RESUMEN
BACKGROUND: There is currently no consensus regarding the optimal type of peritoneal dialysis catheter (PDC). We compared the outcomes of PDCs according to the number of cuffs, intercuff and intraperitoneal segment shape, and presence of a weighted tip. METHODS: A systematic review of the literature was performed using the MEDLINE and Cochrane Library databases (end-of-search date: October 16th, 2019). We included studies comparing double-cuff vs. single-cuff, swan-neck vs. straight-neck, coiled-tip vs. straight-tip, and weighted vs. non-weighted PDCs for the outcomes of interest. We performed meta-analyses using the random-effects model. We assessed the risk of bias using the Newcastle-Ottawa scale and the Cochrane Collaboration's Tool. RESULTS: In total, 38 studies were identified, of which 20 were randomized controlled trials (RCTs) and 18 were observational studies. No statistically significant differences were detected between double-cuff vs. single-cuff, swan-neck vs. straight-neck, and coiled-tip vs. straight tip PDCs in any of the outcomes of interest. Weighted catheters were associated with significantly lower rates of tunnel infection (relative risk [RR] 0.52, 95% confidence interval [CI] 0.31-0.95, p = 0.03), migration (RR 0.07, 95% CI 0.03-0.16, p < 0.001), drainage failure (RR 0.62, 95% CI 0.39-0.96, p = 0.03), cuff extrusion (RR 0.40, 95% CI 0.21-0.74, p < 0.001), and complication-related removal (RR 0.53, 95% CI 0.44-0.64, p < 0.001). DISCUSSION: Among the different types of PDCs, weighted catheters result in lower complication rates and superior long-term outcomes compared to non-weighted catheters. Other aspects of the catheter design do not significantly affect PDC outcomes. PROTOCOL REGISTRATION: PROSPERO 2020 CRD42020158177.
Asunto(s)
Diálisis Peritoneal , Peritonitis , Cateterismo/efectos adversos , Catéteres de Permanencia/efectos adversos , Consenso , Humanos , Diálisis Peritoneal/efectos adversosRESUMEN
Herbert Hoover, the archetypal self-made man, was the 31st president of the United States. His term in office was overwhelmed by the Great Depression and he was defeated by Franklin Delano Roosevelt in the 1932 November presidential election. His post-presidential years were spent writing and serving 4 subsequent presidents. Near the end of his life, he underwent a cholecystectomy for symptomatic gallstones and a colectomy for colon cancer. His health care was complicated by the development of cirrhosis and recurrent gastrointestinal bleeding. After his 90th birthday, he died in October 1964 from massive bleeding due to a Dieulafoy lesion of the gastric cardia. This manuscript will review the details of his health and the physicians who cared for Hoover during his final years.