***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : The optimal time for the commencement of  peritoneal dialysis ( PD ) after PD catheter insertion is unclear . If dialysis is started too soon after insertion , dialysate leaks and infection could occur . However , by starting PD earlier , morbidity and costs can be reduced through lesser hemodialysis requirements . This is the first r and omized controlled trial to determine the safest and shortest interval to commence PD after catheter insertion . Methods : All consecutive patients undergoing PD catheter insertion at the Royal Brisbane and Women 's Hospital and Rockhampton Hospital from 1 March 2008 to 31 May 2013 who met the inclusion and exclusion criteria were invited to participate in the trial . Participants were r and omized to 1 of 3 groups . Group 1 ( G1 ) commenced PD at 1 week , group 2 ( G2 ) at 2 weeks and group 3 ( G3 ) at 4 weeks after PD catheter insertion . These groups were stratified by hospital and the presence of diabetes . Primary outcomes were the incidence of peritoneal fluid leaks or PD-related infection during the 4 weeks after commencement of PD . Results : In total 122 participants were recruited , 39 , 42 , and 41 r and omized to G1 , G2 , and G3 , respectively . The primary outcome catheter leak was significantly higher in G1 ( 28.2 % ) compared with G3 ( 2.4 % , p = 0.001 ) but not compared with G2 ( 9.5 % , p = 0.044 ) , based on intention to treat analysis . These differences were even more marked when analyzed with per protocol method : G1 had a significantly higher percentage ( 32.4 % ) compared with G3 ( 3.3 % , p = 0.003 ) but not compared with G2 ( 10.5 % , p = 0.040 ) . Event percentages of leak were statistically higher in G1 and occurred significantly earlier compared with other groups ( p = 0.002 ) . Amongst diabetics , technique failure was significantly higher ( 28.6 % ) in G3 compared with 0 % in G1 and 7.1 % in G2 ( p = 0.036 ) and earlier in G3 at 163.2 days vs 176.8 and 175.8 ( p = 0.037 ) for G1 and G2 , respectively . Conclusion : Leaks were higher in participants commencing PD at 1 week after catheter insertion compared with the other 2 groups , and technique failure was higher in diabetics starting PD at 4 weeks AIM Catheter malfunction is the main reason for early peritoneal dialysis ( PD ) technique failure . This study aim ed to evaluate the effect of a new surgery technique with catheter fixation to the lower abdominal wall combined with straight upward tunnel and low implant position in reducing catheter malfunction . METHODS Patients with end stage renal disease who received PD in our centre from January 2013 to December 2015 were involved in this study . They were r and omly divided into three groups according to surgical technique : traditional open surgery group , modified open surgery group and modified open surgery with catheter fixation group . All patients were followed up for six months after surgery . Catheter- related complications were analyzed . RESULTS A total of 152 patients were involved . Among them , 49 received traditional open surgery ( TOS group ) , 49 received modified open surgery ( MOS group ) , and 54 received modified open surgery with catheter fixation ( MOS-F group ) . During follow-up , no patients ( 0 % ) in MOS-F group developed catheter malfunction which was significantly lower than that of the TOS group ( 0 vs 16.33 % , P = 0.002 ) . Although not statistically significant , the incidence of catheter malfunction was lower in MOS-F group than that in MOS group ( 0 vs 4.08 % , P = 0.134 ) . No significant difference was observed in the episodes of infection , bleeding , leakage , inflow or outflow pain , hernia and delayed wound healing among the three groups ( all P > 0.05 ) . CONCLUSIONS Catheter fixation combined with straight upward tunnel and low implant position can effectively prevent catheter malfunction in PD catheter placement BACKGROUND Current clinical practice guidelines recommend that no particular type of  peritoneal dialysis ( PD ) catheter has been proved superior to another . However , a recent Cochrane review recommended the need for a large , well- design ed , r and omized , controlled trial of straight versus coiled PD catheters because of the paucity and suboptimal quality of previously performed trials . METHODS A r and omized controlled trial was undertaken at 