis was started within 2 to 3 hours of returning from the operating theatre

Outcomes

  • Exit site/tunnel infection: tunnel infection ‐ obvious purulence from the catheter exit site in association with peritonitis; exit‐site infection ‐ purulence of exit site without peritonitis

  • Peritonitis: dialysate becoming turbid and abdominal pain or a positive culture

  • Catheter removal/replacement

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Selective reporting (reporting bias)

High risk

Not all the outcomes were reported

Other bias

High risk

Introduced new type of catheter and new catheter insertion technique at the same time for the treatment group

Sanchez‐Canel 2016

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: December 2007 to February 2013

  • Follow‐up period: not reported

Participants

  • Country: Spain

  • Setting: single centre

  • PD incident patients ≥18 years

  • Number: treatment group (40); control group (38)

  • Mean age ± SD (years): treatment group (55.4 ± 14.8); control group (59.1 ± 13.2)

  • Sex (M/F): treatment group (21/19); control group (21/17)

  • Diabetes: treatment group (11/40); control group (9/38)

  • Exclusion criteria: life expectancy of less than 6 months

Interventions

Treatment group

  • Single‐cuff self‐locating catheter (with a small tungsten cylinder at the distal end)

Control group

  • Single‐cuff, straight Tenckhoff catheter

Outcomes

  • Mechanical complication: bleeding, leak, hernia

  • Infection‐related complication: peritonitis, exit‐site and tunnel tract infection

  • Catheter replacement

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Selective reporting (reporting bias)

High risk

Some of outcomes were not reported

Other bias

High risk

Different baseline characteristics; BMI significantly higher in the control group
Scott 1994

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: not reported

  • Follow‐up period: 19 months

Participants

  • Country: UK

  • Setting: single centre

  • PD patients

  • Number: treatment group (30); control groups (59)

  • Mean age ± SD (years): not reported

  • Sex (M/F): not reported

  • Diabetes: not reported

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Double cuff, straight Tenckhoff

Control group 1

  • Standard coiled catheter

Control group 2

  • Oreopoulos (Toronto Western double‐disk)

Other information

  • Catheters inserted surgically under standard standardised conditions and surgical techniques

Outcomes

  • Death

  • Peritonitis

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to permit judgement, unclear

Selective reporting (reporting bias)

High risk

Not all the outcomes of interest were reported

Other bias

Unclear risk

Insufficient information to permit judgement
SIPROCE 1997

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: October 1994 to April 1996

  • Follow‐up period: cumulative time of observation in the silver ring group was 857 months compared with 937 months in the control group

Participants

  • Country: Germany

  • Setting: multicentre (7 sites)

  • All patients undergoing PD treatment

  • Number: treatment group (97); control group (98)

  • Mean age ± SD (years): treatment group (44.74 ± 17.6); control group (47.01 ± 18.5)

  • Sex (M/F): treatment group (63/34); control group (52/46)

  • Diabetic: treatment group (19/97); control group (21/98)

  • Exclusion criteria: acute or chronic exit‐site infections; sinus tract/tunnel infections; peritonitis during the ascertainment period (October 1994 to April 1995)

Interventions

Treatment group

  • Silver ring

  • The silver ring was placed at the skin level of the exit site and, if necessary, fixed by a silicone ring with silicone glue to avoid displacement above or below the skin level.

Control group

  • No silver ring

Outcomes

  • First occurrence of exit‐site infection: exit‐site infection was defined as reddening with purulent discharge from the exit site (grade II of the visual classification scale) and/or a significantly increased sulcus fluid flow rate (SFFR) measurement in relation to the visual appearance of the exit site

  • First occurrence of peritonitis

  • Death (all causes)

  • Catheter removal/replacement

  • Technique failure

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

High dropout 30% (59/195)

Selective reporting (reporting bias)

Low risk

Most of the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Stegmayr 2005a

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: not reported

  • Follow‐up period: not reported

Participants

  • Country: Sweden

  • Setting: single centre

  • All patients selected for PD

  • Number: treatment group (10); control group (14)

  • Mean age ± SD (years): not reported separately

  • Sex (M/F): not reported

  • Diabetes: not reported

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Straight catheter

Control group

  • Coiled catheter

Outcomes

  • Catheter outflow failure

  • Catheter removal

  • Peritonitis

Notes

  • Initially planned to recruit 50 patients. The study was interrupted because the analysis showed a significantly higher frequency of catheter exchanges due to drainage dysfunction and malposition among coiled catheters

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts

Selective reporting (reporting bias)

High risk

Few outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Stegmayr 2015

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: February 2007 to June 2013

  • Follow‐up period: median follow‐up was 10 months (range 1 to 76 months; mean 15 ± 17 months)

Participants

  • Country: Sweden

  • Setting: single centre

  • All patients accepted for PD by physician

  • Number: treatment group (29); control group (32)

  • Mean age ± SD (years): treatment group (58 ± 13); control group (60 ± 18)

  • Sex (M/F): treatment group (20/9); control group (17/15)

  • Diabetes: treatment group (7/29); control group (12/32)

  • Exclusion criteria: once the patient was accepted for PD by the physician in charge there were no exclusion criteria for randomisation

Interventions

Treatment group

  • Double cuffed Wolfram self‐locating catheter

Control group

  • Double cuffed Tenckhoff catheter

Outcomes

  • Catheter outflow failure

  • Early and late leak

  • Death

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Quote: "A peritoneal dialysis nurse made randomization from envelopes and provided the surgeon with the respective catheter"

Allocation concealment (selection bias)

Unclear risk

Quote: "A peritoneal dialysis nurse made randomization from envelopes and provided the surgeon with the respective catheter"

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

High dropout; loss to follow‐up: died (7/61), transfer to HD (20/61), transplant (15/61)

Selective reporting (reporting bias)

High risk

Not all the outcomes were reported

Other bias

Unclear risk

Significantly large number of patients from treatment group dropped out due to transplant
Sun 2015a

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: June 2008 to June 2012

  • Follow‐up period: 12 months

Participants

  • Country: China

  • Setting: Single Centre

  • Patients with CKD stage 5

  • Number: treatment group (48); control group (41)

  • Mean age ± SD (years): treatment group (52.3 ± 17.6); control group (54.9 ± 14.9)

  • Sex (M/F): treatment group (27/21); control group (23/18)

  • Diabetes: treatment group (15/48); control group (12/41)

  • Exclusion criteria: history of abdominal surgery; extensive adhesion; severe COPD; PKD

Interventions

Treatment group

  • Vertical tunnel‐based low‐site PD catheter implantation

Control group

  • Traditional open surgery

Outcomes

  • Catheter malfunction

  • Peritonitis, exit‐site infection and tunnel infection

  • PD fluid leakage, outer cuff extrusion, and inflow or outflow pain

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Low dropout rate

Selective reporting (reporting bias)

High risk

Not all the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Timely PD 2010

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: 1 March 2008 to 31 May 2013

  • Follow‐up period: day 180 post catheter insertion

Participants

  • Country: Australia

  • Setting: multicentre (2 sites)

  • ESKD patients over 18 years of age, who will be receiving CAPD or APD within 4 weeks of insertion of a PD catheter

  • Number: treatment group 1 (39); treatment group (42); control group (41)

  • Mean age ± SD (years): treatment group 1 (60.92 ± 15.2); treatment group 2 (57.55 ± 17.9); control group (54.41 ± 15.5)

  • Sex (M/F): treatment group 1 (22/17); treatment group 2 (20/22); control group (26/15)

  • Diabetes: treatment group 1 (15/39); treatment group 2 (14/42); control group (14/41)

  • Exclusion criteria: a history of psychological illness or condition which resulted in inability to understand or comply with the requirements of the study or if there is an acute infectious episode in the last month before enrolment

Interventions

Treatment group 1

  • One‐week break‐in period

Treatment group 2

  • Two‐week break‐in period

Control group

  • Four‐week break‐in period

Outcomes

  • Composite of exit‐site infection or tunnel tract or peritonitis

  • Peritoneal fluid leak

  • Technique failure

Notes

  • Funding source: "This study is partly funded by research grants from the Baxter Renal Division Clinical Evidence Council"

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation sequence was generated using STATA software (permuted block)

Allocation concealment (selection bias)

Low risk

Sealed envelopes

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropout

Selective reporting (reporting bias)

Low risk

Published protocol before study

Other bias

High risk

Protocol violation present
Trooskin 1990

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: not reported

  • Follow‐up period: not reported

Participants

  • Country: USA

  • Setting: multicentre (number of sites not reported)

  • Patients with CKD selected for PD

  • Number: treatment group (44); control group (42)

  • Mean age (years): treatment group (52); control group (49)

  • Sex (M/F): not reported

  • Diabetes: not reported

  • Exclusion criteria: known penicillin allergies

Interventions

Treatment group

  • Surfactant‐treated catheter

  • Single and double‐cuff straight and spiral catheters were used. Catheters (BioGuard ABTM) pretreated with 5% tridodecylmethylammonium chloride (TDMAC) in ethanol

Control group

  • Surfactant‐untreated control catheter

Outcomes

  • Peritonitis

  • Exit‐site/tunnel infection

  • Death

  • Catheter related complication

  • Technique failure

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Double blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Selective reporting (reporting bias)

Low risk

Most of the outcomes of interest were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Tsimoyiannis 2000

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: not reported

  • Follow‐up period: 4‐36 months (mean 21 ± 10)

Participants

  • Country: Greece

  • Setting: single centre

  • Adult patients undergoing insertion of Tenckhoff catheter

  • Number: treatment group (25); control group (25)

  • Mean age, range (years): treatment group (62, 48 to 72); control group (58, 25 to 74)

  • Sex (M/F): treatment group (16/4); control group (18/7)

  • Diabetes: not reported

  • Exclusion criteria: problem for general anaesthesia

Interventions

Treatment group

  • Open laparotomy technique with local anaesthesia. No intra‐abdominal fixation used. CAPD was commenced 24 to 48 hours with small amounts of fluid and the full program started several days later

Control group

  • Laparoscopic placement with general anaesthesia. Catheter secured to the back wall of the uterus in women or to the peritoneum overlaying the back wall of the bladder in men. Immediately after the end of the procedure CAPD was started

Outcomes

  • Mean operative time

  • Peritonitis

  • Tip catheter migration

  • Removal of catheter

  • Fluid leaks

  • Technique failure

Notes

  • Five patients were excluded from laparoscopic group because they developed severe cardiovascular or respiratory disease, which contraindicated general anaesthesia

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Low risk

Quote: "Closed envelope contained information regarding placement into group A or B"

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

10% dropout (5/50)

Selective reporting (reporting bias)

High risk

Not all the outcomes of interest were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Turner 1992

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: March 1990 ‐ March 1991

  • Follow‐up period: 60 weeks

Participants

  • Country: UK

  • Setting: single centre

  • All patients who had a Tenckhoff catheter inserted

  • Number: treatment group 1 (22); treatment group 2 (23); control group (21)

  • Mean age ± SD (years): treatment group 1 (45 ± 15.51); treatment group 2 (40 ± 14.26); control group (43 ± 15.8)

  • Sex (M/F): not reported

  • Diabetes: treatment group 1 (4/22); treatment group 2 (5/23); control group (4/21)

  • Exclusion criteria: not reported

Interventions

Treatment group 1

  • Immobilisation via device

  • Immediately upon insertion of catheter the immobilisation device was placed over the catheter 1‐3 inches from the exit site by the surgeon. It was kept in place at all times and replaced daily after showering. A new immobiliser was positioned before removal of the old one

Treatment group 2

  • Immobilisation via tape

  • Immediately upon insertion of catheter the tape was placed over the catheter 1‐3 inches from the exit site by the surgeon. It was kept in place at all times and replaced daily after showering. A new tape was positioned before removal of the old one

Control group

  • No immobilisation

Outcomes

  • Exit‐site/tunnel infection: defined as clinically apparent infection (purulent drainage, redness, swelling, warmth and tenderness) at the exit site with/without a positive culture

  • Exit‐site/tunnel infection rate

  • Peritonitis

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Selective reporting (reporting bias)

High risk

Not all the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Voss 2012

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: April 1999 to August 2004

  • Follow‐up period: 12 months

Participants

  • Country: New Zealand

  • Setting: multicentre (within the Counties‐Manukau District Health Board, Auckland, New Zealand)

