Different outcomes between downward and lateral peritoneal dialysis catheter exit-site directions

The International Society for Peritoneal Dialysis guidelines suggest lateral or downward exit positions for peritoneal dialysis (PD) catheter. In cases with straight inter-cuff design (used in Thailand), downward exit may lead to more complications due to catheter memory force. We compared lateral (lateral group) and downward (downward group) exits in PD patients.

We retrospectively studied end-stage kidney disease patients with PD catheters from 2011 to 2021 at Chao Phraya Abhaibhubejhr Hospital, Thailand. We analysed catheter malfunction, exit-site infection (ESI) and patient survival.

A total of 425 patients, aged 11–87 years (57% female and 59% with diabetes mellitus). 326 had downward exits, and 99 had lateral exits. Both groups had similar 2-years patient survival (p = 0.592), 1-year survival catheter dysfunction requiring removal (p = 0.146) and First-year ESI (p = 0.432). In the lateral exit group, the percent of catheter dysfunction requiring removal was slightly lower (1.01 vs. 3.99, p = 0.204) while the percent of patient with ESI at first year was slightly higher (8.08 vs. 6.13, p = 0.494) compared to downward exit group.

Lateral exit and downward exit with a straight inter-cuff design have similar outcome of catheter survival/function, exit site infection and patient survival. Lateral exit site is a good option in context of a straight inter-cuff design.