2 metropolitan teaching hospitals comparing the effects of straight versus coiled PD catheters on time to catheter malposition ( primary outcome ) , catheter-associated infection , technique failure , and all-cause mortality . RESULTS One hundred thirty-two PD patients were enrolled and r and omly assigned to insertion of a coiled ( n = 62 ) or straight catheter ( n = 70 ) . There was no significant difference in time to laparoscopic reposition between the 2 cohorts ( log-rank score , 0.41 ; P = 0.52 ) . However , median technique survival was significantly worse for coiled catheters ( 1.5 years ; 95 % confidence interval [ CI ] , 1.2 to 1.8 ) compared with straight catheters ( 2.1 years ; 95 % CI , 1.8 to 2.5 ; P < 0.05 ) , primarily because of increased risk for inadequate dialytic clearance with the former . On univariate Cox proportional hazards model analysis , insertion of a coiled PD catheter was associated significantly with a greater risk for technique failure ( unadjusted hazard ratio , 1.86 ; 95 % CI , 1.03 to 3.36 ) . No difference was observed between the 2 groups with respect to catheter-associated infections or overall patient survival . CONCLUSION Coiled catheters do not influence the risk for drainage failure caused by catheter malposition compared with straight catheters , but are associated with significantly increased risk for PD technique failure , primarily because of inadequate dialytic clearance BACKGROUND : This study was performed to compare the outcomes of open surgical procedure and percutaneously peritoneal dialysis catheter ( PDC ) insertion using laparoscopic needle . METHODS : This r and omized clinical trial study was conducted in the Nephrology Department in Noor Hospital , Isfahan , Iran between 2009 and 2010 . 64 uremic patients were r and omized into two study groups using r and om allocation software .  Thirty four catheters were inserted percutaneously ( P group ) and 30 catheters were placed surgically ( S group ) . Collected information included demographic data , body mass index , and cause of renal disease , duration of operation and length of hospitalization . Outcomes were considered as mechanical and infectious complications . RESULTS : There were no significant differences in age , gender , the mean of body mass index , having history of hemodialysis , diabetes mellitus , hypertension , ischemic heart disease , and length of hospitalization . Hemopenitoneom was more frequent in S group than P group ( 13.3 % versus 3.2 % ; p < 0.0001 ) . There was no significant difference between two groups in early peritonitis , early leakage , hernia , hollow viscous perforation , catheter obstruction , and malpositioning and the time of peritoneal dialysis onset . Outflow failure and the exit site infection were more frequent in S group than P group ( p < 0.0001 ) . Mean of the operative time was longer in S group than P group ( 27.70 ± 2.79 minutes versus 10.48 ± 1.91 minutes , p < 0.001 ) . CONCLUSIONS : Percutaneous catheter insertion has fewer rate of complications and is less time consuming in comparison with surgical method Background  Peritoneal dialysis ( PD )  is an effective treatment for end-stage renal disease . It allows patients more freedom to perform daily activities compared to haemodialysis . Key to successful PD is the presence of a well-functioning dialysis catheter . Several complications , such as in- and outflow obstruction , peritonitis , exit-site infections , leakage and migration , can lead to catheter removal and loss of peritoneal access . Currently , different surgical techniques are in practice for PD-catheter placement . The type of insertion technique used may greatly influence the occurrence of complications . In the literature , up to 35 % catheter failure has been described when using the open technique and only 13 % for the laparoscopic technique . However , a well- design ed r and omized controlled trial is lacking . Methods / Design The LOCI-trial is a multi-center r and omized controlled , single-blind trial ( pilot ) . The study compares the laparoscopic with the open technique for PD catheter insertion . The primary objective is to determine the optimum placement technique in order to minimize the incidence of catheter malfunction at 6 weeks postoperatively . Secondary objectives are to determine the best approach to optimize catheter function and to study the quality of life at 6 months postoperatively comparing the two operative techniques . Discussion This study will generate evidence on any benefits of laparoscopic versus open PD catheter insertion . Trial registration Dutch Trial Register Purpose : In a prospect i ve r and omized study a st and ard dual-tip hemodialysis catheter ( PermCath , Sherwood Medical , St. Louis , MO , USA ) was compared with a newer split-lumen catheter ( Ash Split , Medcomp , Harleysville , PA , USA ) . Methods : Sixty-nine patients ( 42 men , 27 women ; mean age 62 years ) were r and omized to receive either the Ash Split ( AS ) or the PermCath ( PC ) catheter .  