  • Patients planned for PD; ≥ 18 years; suitable for both laparoscopic and radiological PD catheter insertions

  • Number: treatment group (57); control group (56)

  • Mean age, range (years): treatment group (61.1, 53.3 to 71.4); control group (60.8, 51 to 69.7)

  • Sex (M/F): treatment group (28/29); control group (30/26)

  • Diabetes: treatment group (30/57); control group (28/56)

  • Exclusion criteria: severe obesity (BMI > 35); previous abdominal surgery; history consistent with adhesions; severe medical comorbidity precluding general anaesthesia; bleeding diatheses; anticoagulation; HIV infection; ongoing corticosteroid or immunosuppressant use; severe psychiatric disease; definite plans for live donor kidney transplantation

Interventions

Treatment group

  • Percutaneous insertion by radiologists using a modified Seldinger technique under fluoroscopic guidance

Control group

  • Laparoscopic insertion by surgeons under direct vision

Outcomes

  • Complication‐free catheter survival

  • Complications secondary to mechanical causes (insertion failure, patency failure defined as an inadequate inflow/outflow, hernia, dialysate leak or an abdominal hernia)

  • PD related peritonitis, exit‐site infection, catheter tunnel infection

Notes

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote "allocated by simple randomization... performed by the research staff not involved with the care of the subjects"

Allocation concealment (selection bias)

Low risk

Sequentially numbered opaque, sealed envelopes

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts

Selective reporting (reporting bias)

Low risk

Not all the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Winch 2000

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: January 1996 to January 1997

  • Follow‐up period: follow up till September 1998

Participants

  • Country: Australia

  • Setting: single centre

  • Incident PD patients

  • Number: treatment group (11); control group (11)

  • Mean age (range): 63 years (34 to 77)

  • Sex (M/F): 12/10

  • Diabetes: not reported

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Swan neck catheter

Control group

  • Straight curved catheter

Outcomes

  • Exit‐site infection

  • Peritonitis

  • Technique failure

Notes

  • Abstract‐only publication

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

High dropout (8/22)

Selective reporting (reporting bias)

Low risk

Reported most of outcomes

Other bias

Unclear risk

Insufficient information to permit judgement
Wright 1999

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: not reported

  • Follow‐up period: 24 months

Participants

  • Country: UK

  • Setting: single centre

  • All patients fit enough to undergo general anaesthetic and starting PD

  • Number: treatment group (21); control group (24)

  • Mean age ± SD (years): treatment group (46.4 ± 14.8); control group (49.3 ± 20.2)

  • Sex (M/F): treatment group (14/7); control group (15/9)

  • Diabetes: not reported

  • Exclusion criteria: not reported

Interventions

Treatment group

  • Laparoscopic

Control group

  • Conventional/laparotomy

Other information

  • One consultant performed all operations

  • All patients received 2 g of vancomycin IV prior to surgery as prophylaxis

  • Dressings were applied to the same position for all patients in order to blind the ward staff to the technique used

Outcomes

  • Death

  • Peritonitis

  • Peritonitis rate

  • Catheter removal

  • Technique failure

  • Exit‐site infection: data was unclear for patient numbers and has been excluded at this stage

Notes

  • Four laparoscopic procedures were converted to conventional in theatre due to technical difficulties (3) and obesity (1)

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Low risk

"Sealed enveloped containing cards with 'laparoscopic" or "conventional". Cards stored in theatre anaesthetic room and one envelope opened after each patient was anaesthetized"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Low dropout rate (5/50)

Selective reporting (reporting bias)

Low risk

Most outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Xie 2011a

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: October 2006 and February 2008

  • Follow‐up period: Coiled (median: 31 months), straight (44 months); all patients are followed up until death, kidney, transplant, completion of CAPD or end of the study in December 2010, whichever came first

Participants

  • Country: China

  • Setting: single centre

  • Aged 18 to 80 years with presence of ESKD and initiated PD in the hospital; expected survival > 6 months

  • Number: treatment group (40); control group (40)

  • Mean age ± SD (years): treatment group (63 ± 13); control group (60 ± 13)

  • Sex (M/F): treatment group (24/16); control group (25/15)

  • Diabetes: treatment group (8/40); control group (8/40)

  • Exclusion criteria: unstable or poorly controlled CAD; severe congestive heart failure; severe chronic respiratory disease; malignant disease; clinically significant liver disease; AKI; psychiatric disease; previous abdominal surgery; pregnant or lactating women

Interventions

Treatment group

  • Double‐cuffed coiled Swan neck catheter

Control group

  • Double‐cuff straight‐end swan neck catheter (Quinton; straight group)

Outcomes

  • Catheter tip migration with dysfunction

  • All‐cause catheter failure: defined as necessity to remove or reposition the catheter by surgical methods

  • Catheter‐related infections: including peritonitis, exit‐site infection, and tunnel infection

  • Technique survival: defined as time to permanent transition to HD therapy

  • Overall patient survival

Notes

  • Funding source: "This work was supported by the National Basic Research Program of China 973 Program No. 2012CB517600 (No.2012CB517604), the National Natural Science Foundation of China (No. 81000295), Leading Academic Discipline Project of Shanghai Health Bureau (05III 001 and 2003ZD002) and Shanghai Leading Academic Discipline Project (T0201). Dr Xie is supported by the Schrier Family Fellowship from the International Society of Nephrology"

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer generated random numbers

Allocation concealment (selection bias)

Low risk

"Randomization was performed using sequentially numbered opaque sealed envelopes"

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Low dropout (1/80)

Selective reporting (reporting bias)

High risk

Not all the outcomes were reported

Other bias

Unclear risk

Insufficient information to permit judgement
Yip 2010

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: January 2001 onward

  • Follow‐up period: 24 month, mean duration of follow‐up was 18.9 ± 8.0 months

Participants

  • Country: Hong Kong, China

  • Setting: single centre

  • New patients entering chronic PD program

  • Number: treatment group (50); control group (51)

  • Mean age ± SD (years): treatment group (61.5 ± 14.9); control group (64.3 ± 13.7)

  • Sex (M/F): treatment group (30/20); control group (28/23)

  • Diabetes: not reported

  • Exclusion criteria: previous PD; patients requiring laparoscopic implantation of the PD catheter

Interventions

Treatment group

  • Conventional double‐cuffed Tenckhoff catheter with straight tunnel which was converted to an arcuate one using the triple incision method resulting in a downward directed exit

Control group

  • Swan neck catheter

Outcomes

  • Complications including leakage, wound bleeding, wound infection, catheter malposition

  • Exit‐site infection and peritonitis

  • Death (all causes)

Notes

  • The study end point was removal of the catheter or 24 months after implantation, whichever was earlier

  • Additional data requested from authors

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Low dropout rate (6/101)

Selective reporting (reporting bias)

Low risk

All the outcomes were reported

Other bias

Unclear risk

No prophylactic antibiotic for exit site. The study reported the procedures were performed by trained nephrologists in the unit, but unclear about the grade and training experience of the procedurists

Zhang 2016

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: January 2013 to December 2015

  • Follow‐up period: 6 months

Participants

  • Country: China

  • Setting: single centre

  • ESKD patients required RRT

  • Number: treatment group 1 (49); treatment group 2 (54); control group (49)

  • Mean age ± SD (years): treatment group 1 (55.9 ± 17.1); treatment group 2 (57.2 ± 16.6); control group (53.8 ± 19)

  • Sex (M/F): treatment group 1 (32/17); treatment group 2 (29/25); control group (31/18)

  • Diabetes: treatment group 1 (12/49); treatment group 2 (11/54); control group (13/49)

  • Exclusion criteria: contraindications for PD or refuse to choose PD

Interventions

Treatment group 1

  • Modified open surgery group

  • Lower position of catheter implantation; shorter length of intra‐abdominal catheter section which was set during operation based on a real‐time measurement of the distance between the peritoneal opening and the Douglas or rectovesical pouch

Treatment group 2

  • Modified open surgery with catheter fixation group

Control group

  • Traditional open surgery group

Outcomes

  • Catheter malfunction: defined as insufficient inflow and/or outflow of dialysate, including catheter tip migration and non‐migration problems, mainly refractory obstruction

  • Peritonitis, exit‐site and tunnel infections

  • Bleeding, leakage, inflow or outflow pain, hernia and delayed wound healing

Notes

  • Funding source: "This work was supported by The National Natural Science Foundation of China (81500537)"

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated random number table

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts

Selective reporting (reporting bias)

Low risk

All the outcomes were reported

Other bias

High risk

Percentage of patients with pervious abdominal surgery was appear to be higher than the other two modified surgery group (20.4% versus 10.2% and 13.0%)

Zhu 2015

Methods

  • Study design: parallel RCT

  • Study time frame/recruitment period: March 2010 and March 2013

  • Follow‐up period:12 months

Participants

  • Country: China

  • Setting: single centre

  • Patients diagnosed with CKD 5; aged < 70 years; no history of abdominal trauma or surgery (open group) while patients with history of appendectomy, nephrectomy, cholecystectomy and caesarean section can be included in “Mini‐Perc” group; no history of serious lung and chest disease; BMI < 25; can live independently

  • Number: treatment group (35); control group (37)

  • Mean age ± SD (years): treatment group (54.3 ± 16.2); control group (56.8 ± 14.7)

  • Sex (M/F): treatment group (21/14); control group (25/11)

  • Diabetes: treatment group (8/35); control group (10/37)

  • Exclusion criteria: serious abnormalities of coagulation tests; tumour, psychosis, drug addiction, alcoholism, and other special status

Interventions

Treatment group

  • Ureteroscope‐assisted “Mini‐Perc” technique

Control group

  • Modified open surgery

Outcomes

  • Success rate of procedure

  • Intra‐operative anaesthetic dose, the average operation time, the bleeding and blood transfusion rate

  • Catheter migration, catheter blockage, fluid leaking4.Infections of exit site or tunnel, and loss of function

Notes

  • Though it is RCT, there was some pre‐specified criteria eligible for each group "no history of abdominal trauma or surgery (open group) while patients with history of appendectomy, nephrectomy, cholecystectomy and caesarean section can be included in “Mini‐Perc” group"

  • Funding source: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement

Allocation concealment (selection bias)

Unclear risk

Quote: "Randomization was done on the day of intervention using the closed envelope method"

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Selective reporting (reporting bias)

Low risk

All the outcomes were reported

Other bias

High risk

Unequal baseline characteristics between groups, significantly more patients in the treatment had history of abdominal surgery

AKI ‐ acute kidney injury; APD ‐ automated peritoneal dialysis; BMI ‐ body mass index; CAD ‐ coronary artery disease; CAPD ‐ continuous ambulatory peritoneal dialysis; CKD ‐ chronic kidney disease; COPD ‐ chronic obstructive pulmonary disease; ESKD ‐ end‐stage kidney disease; HD ‐ haemodialysis; HIV ‐ human immunodeficiency virus; IQR ‐ interquartile range; IPD ‐ intermittent peritoneal dialysis; IV ‐ intravenous; M/F ‐ male/female; MI ‐ myocardial infarction; PD ‐ peritoneal dialysis; PKD ‐ polycystic kidney disease; RCT ‐ randomised controlled trial; RRT ‐ renal replacement therapy; WCC ‐ white cell count

Characteristics of excluded studies [ordered by study ID]

Ir a:

Study

Reason for exclusion

Crabtree 2003

Issues with randomisation: 5 patients entered the study twice, another 5 patients were not randomised

ISRCTN87054124

Study terminated due to recruitment issues

Moncrief 1994

Study terminated for incomplete recruitment

N0547061060

Unable to obtain sufficient information on the study type, populations or interventions to determine if the study meets all the review criteria

O'Dwyer 2005

Wrong intervention: compared two types of tunnelled HD catheters

Williams 1989

Wrong intervention: compared different methods of therapy for peritonitis

HD ‐ haemodialysis

Characteristics of studies awaiting assessment [ordered by study ID]

Ir a:

Ahmad 2010

Methods

  • Country: Mexico

  • Setting: single centre

  • Follow‐up period: 1 month post insertion

Participants

  • Total 136 patients who meet inclusion criteria were randomised

Interventions

Treatment group

  • Peritoneoscopic

Control group

  • Open surgery

Outcomes

  • Early complications including peritonitis, exit‐site/tunnel infection, leak, catheter block, migration

Notes

  • Unable to confirm whether the study is complete or not. Attempted to contact the authors for further information but unsuccessful

