Development and validation of a risk-based nomogram for predicting peritoneal dialysis catheter dysfunction in end-stage renal disease patients

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BACKGROUND: Peritoneal dialysis catheter (PDC) dysfunction significantly impacts patient survival. While individual risk factors are known, a practical tool that integrates multi-dimensional predictors-including surgical, anatomical, and postoperative parameters-for early risk stratification is lacking. This study evaluates open versus laparoscopic catheterization techniques and aims to develop such a predictive model. METHODS: A retrospective cohort study analyzed 462 end-stage renal disease patients undergoing first PDC implantation (2022-2024). Data included clinical characteristics, surgical method (open/laparoscopic), and dysfunction events. Multivariate COX regression identified independent risk factors, and a nomogram was developed. Model performance was assessed via ROC and calibration curves, with Bootstrap validation. RESULTS: Among 462 patients (324 modeling, 138 validation) with a median follow-up of 30.7 months, laparoscopic catheterization was associated with a significantly lower risk of dysfunction compared to the open approach (18% vs. 27%; hazard ratio [HR] 2.188, 95% CI 1.263-3.791, p = 0.005). Multivariate analysis identified five independent predictors of catheter dysfunction: history of abdominal surgery (HR 6.924, p < 0.001), open catheterization (HR 2.188, p = 0.005), diabetes (HR 2.373, p = 0.016), albumin < 30 g/L (HR 0.865, p < 0.001), and blood potassium < 4 mmol/L (HR 1.479, p = 0.015). The developed nomogram integrating these predictors showed outstanding discriminative performance, with C-indices of 0.953 (95% CI 0.940-0.967) in the modeling cohort and 0.951 (95% CI 0.929-0.972) in the validation cohort. Time-dependent ROC analysis further confirmed its predictive accuracy, with 1- and 2-year AUCs of 0.957/0.979 and 0.921/0.988 in the modeling and validation sets, respectively. Calibration curves showed close alignment between predicted and observed outcomes across both cohorts. The nomogram provides a clinically useful tool for individualized risk assessment and postoperative management. CONCLUSIONS: Laparoscopic catheterization reduces dysfunction risk. The presented nomogram is unique in its integration of readily available surgical, comorbidity, and nutritional metrics into a single, visual tool. It facilitates early identification of high-risk patients, thereby aiding individualized surgical planning and targeted postoperative monitoring to improve PDC longevity.

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