The catheters were inserted into the internal jugular vein . The primary outcome evaluated was blood flow measurements during the first six hemodialysis sessions . Secondary outcomes included : technical difficulties encountered at insertion , early complications and late complications requiring catheter removal or exchange . Results : A total of 69  hemodialysis catheters , 33 AS and 36 PC , were successfully inserted in the internal jugular vein ( right 60 , left 9 ) of 69 patients . Mean blood flow during dialysis ( Qb ) was 270.75 ml/min and 261.86 ml/hr for the AS and PC groups respectively ( p = 0.27 ) . Mean duration of catheter use was 111.7 days ( range 5.4–548.9 days ) and 141.2 days ( range 7.0–560.9 days ) in the AS and PC groups respectively ( p = 0.307 ) . Catheter failures leading to removal or exchange occurred in 20 patients : 14 in the AS group and six in the PC group . Survival curves with censored endpoints ( i.e. , recovery , arteriovenous fistula formation , peritoneal dialysis and transplantation ) showed significantly better outcome with PermCath catheters ( p = 0.024 ) . There was no significant difference in ease of insertion or early complication rates . Conclusion : The Ash Split catheter allows increased rates of blood flow during hemodialysis but this increase was not significant at the beginning ( p = 0.21 ) or end ( p = 0.27 ) of the first six hemodialysis sessions . The Ash Split catheter is more prone to minor complications , particularly dislodgment , than the PermCath catheter BACKGROUND The success of  peritoneal dialysis ( PD )  is dependent on timely and adequate PD catheter access . In many centres , including our own , PD catheter insertion technique has evolved by laparoscopic surgery . An alternative method of catheter insertion is performed by radiologists using a percutaneous modified Seldinger technique under fluoroscopic guidance . However , there are no clinical trials comparing these two methods of catheter insertion . METHODS From 1 April 1999 to 30 August 2004 , we r and omly assigned 113 pre-dialysis patients to receive PD catheter insertion using fluoroscopic guidance under local anaesthesia by radiologists or insertion using laparoscopy under general anaesthesia by a surgeon . The primary endpoint was the occurrence of dialysis catheter complications ( complication-free catheter survival ) by Day 365 , a composite endpoint that included complications secondary to mechanical and infectious causes . Secondary endpoints were the occurrence of catheter removal ( overall catheter survival ) and death from any cause ( patient survival ) by Day 365 , procedure pain , procedure time , procedure room utilization time , length of inpatient admission and direct hospital costs . Results were analysed by univariate and multivariate methods and by Kaplan-Meier survival curves . RESULTS Complication-free catheter survival was significantly higher at 42.5 % [ 95 % confidence interval ( CI ) 29.3 - 55 ] in the radiological group compared with 18.1 % ( 95 % CI 8.9 - 29.8 ) in the laparoscopic group ( P-value = 0.03 ) . Excess complications in the laparoscopic group included peritonitis , peritoneal dialysate leaks and umbilical herniae . One-year overall catheter survival and 1-year subject survival were not different between the groups . Hospital costs were significantly higher in the laparoscopic group by almost a factor of two . CONCLUSIONS Radiological insertion of first 
    Output:
    
There is no strong evidence that any catheter-related intervention , including the use of different catheter types or different insertion techniques , reduces the risks of PD peritonitis or other PD-related infections , technique failure or death ( all causes ) .