LOCI 2011

Methods

  • Multicentre RCT

Participants

  • All patients with an indication for PD

  • ≥ 18 years

Interventions

Treatment group

  • Laparoscopic

Control group

  • Open insertion

Outcomes

  • Catheter survival

  • QoL

Notes

  • Attempted to contact the authors for further information but unsuccessful
Wong 2004b

Methods

  • RCT

  • Drawing envelopes on the last day of antibiotic treatment

Participants

  • Patients who had peritonitis successfully treated with antibiotics

Interventions

Treatment group

  • Changing transfer set on relapse of bacterial peritonitis

Control group

  • No change of transfer set

Outcomes

  • relapsing peritonitis

Notes

  • Unable to contact the author for information. It is unlikely that the results will be published

PD ‐ peritoneal dialysis; QoL ‐ quality of life; RCT ‐ randomised controlled trial

Characteristics of ongoing studies [ordered by study ID]

Ir a:

NCT01023191

Trial name or title

A prospective randomized controlled trial of local anaesthetic percutaneous insertion versus general anaesthetic open surgical placement of continuous peritoneal dialysis catheters in a university teaching hospital

Methods

  • Study design: parallel RCT

  • Country: UK

  • Setting: single centre

Participants

Inclusion criteria

  • Patients referred to vascular consultants for CAPD catheter insertion

  • Ability to give informed written consent

Exclusion criteria

  • Previous abdominal surgery via midline incision

  • Unfit for general anaesthetic

  • Aged under 18 at time of referral

  • Inability to give informed written consent

  • Inability to attend follow up appointments

Interventions

Treatment group

  • Percutaneous Insertion catheter

Control group

  • Open insertion catheter

Outcomes

  • Catheter survival

  • Peri‐operative complications

  • Mechanical complications

  • Infective complications: exit‐site/tunnel infection, peritonitis

  • Length of admission

  • Patient‐reported pain post procedure

  • Operative time

Starting date

December 2011

Contact information

Contact: Ian C Chetter, MB ChB

Notes
NCT02479295

Trial name or title

Randomized controlled trial of straight versus coiled peritoneal dialysis

Methods

  • Study design: parallel RCT

  • Country: Hong Kong

Participants

Inclusion criteria

  • Requires dialysis catheter insertion for maintenance PD

  • Aged ≥ 18 years

  • Willingness to give written consent and comply with the study protocol

Exclusion criteria

  • Known contraindication to PD

  • Participation in another interventional study within last 30 days of randomisation

  • History of a psychological illness or condition that would interfere with the patient's ability to understand the requirement of the study and/or comply with the dialysis procedures

Interventions

Treatment group

  • Tenckhoff catheter with straight intra‐abdominal part

Control group

  • Tenckhoff catheter with coiled intra‐abdominal part

Outcomes

  • Catheter dysfunction required intervention

  • Time to catheter dysfunction

  • Infusion pain

  • Risk of peritonitis

  • Technique failure

  • Catheter survival

Starting date

June 2015

Contact information

Kai Ming Chow, MBChB, FRCP

Notes

PD ‐ peritoneal dialysis; RCT ‐ randomised controlled trial

Data and analyses

Open in table viewer
Comparison 1. Laparoscopy versus laparotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

4

315

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.59, 1.35]
Analysis 1.1
Comparison 1 Laparoscopy versus laparotomy, Outcome 1 Peritonitis.

Comparison 1 Laparoscopy versus laparotomy, Outcome 1 Peritonitis.

2 Peritonitis rate (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 1.2
Comparison 1 Laparoscopy versus laparotomy, Outcome 2 Peritonitis rate (patient‐months).

Comparison 1 Laparoscopy versus laparotomy, Outcome 2 Peritonitis rate (patient‐months).

3 Exit‐site/tunnel infection Show forest plot

3

270

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.43, 2.31]
Analysis 1.3
Comparison 1 Laparoscopy versus laparotomy, Outcome 3 Exit‐site/tunnel infection.

Comparison 1 Laparoscopy versus laparotomy, Outcome 3 Exit‐site/tunnel infection.

4 Catheter removal or replacement Show forest plot

3

167

Risk Ratio (M‐H, Random, 95% CI)

1.20 [0.77, 1.86]
Analysis 1.4
Comparison 1 Laparoscopy versus laparotomy, Outcome 4 Catheter removal or replacement.

Comparison 1 Laparoscopy versus laparotomy, Outcome 4 Catheter removal or replacement.

5 Technique failure Show forest plot

4

283

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.47, 1.08]
Analysis 1.5
Comparison 1 Laparoscopy versus laparotomy, Outcome 5 Technique failure.

Comparison 1 Laparoscopy versus laparotomy, Outcome 5 Technique failure.

6 Death (all causes) Show forest plot

3

270

Risk Ratio (M‐H, Random, 95% CI)

1.26 [0.72, 2.20]
Analysis 1.6
Comparison 1 Laparoscopy versus laparotomy, Outcome 6 Death (all causes).

Comparison 1 Laparoscopy versus laparotomy, Outcome 6 Death (all causes).

7 Dialysate leak Show forest plot

3

167

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.10, 6.97]
Analysis 1.7
Comparison 1 Laparoscopy versus laparotomy, Outcome 7 Dialysate leak.

Comparison 1 Laparoscopy versus laparotomy, Outcome 7 Dialysate leak.
Open in table viewer
Comparison 2. Buried (subcutaneous) versus non‐buried catheter

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis rate (patient‐months) Show forest plot

2

2511

Risk Ratio (M‐H, Random, 95% CI)

1.16 [0.37, 3.60]
Analysis 2.1
Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 1 Peritonitis rate (patient‐months).

Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 1 Peritonitis rate (patient‐months).

2 Exit‐site/tunnel infection rate (patient‐months) Show forest plot

2

2511

Risk Ratio (M‐H, Random, 95% CI)

1.15 [0.39, 3.42]
Analysis 2.2
Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 2 Exit‐site/tunnel infection rate (patient‐months).

Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 2 Exit‐site/tunnel infection rate (patient‐months).

3 Technique failure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 2.3
Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 3 Technique failure.

Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 3 Technique failure.

4 Death (all causes) Show forest plot

2

119

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.39, 2.08]
Analysis 2.4
Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 4 Death (all causes).

Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 4 Death (all causes).

Open in table viewer
Comparison 3. Midline versus lateral insertion

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

2

120

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.32, 1.33]
Analysis 3.1
Comparison 3 Midline versus lateral insertion, Outcome 1 Peritonitis.

Comparison 3 Midline versus lateral insertion, Outcome 1 Peritonitis.

2 Exit‐site/tunnel infection Show forest plot

2

120

Risk Ratio (M‐H, Random, 95% CI)

0.56 [0.12, 2.58]
Analysis 3.2
Comparison 3 Midline versus lateral insertion, Outcome 2 Exit‐site/tunnel infection.

Comparison 3 Midline versus lateral insertion, Outcome 2 Exit‐site/tunnel infection.

3 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 3.3
Comparison 3 Midline versus lateral insertion, Outcome 3 Catheter removal or replacement.

Comparison 3 Midline versus lateral insertion, Outcome 3 Catheter removal or replacement.

4 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 3.4
Comparison 3 Midline versus lateral insertion, Outcome 4 Death (all causes).

Comparison 3 Midline versus lateral insertion, Outcome 4 Death (all causes).
Open in table viewer
Comparison 4. Percutaneous insertion versus open surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Exit‐site/tunnel infection Show forest plot

2

96

Risk Ratio (M‐H, Random, 95% CI)

0.16 [0.02, 1.30]
Analysis 4.1
Comparison 4 Percutaneous insertion versus open surgery, Outcome 1 Exit‐site/tunnel infection.

Comparison 4 Percutaneous insertion versus open surgery, Outcome 1 Exit‐site/tunnel infection.

2 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 4.2
Comparison 4 Percutaneous insertion versus open surgery, Outcome 2 Catheter removal or replacement.

Comparison 4 Percutaneous insertion versus open surgery, Outcome 2 Catheter removal or replacement.

3 Postoperative bleed (haematoma or haemoperitoneum) Show forest plot

2

96

Risk Ratio (M‐H, Random, 95% CI)

0.22 [0.04, 1.26]
Analysis 4.3
Comparison 4 Percutaneous insertion versus open surgery, Outcome 3 Postoperative bleed (haematoma or haemoperitoneum).

Comparison 4 Percutaneous insertion versus open surgery, Outcome 3 Postoperative bleed (haematoma or haemoperitoneum).

Open in table viewer
Comparison 5. Straight versus coiled catheters

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

9

818

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.82, 1.31]
Analysis 5.1
Comparison 5 Straight versus coiled catheters, Outcome 1 Peritonitis.

Comparison 5 Straight versus coiled catheters, Outcome 1 Peritonitis.

2 Peritonitis rate (patient‐months) Show forest plot

5

5882

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.68, 1.21]
Analysis 5.2
Comparison 5 Straight versus coiled catheters, Outcome 2 Peritonitis rate (patient‐months).

Comparison 5 Straight versus coiled catheters, Outcome 2 Peritonitis rate (patient‐months).

3 Exit‐site/tunnel infection Show forest plot

10

826

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.94, 1.34]
Analysis 5.3
Comparison 5 Straight versus coiled catheters, Outcome 3 Exit‐site/tunnel infection.

Comparison 5 Straight versus coiled catheters, Outcome 3 Exit‐site/tunnel infection.

4 Exit‐site/tunnel infection rate (patient‐months) Show forest plot

4

5286

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.77, 1.43]
Analysis 5.4
Comparison 5 Straight versus coiled catheters, Outcome 4 Exit‐site/tunnel infection rate (patient‐months).

Comparison 5 Straight versus coiled catheters, Outcome 4 Exit‐site/tunnel infection rate (patient‐months).

5 Catheter removal or replacement Show forest plot

9

713

Risk Ratio (M‐H, Random, 95% CI)

1.11 [0.73, 1.66]
Analysis 5.5
Comparison 5 Straight versus coiled catheters, Outcome 5 Catheter removal or replacement.

Comparison 5 Straight versus coiled catheters, Outcome 5 Catheter removal or replacement.

6 Technique failure Show forest plot

4

442

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.51, 1.31]
Analysis 5.6
Comparison 5 Straight versus coiled catheters, Outcome 6 Technique failure.

Comparison 5 Straight versus coiled catheters, Outcome 6 Technique failure.

7 Death (all causes) Show forest plot

8

703

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.62, 1.46]
Analysis 5.7
Comparison 5 Straight versus coiled catheters, Outcome 7 Death (all causes).

Comparison 5 Straight versus coiled catheters, Outcome 7 Death (all causes).

8 Peritonitis (studies with low risk of attrition bias) Show forest plot

4

345

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.69, 1.26]
Analysis 5.8
Comparison 5 Straight versus coiled catheters, Outcome 8 Peritonitis (studies with low risk of attrition bias).

Comparison 5 Straight versus coiled catheters, Outcome 8 Peritonitis (studies with low risk of attrition bias).

9 Peritonitis rate (patient‐months) (studies with low risk of attrition bias) Show forest plot

3

1771

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.61, 1.35]
Analysis 5.9
Comparison 5 Straight versus coiled catheters, Outcome 9 Peritonitis rate (patient‐months) (studies with low risk of attrition bias).

Comparison 5 Straight versus coiled catheters, Outcome 9 Peritonitis rate (patient‐months) (studies with low risk of attrition bias).

10 Exit‐site/tunnel infection (studies with low risk of attrition bias) Show forest plot

6

425

Risk Ratio (M‐H, Random, 95% CI)

1.14 [0.94, 1.39]
Analysis 5.10
Comparison 5 Straight versus coiled catheters, Outcome 10 Exit‐site/tunnel infection (studies with low risk of attrition bias).

Comparison 5 Straight versus coiled catheters, Outcome 10 Exit‐site/tunnel infection (studies with low risk of attrition bias).

11 Exit‐site/tunnel infection rate (patient‐months) (studies with low risk of attrition bias) Show forest plot

2

1175

Risk Ratio (M‐H, Random, 95% CI)

1.18 [0.76, 1.82]
Analysis 5.11
Comparison 5 Straight versus coiled catheters, Outcome 11 Exit‐site/tunnel infection rate (patient‐months) (studies with low risk of attrition bias).

