Does Final Peritoneal Dialysis Catheter Tip Position Predict Early Catheter Dysfunction?
Bibliographic record
Abstract
Background: It is believed that, for a functioning peritoneal dialysis (PD) catheter, the inserter needs to place the catheter in an optimal position. Exact tip position within the pelvis in relation to the pubic symphysis can be determined at time of placement for fluoroscopically guided PD catheters. Methods: A retrospective cohort of adult PD patients in London, Ontario, who underwent percutaneous PD catheter insertion using fluoroscopy from 2013 to 2017 were reviewed. The distance between the top of the pubic symphysis and the bottom of the catheter coil was measured using Citrix software of stored images. Univariate and multivariate backward stepwise logistic regression analyses were conducted for the outcome of early catheter flow dysfunction versus each of final catheter tip position and baseline covariables included age, sex, race, body mass index (BMI), cause of Kidney Failure and number of prior abdominal surgeries with P-value <0.2 for variable inclusion in stepwise regression. Early catheter flow dysfunction was defined as the failure to achieve sufficient inflow/outflow to maintain any modality of PD, refractory to non-procedural interventions, and necessitating a repositioning procedure within 3 months of PD start. Results: 286 patients who underwent fluoroscopic catheter insertion during the study period had a trial of PD. Of 35 patients who experienced early catheter dysfunction, 31/35 underwent a repositioning procedure. There was no difference between final catheter tip position of catheters that did or did not experience early flow dysfunction [catheter-tip to pubis symphysis median distance (Q1-Q3) 37 (29-53) vs 38 (26-50) mm, p=0.62]. In univariate analyses, no variable was associated with a significant difference in frequency of catheter dysfunction. Backward stepwise multivariate analyses of catheter dysfunction retained BMI, age and cause of Kidney Failure with only BMI significantly associated with frequency of early catheter flow dysfunction (OR 1.07 ± 0.04, p=0.04). Conclusions: Final pelvic PD catheter tip position, relative to the pubic symphysis at time of fluoroscopic insertion, was not predictive of early catheter flow dysfunction. In light of this, the frequent focus of inserters on “optimal” placement may be unwarranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".