Objective: To determine the natural history of a surgically placed Tenckhoff catheter in patients on continuous ambulatory peritoneal dialysis (CAPD).

Design: Prospective 7-year study analyzing catheter survival of all catheters using the Kaplan-Meier life table methodology.

Setting: Teaching hospital, department of nephrology.

Patients: One hundred and fifteen unselected patients beginning CAPD.

Interventions: Removal of the catheter required for the following complications: exit-site or tunnel infections or relapsing peritonitis, outflow obstruction, pericatheter leak, and development of hernias.

Main outcome measures: Period between insertion and removal of the catheter.

Results: The cumulative survival of all catheters after 1, 2, and 3 years of CAPD was 87%, 69% and 65%. Catheter survival of the first versus the second catheter after 1 year was significantly longer (p = 0.03). The difference was not significant in relation to diabetes, age, and sex. Infectious complications caused 61% (n = 19) of all 31 catheter failures, mainly due to tunnel infections caused by Staphylococcus aureus (n = 12). "Mechanical" complications accounted for 49% (n = 12) of catheter failures. Eight of 12 mechanical complications were outflow failures. Seven patients had to be transferred to hemodialysis.

Conclusions: The straight Tenckhoff catheter is a reliable peritoneal access device for CAPD in an unselected patient population.