Comparison 5 Straight versus coiled catheters, Outcome 11 Exit‐site/tunnel infection rate (patient‐months) (studies with low risk of attrition bias).

12 Catheter removal or replacement (studies with low risk of attrition bias) Show forest plot

5

329

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.45, 1.33]
Analysis 5.12
Comparison 5 Straight versus coiled catheters, Outcome 12 Catheter removal or replacement (studies with low risk of attrition bias).

Comparison 5 Straight versus coiled catheters, Outcome 12 Catheter removal or replacement (studies with low risk of attrition bias).

13 Dialysate leak Show forest plot

7

550

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.16, 3.49]
Analysis 5.13
Comparison 5 Straight versus coiled catheters, Outcome 13 Dialysate leak.

Comparison 5 Straight versus coiled catheters, Outcome 13 Dialysate leak.

14 Postoperative bleeding (haematoma or haemoperitoneum) Show forest plot

4

358

Risk Ratio (M‐H, Random, 95% CI)

1.14 [0.24, 5.34]
Analysis 5.14
Comparison 5 Straight versus coiled catheters, Outcome 14 Postoperative bleeding (haematoma or haemoperitoneum).

Comparison 5 Straight versus coiled catheters, Outcome 14 Postoperative bleeding (haematoma or haemoperitoneum).

Open in table viewer
Comparison 6. Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

2

140

Risk Ratio (M‐H, Random, 95% CI)

1.29 [0.85, 1.96]
Analysis 6.1
Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 1 Peritonitis.

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 1 Peritonitis.

2 Peritonitis rate (patient‐months) Show forest plot

2

2535

Risk Ratio (M‐H, Random, 95% CI)

1.22 [0.54, 2.75]
Analysis 6.2
Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 2 Peritonitis rate (patient‐months).

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 2 Peritonitis rate (patient‐months).

3 Exit‐site/tunnel infection Show forest plot

2

140

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.77, 1.21]
Analysis 6.3
Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 3 Exit‐site/tunnel infection.

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 3 Exit‐site/tunnel infection.

4 Exit‐site/tunnel infection rate (patient‐months) Show forest plot

2

2535

Risk Ratio (M‐H, Random, 95% CI)

0.67 [0.50, 0.90]
Analysis 6.4
Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 4 Exit‐site/tunnel infection rate (patient‐months).

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 4 Exit‐site/tunnel infection rate (patient‐months).

5 Catheter removal or replacement Show forest plot

2

140

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.42, 1.72]
Analysis 6.5
Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 5 Catheter removal or replacement.

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 5 Catheter removal or replacement.

6 Technique failure Show forest plot

2

140

Risk Ratio (M‐H, Random, 95% CI)

0.64 [0.26, 1.58]
Analysis 6.6
Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 6 Technique failure.

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 6 Technique failure.

7 Death (all causes) Show forest plot

2

140

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.27, 2.03]
Analysis 6.7
Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 7 Death (all causes).

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 7 Death (all causes).

Open in table viewer
Comparison 7. Self‐locating catheter versus straight tenckhoff catheter

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 7.1
Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 1 Peritonitis.

Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 1 Peritonitis.

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 7.2
Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 2 Exit‐site/tunnel infection.

Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 2 Exit‐site/tunnel infection.

3 Catheter removal or replacement Show forest plot

2

139

Risk Ratio (M‐H, Random, 95% CI)

0.32 [0.03, 3.06]
Analysis 7.3
Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 3 Catheter removal or replacement.

Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 3 Catheter removal or replacement.

4 Technique failure Show forest plot

2

139

Risk Ratio (M‐H, Random, 95% CI)

0.64 [0.39, 1.04]
Analysis 7.4
Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 4 Technique failure.

Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 4 Technique failure.

5 Death (all causes) Show forest plot

2

139

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.11, 9.75]
Analysis 7.5
Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 5 Death (all causes).

Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 5 Death (all causes).

6 Dialysate leak Show forest plot

2

139

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.46, 2.35]
Analysis 7.6
Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 6 Dialysate leak.

Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 6 Dialysate leak.

Open in table viewer
Comparison 8. Open insertion with omentum folding versus open surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 8.1
Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 1 Peritonitis.

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 1 Peritonitis.

2 Peritonitis rate (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 8.2
Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 2 Peritonitis rate (patient‐months).

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 2 Peritonitis rate (patient‐months).

3 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 8.3
Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 3 Exit‐site/tunnel infection.

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 3 Exit‐site/tunnel infection.

4 Exit‐site/tunnel infection rate (patient‐month) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 8.4
Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 4 Exit‐site/tunnel infection rate (patient‐month).

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 4 Exit‐site/tunnel infection rate (patient‐month).

5 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 8.5
Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 5 Catheter removal or replacement.

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 5 Catheter removal or replacement.

6 Technique failure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 8.6
Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 6 Technique failure.

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 6 Technique failure.

7 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 8.7
Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 7 Death (all causes).

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 7 Death (all causes).

8 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 8.8
Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 8 Dialysate leak.

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 8 Dialysate leak.

9 Postoperative bleed (haematoma or haemoperitoneum) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 8.9
Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 9 Postoperative bleed (haematoma or haemoperitoneum).

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 9 Postoperative bleed (haematoma or haemoperitoneum).

Open in table viewer
Comparison 9. Modified surgery with or without catheter fixation versus open surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 9.1
Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 1 Peritonitis.

Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 1 Peritonitis.

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 9.2
Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 2 Exit‐site/tunnel infection.

Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 2 Exit‐site/tunnel infection.

3 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 9.3
Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 3 Catheter removal or replacement.

Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 3 Catheter removal or replacement.

4 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 9.4
Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 4 Dialysate leak.

Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 4 Dialysate leak.

5 Postoperative bleed (haematoma or haemoperitoneum) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 9.5
Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 5 Postoperative bleed (haematoma or haemoperitoneum).

Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 5 Postoperative bleed (haematoma or haemoperitoneum).

Open in table viewer
Comparison 10. Vertical tunnel‐based low‐site insertion versus open surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 10.1
Comparison 10 Vertical tunnel‐based low‐site insertion versus open surgery, Outcome 1 Peritonitis.

Comparison 10 Vertical tunnel‐based low‐site insertion versus open surgery, Outcome 1 Peritonitis.

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 10.2
Comparison 10 Vertical tunnel‐based low‐site insertion versus open surgery, Outcome 2 Exit‐site/tunnel infection.

Comparison 10 Vertical tunnel‐based low‐site insertion versus open surgery, Outcome 2 Exit‐site/tunnel infection.

Open in table viewer
Comparison 11. Ureteroscope‐assisted technique versus modified open surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 11.1
Comparison 11 Ureteroscope‐assisted technique versus modified open surgery, Outcome 1 Peritonitis.

Comparison 11 Ureteroscope‐assisted technique versus modified open surgery, Outcome 1 Peritonitis.

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 11.2
Comparison 11 Ureteroscope‐assisted technique versus modified open surgery, Outcome 2 Exit‐site/tunnel infection.

Comparison 11 Ureteroscope‐assisted technique versus modified open surgery, Outcome 2 Exit‐site/tunnel infection.

3 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 11.3
Comparison 11 Ureteroscope‐assisted technique versus modified open surgery, Outcome 3 Death (all causes).

Comparison 11 Ureteroscope‐assisted technique versus modified open surgery, Outcome 3 Death (all causes).

Open in table viewer
Comparison 12. Radiological versus surgical implantation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis rate (patient‐month) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 12.1
Comparison 12 Radiological versus surgical implantation, Outcome 1 Peritonitis rate (patient‐month).

Comparison 12 Radiological versus surgical implantation, Outcome 1 Peritonitis rate (patient‐month).

2 Exit‐site/tunnel infection (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 12.2
Comparison 12 Radiological versus surgical implantation, Outcome 2 Exit‐site/tunnel infection (patient‐months).

Comparison 12 Radiological versus surgical implantation, Outcome 2 Exit‐site/tunnel infection (patient‐months).

3 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 12.3
Comparison 12 Radiological versus surgical implantation, Outcome 3 Catheter removal or replacement.

Comparison 12 Radiological versus surgical implantation, Outcome 3 Catheter removal or replacement.

4 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 12.4
Comparison 12 Radiological versus surgical implantation, Outcome 4 Death (all causes).

Comparison 12 Radiological versus surgical implantation, Outcome 4 Death (all causes).

5 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 12.5
Comparison 12 Radiological versus surgical implantation, Outcome 5 Dialysate leak.

Comparison 12 Radiological versus surgical implantation, Outcome 5 Dialysate leak.
Open in table viewer
Comparison 13. Cystoscopy‐assisted surgery versus open surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 13.1
Comparison 13 Cystoscopy‐assisted surgery versus open surgery, Outcome 1 Peritonitis.

Comparison 13 Cystoscopy‐assisted surgery versus open surgery, Outcome 1 Peritonitis.

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 13.2
Comparison 13 Cystoscopy‐assisted surgery versus open surgery, Outcome 2 Exit‐site/tunnel infection.

Comparison 13 Cystoscopy‐assisted surgery versus open surgery, Outcome 2 Exit‐site/tunnel infection.

3 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 13.3
Comparison 13 Cystoscopy‐assisted surgery versus open surgery, Outcome 3 Dialysate leak.

Comparison 13 Cystoscopy‐assisted surgery versus open surgery, Outcome 3 Dialysate leak.

Open in table viewer
Comparison 14. Laparoscopic Moncrief‐Popovich versus Trocar technique

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 14.1
Comparison 14 Laparoscopic Moncrief‐Popovich versus Trocar technique, Outcome 1 Peritonitis.

Comparison 14 Laparoscopic Moncrief‐Popovich versus Trocar technique, Outcome 1 Peritonitis.

2 Exit‐site infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 14.2
Comparison 14 Laparoscopic Moncrief‐Popovich versus Trocar technique, Outcome 2 Exit‐site infection.

Comparison 14 Laparoscopic Moncrief‐Popovich versus Trocar technique, Outcome 2 Exit‐site infection.

3 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 14.3
Comparison 14 Laparoscopic Moncrief‐Popovich versus Trocar technique, Outcome 3 Dialysate leak.

Comparison 14 Laparoscopic Moncrief‐Popovich versus Trocar technique, Outcome 3 Dialysate leak.

Open in table viewer
Comparison 15. Single versus double cuff

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 15.1
Comparison 15 Single versus double cuff, Outcome 1 Peritonitis.

Comparison 15 Single versus double cuff, Outcome 1 Peritonitis.

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 15.2
Comparison 15 Single versus double cuff, Outcome 2 Exit‐site/tunnel infection.

Comparison 15 Single versus double cuff, Outcome 2 Exit‐site/tunnel infection.

3 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 15.3
Comparison 15 Single versus double cuff, Outcome 3 Catheter removal or replacement.

Comparison 15 Single versus double cuff, Outcome 3 Catheter removal or replacement.

4 Technique failure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 15.4
Comparison 15 Single versus double cuff, Outcome 4 Technique failure.

Comparison 15 Single versus double cuff, Outcome 4 Technique failure.

5 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 15.5
Comparison 15 Single versus double cuff, Outcome 5 Death (all causes).

Comparison 15 Single versus double cuff, Outcome 5 Death (all causes).
Open in table viewer
Comparison 16. Triple cuff versus double catheter

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 16.1
Comparison 16 Triple cuff versus double catheter, Outcome 1 Peritonitis.

Comparison 16 Triple cuff versus double catheter, Outcome 1 Peritonitis.

2 Peritonitis rate (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 16.2
Comparison 16 Triple cuff versus double catheter, Outcome 2 Peritonitis rate (patient‐months).

Comparison 16 Triple cuff versus double catheter, Outcome 2 Peritonitis rate (patient‐months).

3 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 16.3
Comparison 16 Triple cuff versus double catheter, Outcome 3 Exit‐site/tunnel infection.

Comparison 16 Triple cuff versus double catheter, Outcome 3 Exit‐site/tunnel infection.

4 Exit‐site/tunnel infection (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 16.4
Comparison 16 Triple cuff versus double catheter, Outcome 4 Exit‐site/tunnel infection (patient‐months).

Comparison 16 Triple cuff versus double catheter, Outcome 4 Exit‐site/tunnel infection (patient‐months).

5 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 16.5
Comparison 16 Triple cuff versus double catheter, Outcome 5 Catheter removal or replacement.

Comparison 16 Triple cuff versus double catheter, Outcome 5 Catheter removal or replacement.

