Negative-pressure wound therapy is effective for peritoneal dialysis catheter exit-site management in the early postoperative period

Abstract

Peritoneal dialysis (PD) catheter exit-site care is critically important for the prevention of catheter-related infections (CRIs) and subsequent peritonitis. The postoperative management of the site is particularly essential because it has an open wound that is always adjacent to a PD catheter tube. This study aimed to examine the effectiveness of negative-pressure wound therapy (NPWT) for postoperative PD catheter exit sites. Thirty patients with end-stage renal disease who underwent simultaneous PD catheter insertion and exit-site formation were randomly assigned to receive NPWT (NPWT group) or conventional dressing (non-NPWT group) for the first seven postoperative days. The exit-site scores on the seventh postoperative day was lower in the NPWT group than in the non-NPWT group (p = 0.0049). Analysis of variance F statistic for the effect of NPWT over 180 days was highly significant (11.482595, p = 0.007). There were no statistically significant differences between the time to first CRI and PD-related peritonitis between the two groups. There was one case of CRI with relapsing peritonitis and catheter loss in the non-NPWT group. These findings demonstrate the association between NPWT and low exit-site score. NPWT can be recommended for the management of PD catheter exit sites in the early postoperative period.

Figure 1

Allocation and course of study participants. PD, peritoneal dialysis; SMAP, stepwise initiation of peritoneal dialysis using the Moncrief–Popovich technique; NPWT, negative-pressure wound therapy.

Figure 2

Exit-site scores over 180 days in the NPWT and non-NPWT groups. The exit-site scores on the seventh postoperative day and over 180 days are significantly lower in the NPWT group than in the non-NPWT group (p = 0.0049, Mann–Whitney U test; p = 0.007, analysis of variance, respectively). *p < 0.05. NPWT, negative-pressure wound therapy.

Figure 3

Kaplan–Meier curves of time to (a) first catheter-related infection and (b) PD-related peritonitis for the NPWT and non-NPWT groups. No statistically significant differences between the two groups are observed for both endpoints (p = 0.2645 and p = 0.3173, respectively; log-rank test). *p < 0.05. PD, peritoneal dialysis; NPWT, negative-pressure wound therapy.