6 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 16.6
Comparison 16 Triple cuff versus double catheter, Outcome 6 Dialysate leak.

Comparison 16 Triple cuff versus double catheter, Outcome 6 Dialysate leak.
Open in table viewer
Comparison 17. Swan‐neck versus straight curled catheter

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 17.1
Comparison 17 Swan‐neck versus straight curled catheter, Outcome 1 Peritonitis.

Comparison 17 Swan‐neck versus straight curled catheter, Outcome 1 Peritonitis.

2 Peritonitis rate (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 17.2
Comparison 17 Swan‐neck versus straight curled catheter, Outcome 2 Peritonitis rate (patient‐months).

Comparison 17 Swan‐neck versus straight curled catheter, Outcome 2 Peritonitis rate (patient‐months).

3 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 17.3
Comparison 17 Swan‐neck versus straight curled catheter, Outcome 3 Exit‐site/tunnel infection.

Comparison 17 Swan‐neck versus straight curled catheter, Outcome 3 Exit‐site/tunnel infection.

4 Exit‐site/tunnel infection rate (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 17.4
Comparison 17 Swan‐neck versus straight curled catheter, Outcome 4 Exit‐site/tunnel infection rate (patient‐months).

Comparison 17 Swan‐neck versus straight curled catheter, Outcome 4 Exit‐site/tunnel infection rate (patient‐months).

5 Technique failure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 17.5
Comparison 17 Swan‐neck versus straight curled catheter, Outcome 5 Technique failure.

Comparison 17 Swan‐neck versus straight curled catheter, Outcome 5 Technique failure.

6 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 17.6
Comparison 17 Swan‐neck versus straight curled catheter, Outcome 6 Dialysate leak.

Comparison 17 Swan‐neck versus straight curled catheter, Outcome 6 Dialysate leak.
Open in table viewer
Comparison 18. Antibiotic‐treated catheter versus none

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 18.1
Comparison 18 Antibiotic‐treated catheter versus none, Outcome 1 Peritonitis.

Comparison 18 Antibiotic‐treated catheter versus none, Outcome 1 Peritonitis.

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 18.2
Comparison 18 Antibiotic‐treated catheter versus none, Outcome 2 Exit‐site/tunnel infection.

Comparison 18 Antibiotic‐treated catheter versus none, Outcome 2 Exit‐site/tunnel infection.

3 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 18.3
Comparison 18 Antibiotic‐treated catheter versus none, Outcome 3 Catheter removal or replacement.

Comparison 18 Antibiotic‐treated catheter versus none, Outcome 3 Catheter removal or replacement.

4 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 18.4
Comparison 18 Antibiotic‐treated catheter versus none, Outcome 4 Death (all causes).

Comparison 18 Antibiotic‐treated catheter versus none, Outcome 4 Death (all causes).
Open in table viewer
Comparison 19. Immobilisation versus no immobilisation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 19.1
Comparison 19 Immobilisation versus no immobilisation, Outcome 1 Peritonitis.

Comparison 19 Immobilisation versus no immobilisation, Outcome 1 Peritonitis.

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 19.2
Comparison 19 Immobilisation versus no immobilisation, Outcome 2 Exit‐site/tunnel infection.

Comparison 19 Immobilisation versus no immobilisation, Outcome 2 Exit‐site/tunnel infection.

Open in table viewer
Comparison 20. Silver ring versus no silver ring

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 20.1
Comparison 20 Silver ring versus no silver ring, Outcome 1 Peritonitis.

Comparison 20 Silver ring versus no silver ring, Outcome 1 Peritonitis.

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 20.2
Comparison 20 Silver ring versus no silver ring, Outcome 2 Exit‐site/tunnel infection.

Comparison 20 Silver ring versus no silver ring, Outcome 2 Exit‐site/tunnel infection.

3 Technique failure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 20.3
Comparison 20 Silver ring versus no silver ring, Outcome 3 Technique failure.

Comparison 20 Silver ring versus no silver ring, Outcome 3 Technique failure.

4 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 20.4
Comparison 20 Silver ring versus no silver ring, Outcome 4 Death (all causes).

Comparison 20 Silver ring versus no silver ring, Outcome 4 Death (all causes).

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Comparison 1 Laparoscopy versus laparotomy, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 1.1

Comparison 1 Laparoscopy versus laparotomy, Outcome 1 Peritonitis.

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Comparison 1 Laparoscopy versus laparotomy, Outcome 2 Peritonitis rate (patient‐months).
Figuras y tablas -
Analysis 1.2

Comparison 1 Laparoscopy versus laparotomy, Outcome 2 Peritonitis rate (patient‐months).

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Comparison 1 Laparoscopy versus laparotomy, Outcome 3 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 1.3

Comparison 1 Laparoscopy versus laparotomy, Outcome 3 Exit‐site/tunnel infection.

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Comparison 1 Laparoscopy versus laparotomy, Outcome 4 Catheter removal or replacement.
Figuras y tablas -
Analysis 1.4

Comparison 1 Laparoscopy versus laparotomy, Outcome 4 Catheter removal or replacement.

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Comparison 1 Laparoscopy versus laparotomy, Outcome 5 Technique failure.
Figuras y tablas -
Analysis 1.5

Comparison 1 Laparoscopy versus laparotomy, Outcome 5 Technique failure.

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Comparison 1 Laparoscopy versus laparotomy, Outcome 6 Death (all causes).
Figuras y tablas -
Analysis 1.6

Comparison 1 Laparoscopy versus laparotomy, Outcome 6 Death (all causes).

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Comparison 1 Laparoscopy versus laparotomy, Outcome 7 Dialysate leak.
Figuras y tablas -
Analysis 1.7

Comparison 1 Laparoscopy versus laparotomy, Outcome 7 Dialysate leak.

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Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 1 Peritonitis rate (patient‐months).
Figuras y tablas -
Analysis 2.1

Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 1 Peritonitis rate (patient‐months).

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Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 2 Exit‐site/tunnel infection rate (patient‐months).
Figuras y tablas -
Analysis 2.2

Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 2 Exit‐site/tunnel infection rate (patient‐months).

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Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 3 Technique failure.
Figuras y tablas -
Analysis 2.3

Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 3 Technique failure.

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Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 4 Death (all causes).
Figuras y tablas -
Analysis 2.4

Comparison 2 Buried (subcutaneous) versus non‐buried catheter, Outcome 4 Death (all causes).

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Comparison 3 Midline versus lateral insertion, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 3.1

Comparison 3 Midline versus lateral insertion, Outcome 1 Peritonitis.

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Comparison 3 Midline versus lateral insertion, Outcome 2 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 3.2

Comparison 3 Midline versus lateral insertion, Outcome 2 Exit‐site/tunnel infection.

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Comparison 3 Midline versus lateral insertion, Outcome 3 Catheter removal or replacement.
Figuras y tablas -
Analysis 3.3

Comparison 3 Midline versus lateral insertion, Outcome 3 Catheter removal or replacement.

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Comparison 3 Midline versus lateral insertion, Outcome 4 Death (all causes).
Figuras y tablas -
Analysis 3.4

Comparison 3 Midline versus lateral insertion, Outcome 4 Death (all causes).

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Comparison 4 Percutaneous insertion versus open surgery, Outcome 1 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 4.1

Comparison 4 Percutaneous insertion versus open surgery, Outcome 1 Exit‐site/tunnel infection.

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Comparison 4 Percutaneous insertion versus open surgery, Outcome 2 Catheter removal or replacement.
Figuras y tablas -
Analysis 4.2

Comparison 4 Percutaneous insertion versus open surgery, Outcome 2 Catheter removal or replacement.

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Comparison 4 Percutaneous insertion versus open surgery, Outcome 3 Postoperative bleed (haematoma or haemoperitoneum).
Figuras y tablas -
Analysis 4.3

Comparison 4 Percutaneous insertion versus open surgery, Outcome 3 Postoperative bleed (haematoma or haemoperitoneum).

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Comparison 5 Straight versus coiled catheters, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 5.1

Comparison 5 Straight versus coiled catheters, Outcome 1 Peritonitis.

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Comparison 5 Straight versus coiled catheters, Outcome 2 Peritonitis rate (patient‐months).
Figuras y tablas -
Analysis 5.2

Comparison 5 Straight versus coiled catheters, Outcome 2 Peritonitis rate (patient‐months).

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Comparison 5 Straight versus coiled catheters, Outcome 3 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 5.3

Comparison 5 Straight versus coiled catheters, Outcome 3 Exit‐site/tunnel infection.

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Comparison 5 Straight versus coiled catheters, Outcome 4 Exit‐site/tunnel infection rate (patient‐months).
Figuras y tablas -
Analysis 5.4

Comparison 5 Straight versus coiled catheters, Outcome 4 Exit‐site/tunnel infection rate (patient‐months).

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Comparison 5 Straight versus coiled catheters, Outcome 5 Catheter removal or replacement.
Figuras y tablas -
Analysis 5.5

Comparison 5 Straight versus coiled catheters, Outcome 5 Catheter removal or replacement.

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Comparison 5 Straight versus coiled catheters, Outcome 6 Technique failure.
Figuras y tablas -
Analysis 5.6

Comparison 5 Straight versus coiled catheters, Outcome 6 Technique failure.

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Comparison 5 Straight versus coiled catheters, Outcome 7 Death (all causes).
Figuras y tablas -
Analysis 5.7

Comparison 5 Straight versus coiled catheters, Outcome 7 Death (all causes).

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Comparison 5 Straight versus coiled catheters, Outcome 8 Peritonitis (studies with low risk of attrition bias).
Figuras y tablas -
Analysis 5.8

Comparison 5 Straight versus coiled catheters, Outcome 8 Peritonitis (studies with low risk of attrition bias).

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Comparison 5 Straight versus coiled catheters, Outcome 9 Peritonitis rate (patient‐months) (studies with low risk of attrition bias).
Figuras y tablas -
Analysis 5.9

Comparison 5 Straight versus coiled catheters, Outcome 9 Peritonitis rate (patient‐months) (studies with low risk of attrition bias).

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Comparison 5 Straight versus coiled catheters, Outcome 10 Exit‐site/tunnel infection (studies with low risk of attrition bias).
Figuras y tablas -
Analysis 5.10

Comparison 5 Straight versus coiled catheters, Outcome 10 Exit‐site/tunnel infection (studies with low risk of attrition bias).

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Comparison 5 Straight versus coiled catheters, Outcome 11 Exit‐site/tunnel infection rate (patient‐months) (studies with low risk of attrition bias).
Figuras y tablas -
Analysis 5.11

Comparison 5 Straight versus coiled catheters, Outcome 11 Exit‐site/tunnel infection rate (patient‐months) (studies with low risk of attrition bias).

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Comparison 5 Straight versus coiled catheters, Outcome 12 Catheter removal or replacement (studies with low risk of attrition bias).
Figuras y tablas -
Analysis 5.12

Comparison 5 Straight versus coiled catheters, Outcome 12 Catheter removal or replacement (studies with low risk of attrition bias).

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Comparison 5 Straight versus coiled catheters, Outcome 13 Dialysate leak.
Figuras y tablas -
Analysis 5.13

Comparison 5 Straight versus coiled catheters, Outcome 13 Dialysate leak.

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Comparison 5 Straight versus coiled catheters, Outcome 14 Postoperative bleeding (haematoma or haemoperitoneum).
Figuras y tablas -
Analysis 5.14

Comparison 5 Straight versus coiled catheters, Outcome 14 Postoperative bleeding (haematoma or haemoperitoneum).

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Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 6.1

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 1 Peritonitis.

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Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 2 Peritonitis rate (patient‐months).
Figuras y tablas -
Analysis 6.2

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 2 Peritonitis rate (patient‐months).

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Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 3 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 6.3

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 3 Exit‐site/tunnel infection.

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Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 4 Exit‐site/tunnel infection rate (patient‐months).
Figuras y tablas -
Analysis 6.4

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 4 Exit‐site/tunnel infection rate (patient‐months).

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Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 5 Catheter removal or replacement.
Figuras y tablas -
Analysis 6.5

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 5 Catheter removal or replacement.

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Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 6 Technique failure.
Figuras y tablas -
Analysis 6.6

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 6 Technique failure.

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Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 7 Death (all causes).
Figuras y tablas -
Analysis 6.7

Comparison 6 Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck, Outcome 7 Death (all causes).

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Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 7.1

Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 1 Peritonitis.

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Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 2 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 7.2

Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 2 Exit‐site/tunnel infection.

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Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 3 Catheter removal or replacement.
Figuras y tablas -
Analysis 7.3

Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 3 Catheter removal or replacement.

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Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 4 Technique failure.
Figuras y tablas -
Analysis 7.4

Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 4 Technique failure.

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Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 5 Death (all causes).
Figuras y tablas -
Analysis 7.5

Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 5 Death (all causes).

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Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 6 Dialysate leak.
Figuras y tablas -
Analysis 7.6

Comparison 7 Self‐locating catheter versus straight tenckhoff catheter, Outcome 6 Dialysate leak.

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Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 8.1

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 1 Peritonitis.

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Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 2 Peritonitis rate (patient‐months).
Figuras y tablas -
Analysis 8.2

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 2 Peritonitis rate (patient‐months).

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Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 3 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 8.3

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 3 Exit‐site/tunnel infection.

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Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 4 Exit‐site/tunnel infection rate (patient‐month).
Figuras y tablas -
Analysis 8.4

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 4 Exit‐site/tunnel infection rate (patient‐month).

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Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 5 Catheter removal or replacement.
Figuras y tablas -
Analysis 8.5

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 5 Catheter removal or replacement.

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Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 6 Technique failure.
Figuras y tablas -
Analysis 8.6

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 6 Technique failure.

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Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 7 Death (all causes).
Figuras y tablas -
Analysis 8.7

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 7 Death (all causes).

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Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 8 Dialysate leak.
Figuras y tablas -
Analysis 8.8

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 8 Dialysate leak.

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Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 9 Postoperative bleed (haematoma or haemoperitoneum).
Figuras y tablas -
Analysis 8.9

Comparison 8 Open insertion with omentum folding versus open surgery, Outcome 9 Postoperative bleed (haematoma or haemoperitoneum).

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Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 9.1

Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 1 Peritonitis.

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Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 2 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 9.2

Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 2 Exit‐site/tunnel infection.

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Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 3 Catheter removal or replacement.
Figuras y tablas -
Analysis 9.3

Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 3 Catheter removal or replacement.

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Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 4 Dialysate leak.
Figuras y tablas -
Analysis 9.4

Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 4 Dialysate leak.

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Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 5 Postoperative bleed (haematoma or haemoperitoneum).
Figuras y tablas -
Analysis 9.5

Comparison 9 Modified surgery with or without catheter fixation versus open surgery, Outcome 5 Postoperative bleed (haematoma or haemoperitoneum).

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Comparison 10 Vertical tunnel‐based low‐site insertion versus open surgery, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 10.1

Comparison 10 Vertical tunnel‐based low‐site insertion versus open surgery, Outcome 1 Peritonitis.

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Comparison 10 Vertical tunnel‐based low‐site insertion versus open surgery, Outcome 2 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 10.2

Comparison 10 Vertical tunnel‐based low‐site insertion versus open surgery, Outcome 2 Exit‐site/tunnel infection.

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Comparison 11 Ureteroscope‐assisted technique versus modified open surgery, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 11.1

Comparison 11 Ureteroscope‐assisted technique versus modified open surgery, Outcome 1 Peritonitis.

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Comparison 11 Ureteroscope‐assisted technique versus modified open surgery, Outcome 2 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 11.2

Comparison 11 Ureteroscope‐assisted technique versus modified open surgery, Outcome 2 Exit‐site/tunnel infection.

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Comparison 11 Ureteroscope‐assisted technique versus modified open surgery, Outcome 3 Death (all causes).
Figuras y tablas -
Analysis 11.3

Comparison 11 Ureteroscope‐assisted technique versus modified open surgery, Outcome 3 Death (all causes).

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Comparison 12 Radiological versus surgical implantation, Outcome 1 Peritonitis rate (patient‐month).
Figuras y tablas -
Analysis 12.1

Comparison 12 Radiological versus surgical implantation, Outcome 1 Peritonitis rate (patient‐month).

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Comparison 12 Radiological versus surgical implantation, Outcome 2 Exit‐site/tunnel infection (patient‐months).
Figuras y tablas -
Analysis 12.2

Comparison 12 Radiological versus surgical implantation, Outcome 2 Exit‐site/tunnel infection (patient‐months).

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Comparison 12 Radiological versus surgical implantation, Outcome 3 Catheter removal or replacement.
Figuras y tablas -
Analysis 12.3

Comparison 12 Radiological versus surgical implantation, Outcome 3 Catheter removal or replacement.

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Comparison 12 Radiological versus surgical implantation, Outcome 4 Death (all causes).
Figuras y tablas -
Analysis 12.4

Comparison 12 Radiological versus surgical implantation, Outcome 4 Death (all causes).

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Comparison 12 Radiological versus surgical implantation, Outcome 5 Dialysate leak.
Figuras y tablas -
Analysis 12.5

Comparison 12 Radiological versus surgical implantation, Outcome 5 Dialysate leak.

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Comparison 13 Cystoscopy‐assisted surgery versus open surgery, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 13.1

Comparison 13 Cystoscopy‐assisted surgery versus open surgery, Outcome 1 Peritonitis.

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Comparison 13 Cystoscopy‐assisted surgery versus open surgery, Outcome 2 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 13.2

Comparison 13 Cystoscopy‐assisted surgery versus open surgery, Outcome 2 Exit‐site/tunnel infection.

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Comparison 13 Cystoscopy‐assisted surgery versus open surgery, Outcome 3 Dialysate leak.
Figuras y tablas -
Analysis 13.3

Comparison 13 Cystoscopy‐assisted surgery versus open surgery, Outcome 3 Dialysate leak.

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Comparison 14 Laparoscopic Moncrief‐Popovich versus Trocar technique, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 14.1

Comparison 14 Laparoscopic Moncrief‐Popovich versus Trocar technique, Outcome 1 Peritonitis.

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Comparison 14 Laparoscopic Moncrief‐Popovich versus Trocar technique, Outcome 2 Exit‐site infection.
Figuras y tablas -
Analysis 14.2

Comparison 14 Laparoscopic Moncrief‐Popovich versus Trocar technique, Outcome 2 Exit‐site infection.

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Comparison 14 Laparoscopic Moncrief‐Popovich versus Trocar technique, Outcome 3 Dialysate leak.
Figuras y tablas -
Analysis 14.3

Comparison 14 Laparoscopic Moncrief‐Popovich versus Trocar technique, Outcome 3 Dialysate leak.

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Comparison 15 Single versus double cuff, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 15.1

Comparison 15 Single versus double cuff, Outcome 1 Peritonitis.

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Comparison 15 Single versus double cuff, Outcome 2 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 15.2

Comparison 15 Single versus double cuff, Outcome 2 Exit‐site/tunnel infection.

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Comparison 15 Single versus double cuff, Outcome 3 Catheter removal or replacement.
Figuras y tablas -
Analysis 15.3

Comparison 15 Single versus double cuff, Outcome 3 Catheter removal or replacement.

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Comparison 15 Single versus double cuff, Outcome 4 Technique failure.
Figuras y tablas -
Analysis 15.4

Comparison 15 Single versus double cuff, Outcome 4 Technique failure.

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Comparison 15 Single versus double cuff, Outcome 5 Death (all causes).
Figuras y tablas -
Analysis 15.5

Comparison 15 Single versus double cuff, Outcome 5 Death (all causes).

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Comparison 16 Triple cuff versus double catheter, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 16.1

Comparison 16 Triple cuff versus double catheter, Outcome 1 Peritonitis.

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Comparison 16 Triple cuff versus double catheter, Outcome 2 Peritonitis rate (patient‐months).
Figuras y tablas -
Analysis 16.2

Comparison 16 Triple cuff versus double catheter, Outcome 2 Peritonitis rate (patient‐months).

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Comparison 16 Triple cuff versus double catheter, Outcome 3 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 16.3

Comparison 16 Triple cuff versus double catheter, Outcome 3 Exit‐site/tunnel infection.

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Comparison 16 Triple cuff versus double catheter, Outcome 4 Exit‐site/tunnel infection (patient‐months).
Figuras y tablas -
Analysis 16.4

Comparison 16 Triple cuff versus double catheter, Outcome 4 Exit‐site/tunnel infection (patient‐months).

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Comparison 16 Triple cuff versus double catheter, Outcome 5 Catheter removal or replacement.
Figuras y tablas -
Analysis 16.5

Comparison 16 Triple cuff versus double catheter, Outcome 5 Catheter removal or replacement.

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Comparison 16 Triple cuff versus double catheter, Outcome 6 Dialysate leak.
Figuras y tablas -
Analysis 16.6

Comparison 16 Triple cuff versus double catheter, Outcome 6 Dialysate leak.

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Comparison 17 Swan‐neck versus straight curled catheter, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 17.1

Comparison 17 Swan‐neck versus straight curled catheter, Outcome 1 Peritonitis.

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Comparison 17 Swan‐neck versus straight curled catheter, Outcome 2 Peritonitis rate (patient‐months).
Figuras y tablas -
Analysis 17.2

Comparison 17 Swan‐neck versus straight curled catheter, Outcome 2 Peritonitis rate (patient‐months).

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Comparison 17 Swan‐neck versus straight curled catheter, Outcome 3 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 17.3

Comparison 17 Swan‐neck versus straight curled catheter, Outcome 3 Exit‐site/tunnel infection.

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Comparison 17 Swan‐neck versus straight curled catheter, Outcome 4 Exit‐site/tunnel infection rate (patient‐months).
Figuras y tablas -
Analysis 17.4

Comparison 17 Swan‐neck versus straight curled catheter, Outcome 4 Exit‐site/tunnel infection rate (patient‐months).

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Comparison 17 Swan‐neck versus straight curled catheter, Outcome 5 Technique failure.
Figuras y tablas -
Analysis 17.5

Comparison 17 Swan‐neck versus straight curled catheter, Outcome 5 Technique failure.

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Comparison 17 Swan‐neck versus straight curled catheter, Outcome 6 Dialysate leak.
Figuras y tablas -
Analysis 17.6

Comparison 17 Swan‐neck versus straight curled catheter, Outcome 6 Dialysate leak.

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Comparison 18 Antibiotic‐treated catheter versus none, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 18.1

Comparison 18 Antibiotic‐treated catheter versus none, Outcome 1 Peritonitis.

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Comparison 18 Antibiotic‐treated catheter versus none, Outcome 2 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 18.2

Comparison 18 Antibiotic‐treated catheter versus none, Outcome 2 Exit‐site/tunnel infection.

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Comparison 18 Antibiotic‐treated catheter versus none, Outcome 3 Catheter removal or replacement.
Figuras y tablas -
Analysis 18.3

Comparison 18 Antibiotic‐treated catheter versus none, Outcome 3 Catheter removal or replacement.

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Comparison 18 Antibiotic‐treated catheter versus none, Outcome 4 Death (all causes).
Figuras y tablas -
Analysis 18.4

Comparison 18 Antibiotic‐treated catheter versus none, Outcome 4 Death (all causes).

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Comparison 19 Immobilisation versus no immobilisation, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 19.1

Comparison 19 Immobilisation versus no immobilisation, Outcome 1 Peritonitis.

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Comparison 19 Immobilisation versus no immobilisation, Outcome 2 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 19.2

Comparison 19 Immobilisation versus no immobilisation, Outcome 2 Exit‐site/tunnel infection.

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Comparison 20 Silver ring versus no silver ring, Outcome 1 Peritonitis.
Figuras y tablas -
Analysis 20.1

Comparison 20 Silver ring versus no silver ring, Outcome 1 Peritonitis.

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Comparison 20 Silver ring versus no silver ring, Outcome 2 Exit‐site/tunnel infection.
Figuras y tablas -
Analysis 20.2

Comparison 20 Silver ring versus no silver ring, Outcome 2 Exit‐site/tunnel infection.

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Comparison 20 Silver ring versus no silver ring, Outcome 3 Technique failure.
Figuras y tablas -
Analysis 20.3

Comparison 20 Silver ring versus no silver ring, Outcome 3 Technique failure.

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Comparison 20 Silver ring versus no silver ring, Outcome 4 Death (all causes).
Figuras y tablas -
Analysis 20.4

Comparison 20 Silver ring versus no silver ring, Outcome 4 Death (all causes).

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Summary of findings for the main comparison. Laparoscopy versus laparotomy for preventing catheter‐related infections in chronic peritoneal dialysis patients

Laparoscopy versus laparotomy for preventing catheter‐related infections in chronic peritoneal dialysis patients

Patient or population: chronic peritoneal dialysis patients
Intervention: laparoscopy
Comparison: laparotomy

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants or patient‐months
(studies)

Certainty of the evidence
(GRADE)

Risk with laparotomy

Risk with laparoscopy

Peritonitis

242 per 1,000

218 per 1,000
(143 to 327)

RR 0.90
(0.59 to 1.35)

315 (4)

⊕⊕⊕⊝
MODERATE 1

Peritonitis rate (patient‐months)

59 per 1,000

52 per 1,000
(23 to 122)

RR 0.89
(0.39 to 2.07)

375 (1)

⊕⊝⊝⊝
VERY LOW 2

Exit‐site/tunnel infection

125 per 1,000

125 per 1,000
(54 to 289)

RR 1.00
(0.43 to 2.31)

270 (3)

⊕⊕⊝⊝
LOW 3

Catheter removal or replacement

281 per 1,000

337 per 1,000
(216 to 522)

RR 1.20
(0.77 to 1.86)

167 (3)

⊕⊕⊝⊝
LOW 3

Technique failure

293 per 1,000

208 per 1,000
(137 to 316)

RR 0.71
(0.47 to 1.08)

283 (4)

⊕⊕⊝⊝
LOW 3

Death (all causes)

140 per 1,000

176 per 1,000
(101 to 307)

RR 1.26
(0.72 to 2.20)

270 (3)

⊕⊕⊕⊝
MODERATE 1

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Downgraded one level: suboptimal quality of studies

2 Downgraded two levels: single study with suboptimal quality and imprecision

3 Downgraded two levels: suboptimal quality and imprecision

Figuras y tablas -
Summary of findings for the main comparison. Laparoscopy versus laparotomy for preventing catheter‐related infections in chronic peritoneal dialysis patients
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Summary of findings 2. Buried (subcutaneous) versus non‐buried catheter for preventing catheter‐related infections in chronic peritoneal dialysis patients

Buried (subcutaneous) versus non‐buried catheter for preventing catheter‐related infections in chronic peritoneal dialysis patients

Patient or population: chronic peritoneal dialysis patients
Intervention: buried (subcutaneous) catheter
Comparison: non‐buried catheter

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants or patient‐months
(studies)

Certainty of the evidence
(GRADE)

Risk with non‐buried

Risk with buried (subcutaneous)

Peritonitis rate (patient‐months)

37 per 1,000

43 per 1,000
(14 to 133)

RR 1.16
(0.37 to 3.60)

2511 (2)

⊕⊝⊝⊝
VERY LOW 1

Exit‐site/tunnel infection rate (patient‐months)

31 per 1,000

36 per 1,000
(12 to 106)

RR 1.15
(0.39 to 3.42)

2511 (2)

⊕⊝⊝⊝
VERY LOW 1

Technique failure

367 per 1,000

268 per 1,000
(125 to 568)

RR 0.73
(0.34 to 1.55)

60 (1)

⊕⊝⊝⊝
VERY LOW 2

Death (all causes)

169 per 1,000

153 per 1,000
(66 to 353)

RR 0.90
(0.39 to 2.08)

119 (2)

⊕⊕⊕⊝
MODERATE 3

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Downgraded three levels: suboptimal quality, inconsistency, and imprecision

2 Downgraded three levels: single study, suboptimal quality, and imprecision

3 Downgraded two levels: suboptimal quality of studies and imprecision

Figuras y tablas -
Summary of findings 2. Buried (subcutaneous) versus non‐buried catheter for preventing catheter‐related infections in chronic peritoneal dialysis patients
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Summary of findings 3. Midline versus lateral insertion for preventing catheter‐related infections in chronic peritoneal dialysis patients

Midline versus lateral insertion for preventing catheter‐related infections in chronic peritoneal dialysis patients

Patient or population: chronic peritoneal dialysis patients
Intervention: midline insertion
Comparison: lateral insertion

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Certainty of the evidence
(GRADE)

Risk with lateral

Risk with midline

Peritonitis

255 per 1,000

166 per 1,000
(82 to 339)

RR 0.65
(0.32 to 1.33)

120 (2)

⊕⊕⊕⊝
MODERATE 1

Exit‐site/tunnel infection

78 per 1,000

44 per 1,000
(9 to 202)

RR 0.56
(0.12 to 2.58)

120 (2)

⊕⊕⊝⊝
LOW 2

Catheter removal or replacement

514 per 1,000

293 per 1,000
(170 to 504)

RR 0.57
(0.33 to 0.98)

83 (1)

⊕⊝⊝⊝

VERY LOW 3

Death (all causes)

0 per 1,000

0 per 1,000
(0 to 0)

RR 8.50
(0.50 to 143.32)

37 (1)

⊕⊝⊝⊝
VERY LOW 3

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Downgraded one level: suboptimal quality of studies

2 Downgraded two levels: suboptimal quality and imprecision

3 Downgraded three levels: single study, suboptimal quality study, and imprecision

Figuras y tablas -
Summary of findings 3. Midline versus lateral insertion for preventing catheter‐related infections in chronic peritoneal dialysis patients
Ir a la tabla de la revisión
Summary of findings 4. Percutaneous insertion versus open surgery for preventing catheter‐related infections in chronic peritoneal dialysis patients

Percutaneous insertion versus open surgery for preventing catheter‐related infections in chronic peritoneal dialysis patients

Patient or population: chronic peritoneal dialysis patients
Intervention: percutaneous insertion
Comparison: open surgery

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Certainty of the evidence
(GRADE)

Risk with open surgery

Risk with percutaneous insertion

Exit‐site/tunnel infection

106 per 1,000

17 per 1,000
(2 to 138)

RR 0.16
(0.02 to 1.30)

96
(2 RCTs)

⊕⊕⊕⊝
MODERATE 1

Catheter removal or replacement

133 per 1,000

32 per 1,000
(4 to 272)

RR 0.24
(0.03 to 2.04)

61
(1 RCT)

⊕⊝⊝⊝
VERY LOW 2

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Downgraded one level: suboptimal quality of studies

2 Downgraded two levels: single study with suboptimal quality and imprecision

Figuras y tablas -
Summary of findings 4. Percutaneous insertion versus open surgery for preventing catheter‐related infections in chronic peritoneal dialysis patients
Ir a la tabla de la revisión
Summary of findings 5. Straight versus coiled catheters for preventing catheter‐related infections in chronic peritoneal dialysis patients

Straight versus coiled catheters for preventing catheter‐related infections in chronic peritoneal dialysis patients

Patient or population: chronic peritoneal dialysis patients
Intervention: straight
Comparison: coiled

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants or patient‐months
(studies)

Certainty of the evidence
(GRADE)

Risk with coiled

Risk with straight

Peritonitis

217 per 1,000

225 per 1,000
(178 to 284)

RR 1.04
(0.82 to 1.31)

818 (9)

⊕⊕⊕⊝
MODERATE 1

Peritonitis rate (patient‐months)

32 per 1,000

29 per 1,000
(22 to 39)

RR 0.91
(0.68 to 1.21)

5882 (5)

⊕⊕⊕⊝
MODERATE 1

Exit‐site/tunnel infection

281 per 1,000

314 per 1,000
(264 to 376)

RR 1.12
(0.94 to 1.34)

826 (10)

⊕⊕⊕⊝
MODERATE 1

Exit‐site/tunnel infection rate (patient‐months)

27 per 1,000

28 per 1,000
(21 to 39)

RR 1.05
(0.77 to 1.43)

5286 (4)

⊕⊕⊕⊝
MODERATE 1

Catheter removal or replacement

249 per 1,000

276 per 1,000
(181 to 413)

RR 1.11
(0.73 to 1.66)

713 (9)

⊕⊝⊝⊝
VERY LOW 1 2 3

Technique failure

131 per 1,000

108 per 1,000
(67 to 172)

RR 0.82
(0.51 to 1.31)

442 (4)

⊕⊕⊕⊝
MODERATE 1

Death (all causes)

124 per 1,000

117 per 1,000
(77 to 180)

RR 0.95
(0.62 to 1.46)

703 (8)

⊕⊕⊝⊝
LOW 1 3

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Downgraded one level: most studies are of suboptimal quality

2 Downgrade one level: inconsistency

3 Downgraded one level: publication bias

Figuras y tablas -
Summary of findings 5. Straight versus coiled catheters for preventing catheter‐related infections in chronic peritoneal dialysis patients
Ir a la tabla de la revisión
Summary of findings 6. Tenckhoff catheter with artificial curve at tunnel tract versus swan‐neck for preventing catheter‐related infections in chronic peritoneal dialysis patients

Tenckhoff catheter with artificial curve at tunnel tract versus swan‐neck for preventing catheter‐related infections in chronic peritoneal dialysis patients

Patient or population: preventing catheter‐related infections in chronic peritoneal dialysis patients
Intervention: Tenckhoff catheter with artificial curve at tunnel tract
Comparison: swan‐neck

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants or patient‐months
(studies)

Certainty of the evidence
(GRADE)

Risk with swan‐neck

Risk with Tenckhoff

Peritonitis

329 per 1,000

424 per 1,000
(279 to 644)

RR 1.29
(0.85 to 1.96)

140 (2)

⊕⊕⊝⊝
LOW 1

Peritonitis rate (patient‐months)

47 per 1,000

57 per 1,000
(25 to 129)

RR 1.22
(0.54 to 2.75)

2535 (2)

⊕⊕⊝⊝
LOW 2

Exit‐site/tunnel infection

671 per 1,000

645 per 1,000
(517 to 812)

RR 0.96
(0.77 to 1.21)

140 (2)

⊕⊕⊕⊝
MODERATE 3

Exit‐site/tunnel infection rate (patient‐months)

83 per 1,000

55 per 1,000
(41 to 74)

RR 0.67
(0.50 to 0.90)

2535 (2)

⊕⊕⊕⊝
MODERATE 3

Catheter removal or replacement

229 per 1,000

194 per 1,000
(96 to 393)

RR 0.85
(0.42 to 1.72)

140 (2)

⊕⊕⊕⊝
MODERATE 3

Technique failure

157 per 1,000

101 per 1,000
(41 to 248)

RR 0.64
(0.26 to 1.58)

140 (2)

⊕⊕⊕⊝
MODERATE 3

Death (all causes)

114 per 1,000

85 per 1,000
(31 to 232)

RR 0.74
(0.27 to 2.03)

140 (2)

⊕⊕⊝⊝
LOW 1

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Downgraded two levels: suboptimal quality of studies and imprecision

2 Downgraded two levels: suboptimal quality of studies and inconsistency

3 Downgraded one level: suboptimal quality of studies

Figuras y tablas -
Summary of findings 6. Tenckhoff catheter with artificial curve at tunnel tract versus swan‐neck for preventing catheter‐related infections in chronic peritoneal dialysis patients
Ir a la tabla de la revisión
Summary of findings 7. Self‐locating versus straight Tenckhoff catheter for preventing catheter‐related infections in chronic peritoneal dialysis patients

Self‐locating versus straight Tenckhoff catheter for preventing catheter‐related infections in chronic peritoneal dialysis patients

Patient or population: chronic peritoneal dialysis patients
Intervention: self‐locating catheter
Comparison: straight Tenckhoff catheter

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Certainty of the evidence
(GRADE)

Risk with straight Tenckhoff

Risk with self‐locating

Peritonitis

684 per 1,000

773 per 1,000
(588 to 1,000)

RR 1.13
(0.86 to 1.49)

78 (1)

⊕⊝⊝⊝
VERY LOW 1

Exit‐site/tunnel infection

184 per 1,000

175 per 1,000
(68 to 451)

RR 0.95
(0.37 to 2.45)

78 (1)

⊕⊝⊝⊝
VERY LOW 1

Catheter removal or replacement

343 per 1,000

110 per 1,000
(10 to 1,000)

RR 0.32
(0.03 to 3.06)

139 (2)

⊕⊝⊝⊝
VERY LOW 2

Technique failure

414 per 1,000

265 per 1,000
(162 to 431)

RR 0.64
(0.39 to 1.04)

139 (2)

⊕⊕⊕⊝
MODERATE 3

Death (all causes)

71 per 1,000

73 per 1,000
(8 to 696)

RR 1.02
(0.11 to 9.75)

139 (2)

⊕⊕⊝⊝
LOW 4

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Downgraded three levels: single study, suboptimal quality, and imprecision

2 Downgraded three levels: suboptimal quality, imprecision and inconsistency

3 Downgraded one level: suboptimal quality of study

4 Downgraded two levels: suboptimal quality and imprecision

Figuras y tablas -
Summary of findings 7. Self‐locating versus straight Tenckhoff catheter for preventing catheter‐related infections in chronic peritoneal dialysis patients
Ir a la tabla de la revisión
Table 1. Adverse events

Study ID

Intervention
group

Control group

Events

Total

Events

Total

Haematoma or haemoperitoneum

Atapour 2011

1

31

4

30

Chen 2014a

7

34

4

32

Sanchez‐Canel 2016

7

40

6

38

Al‐Hwiesh 2016

0

36

0

37

Merrikhi 2014

0

18

2

17

Ouyang 2015

3

99

2

90

Eklund 1994

0

20

0

20

Eklund 1995

0

20

0

20

Li 2009e

14

20

22

19

Rubin 1990

1

48

1

35

Scott 1994

0

30

1

59

Zhang 2016

1

103

0

49

Dialysate leak

Chen 2014a

2

34

1

32

Sanchez‐Canel 2016

9

40

7

38

Jwo 2010

7

40

6

37

Atapour 2011

1

31

1

30

Al‐Hwiesh 2016

2

36

3

37

Akcicek 1995

2

10

4

12

Akyol 1990

0

20

2

20

Eklund 1994

0

20

4

20

Eklund 1995

0

20

0

20

Nielsen 1995

1

38

0

34

Ouyang 2015

0

99

3

90

Qian 2014

0

14

1

15

Rubin 1990

6

48

3

35

Scott 1994

2

30

0

59

Stegmayr 2015

1

29

3

32

Voss 2012

4

57

10

56

Winch 2000

2

11

0

11

Wright 1999

2

21

0

24

Xie 2011a

1

40

0

40

Yip 2010

0

50

0

51

Zhang 2016

0

103

1

49

Viscus perforation

Nielsen 1995 (bladder perforation)

0

38

1

34

Al‐Hwiesh 2016 (bowel perforation)

0

36

0

37

Merrikhi 2014 (hollow viscus perforation)

0

18

0

17

Atapour 2011

0

31

0

30

Outflow failure or catheter tip migration

Atapour 2011

1

31

4

30

Li 2009e

2

20

1

19

Sanchez‐Canel 2016

12

40

25

38

Voss 2012

3

57

4

56

Al‐Hwiesh 2016

1

36

11

37

Scott 1994

1

30

2

59

Lye 1996

3

20

1

20

Qian 2014

0

14

1

15

Akcicek 1995

1

10

3

12

Winch 2000

1

11

1

11

Hernia

Chen 2014a

0

34

1

32

Jwo 2010

2

40

1

37

Sanchez‐Canel 2016

7

40

7

38

Ouyang 2015

4

99

6

90

Xie 2011a

2

40

2

40

Voss 2012

4

57

8

56

Zhang 2016

0

103

1

49
Figuras y tablas -
Table 1. Adverse events
Ir a la tabla de la revisión
Table 2. Methods of insertion, catheter types and other interventions on the incidence of peritonitis and peritonitis rate

Name of studies

Relative risk

95% CI

P value

Peritonitis

Methods of catheter implantation

Chen 2014a

1.41

0.25 to 7.91

0.69

Turner 1992

1.20

0.59 to 2.42

0.61

Sun 2015a

0.93

0.48 to 1.80

0.82

Zhang 2016

0.39

0.11 to 1.42

0.15

Zhu 2015

0.81

0.41 to 1.61

0.55

Qian 2014

0.21

0.03 to 1.61

0.13

Akcicek 1995

0.60

0.20 to 1.81

0.36

Types of catheter

Eklund 1997

0.82

0.50 to 1.35

0.44

Al‐Hwiesh 2016

0.34

0.07 to 1.59

0.17

Winch 2000

0.80

0.29 to 2.21

0.67

Trooskin 1990

0.78

0.6 to 1.69

0.53

Other intervention

SIPROCE 1997

0.90

0.49 to 1.66

0.73

Turner 1992

1.20

0.59 to 2.42

0.61

Peritonitis rate (patient‐month)

Methods of catheter implantation

Chen 2014a

1.40

0.23 to 8.34

0.71

Voss 2012

0.67

0.38 to 1.18

0.16

Types of catheters

Al‐Hwiesh 2016

0.34

0.07 to 1.69

0.19

Winch 2000

0.69

0.19 to 2.53

0.57

CI: confidence interval
Figuras y tablas -
Table 2. Methods of insertion, catheter types and other interventions on the incidence of peritonitis and peritonitis rate
Ir a la tabla de la revisión
Comparison 1. Laparoscopy versus laparotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

4

315

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.59, 1.35]

2 Peritonitis rate (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Exit‐site/tunnel infection Show forest plot

3

270

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.43, 2.31]

4 Catheter removal or replacement Show forest plot

3

167

Risk Ratio (M‐H, Random, 95% CI)

1.20 [0.77, 1.86]

5 Technique failure Show forest plot

4

283

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.47, 1.08]

6 Death (all causes) Show forest plot

3

270

Risk Ratio (M‐H, Random, 95% CI)

1.26 [0.72, 2.20]

7 Dialysate leak Show forest plot

3

167

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.10, 6.97]
Figuras y tablas -
Comparison 1. Laparoscopy versus laparotomy
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Comparison 2. Buried (subcutaneous) versus non‐buried catheter

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis rate (patient‐months) Show forest plot

2

2511

Risk Ratio (M‐H, Random, 95% CI)

1.16 [0.37, 3.60]

2 Exit‐site/tunnel infection rate (patient‐months) Show forest plot

2

2511

Risk Ratio (M‐H, Random, 95% CI)

1.15 [0.39, 3.42]

3 Technique failure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Death (all causes) Show forest plot

2

119

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.39, 2.08]
Figuras y tablas -
Comparison 2. Buried (subcutaneous) versus non‐buried catheter
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Comparison 3. Midline versus lateral insertion

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

2

120

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.32, 1.33]

2 Exit‐site/tunnel infection Show forest plot

2

120

Risk Ratio (M‐H, Random, 95% CI)

0.56 [0.12, 2.58]

3 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 3. Midline versus lateral insertion
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Comparison 4. Percutaneous insertion versus open surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Exit‐site/tunnel infection Show forest plot

2

96

Risk Ratio (M‐H, Random, 95% CI)

0.16 [0.02, 1.30]

2 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Postoperative bleed (haematoma or haemoperitoneum) Show forest plot

2

96

Risk Ratio (M‐H, Random, 95% CI)

0.22 [0.04, 1.26]
Figuras y tablas -
Comparison 4. Percutaneous insertion versus open surgery
Ir a la tabla de la revisión
Comparison 5. Straight versus coiled catheters

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

9

818

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.82, 1.31]

2 Peritonitis rate (patient‐months) Show forest plot

5

5882

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.68, 1.21]

3 Exit‐site/tunnel infection Show forest plot

10

826

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.94, 1.34]

4 Exit‐site/tunnel infection rate (patient‐months) Show forest plot

4

5286

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.77, 1.43]

5 Catheter removal or replacement Show forest plot

9

713

Risk Ratio (M‐H, Random, 95% CI)

1.11 [0.73, 1.66]

6 Technique failure Show forest plot

4

442

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.51, 1.31]

7 Death (all causes) Show forest plot

8

703

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.62, 1.46]

8 Peritonitis (studies with low risk of attrition bias) Show forest plot

4

345

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.69, 1.26]

9 Peritonitis rate (patient‐months) (studies with low risk of attrition bias) Show forest plot

3

1771

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.61, 1.35]

10 Exit‐site/tunnel infection (studies with low risk of attrition bias) Show forest plot

6

425

Risk Ratio (M‐H, Random, 95% CI)

1.14 [0.94, 1.39]

11 Exit‐site/tunnel infection rate (patient‐months) (studies with low risk of attrition bias) Show forest plot

2

1175

Risk Ratio (M‐H, Random, 95% CI)

1.18 [0.76, 1.82]

12 Catheter removal or replacement (studies with low risk of attrition bias) Show forest plot

5

329

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.45, 1.33]

13 Dialysate leak Show forest plot

7

550

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.16, 3.49]

14 Postoperative bleeding (haematoma or haemoperitoneum) Show forest plot

4

358

Risk Ratio (M‐H, Random, 95% CI)

1.14 [0.24, 5.34]
Figuras y tablas -
Comparison 5. Straight versus coiled catheters
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Comparison 6. Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

2

140

Risk Ratio (M‐H, Random, 95% CI)

1.29 [0.85, 1.96]

2 Peritonitis rate (patient‐months) Show forest plot

2

2535

Risk Ratio (M‐H, Random, 95% CI)

1.22 [0.54, 2.75]

3 Exit‐site/tunnel infection Show forest plot

2

140

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.77, 1.21]

4 Exit‐site/tunnel infection rate (patient‐months) Show forest plot

2

2535

Risk Ratio (M‐H, Random, 95% CI)

0.67 [0.50, 0.90]

5 Catheter removal or replacement Show forest plot

2

140

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.42, 1.72]

6 Technique failure Show forest plot

2

140

Risk Ratio (M‐H, Random, 95% CI)

0.64 [0.26, 1.58]

7 Death (all causes) Show forest plot

2

140

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.27, 2.03]
Figuras y tablas -
Comparison 6. Tenckhoff catheter with artificial curve at tunnel tract versus Swan‐neck
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Comparison 7. Self‐locating catheter versus straight tenckhoff catheter

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Catheter removal or replacement Show forest plot

2

139

Risk Ratio (M‐H, Random, 95% CI)

0.32 [0.03, 3.06]

4 Technique failure Show forest plot

2

139

Risk Ratio (M‐H, Random, 95% CI)

0.64 [0.39, 1.04]

5 Death (all causes) Show forest plot

2

139

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.11, 9.75]

6 Dialysate leak Show forest plot

2

139

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.46, 2.35]
Figuras y tablas -
Comparison 7. Self‐locating catheter versus straight tenckhoff catheter
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Comparison 8. Open insertion with omentum folding versus open surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Peritonitis rate (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Exit‐site/tunnel infection rate (patient‐month) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

5 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

6 Technique failure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

7 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

8 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

9 Postoperative bleed (haematoma or haemoperitoneum) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 8. Open insertion with omentum folding versus open surgery
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Comparison 9. Modified surgery with or without catheter fixation versus open surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

5 Postoperative bleed (haematoma or haemoperitoneum) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 9. Modified surgery with or without catheter fixation versus open surgery
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Comparison 10. Vertical tunnel‐based low‐site insertion versus open surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 10. Vertical tunnel‐based low‐site insertion versus open surgery
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Comparison 11. Ureteroscope‐assisted technique versus modified open surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 11. Ureteroscope‐assisted technique versus modified open surgery
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Comparison 12. Radiological versus surgical implantation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis rate (patient‐month) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit‐site/tunnel infection (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

5 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 12. Radiological versus surgical implantation
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Comparison 13. Cystoscopy‐assisted surgery versus open surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 13. Cystoscopy‐assisted surgery versus open surgery
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Comparison 14. Laparoscopic Moncrief‐Popovich versus Trocar technique

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit‐site infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 14. Laparoscopic Moncrief‐Popovich versus Trocar technique
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Comparison 15. Single versus double cuff

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Technique failure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

5 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 15. Single versus double cuff
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Comparison 16. Triple cuff versus double catheter

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Peritonitis rate (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Exit‐site/tunnel infection (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

5 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

6 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 16. Triple cuff versus double catheter
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Comparison 17. Swan‐neck versus straight curled catheter

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Peritonitis rate (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Exit‐site/tunnel infection rate (patient‐months) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

5 Technique failure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

6 Dialysate leak Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 17. Swan‐neck versus straight curled catheter
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Comparison 18. Antibiotic‐treated catheter versus none

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Catheter removal or replacement Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 18. Antibiotic‐treated catheter versus none
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Comparison 19. Immobilisation versus no immobilisation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 19. Immobilisation versus no immobilisation
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Comparison 20. Silver ring versus no silver ring

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit‐site/tunnel infection Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Technique failure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Death (all causes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 20. Silver ring versus no silver ring
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