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Changes to indications for tunneled cuffed catheter use in hemodialysis patients: A single-center experience
Takeshi Okamoto1, Tsutomu Sakurada1, Kenichiro Koitabashi1
1Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan.
Insights
Indications for tunnel cuffed catheters (TCCs) are expanding in elderly end-stage renal disease patients. While TCC use increased, catheter survival and complication rates remained similar, suggesting TCCs are a viable option for this growing population.
Area of Science:
- Nephrology
- Vascular Access Surgery
Background:
- The increasing prevalence of elderly patients with end-stage renal disease (ESRD) presents challenges in establishing suitable vascular access for hemodialysis.
- Arteriovenous fistulas (AVFs) are preferred, but many elderly ESRD patients lack appropriate vessels, leading to increased reliance on alternative access methods like tunnel cuffed catheters (TCCs).
Purpose of the Study:
- To investigate the trends in TCC utilization and the evolving indications for TCC insertion in ESRD patients over a decade.
- To compare patient demographics and clinical characteristics between early and late phases of TCC insertion.
Main Methods:
- A single-center retrospective study analyzed 143 TCCs inserted in 95 patients between July 2005 and July 2017.
- Patients were categorized into early and late-phase groups based on the median observation period, and demographic and clinical data were compared.
Main Results:
- The late-phase group (93 TCCs) was older and had a higher incidence of hypertensive nephropathy and increased indications for bridge vascular access and severe cardiac dysfunction compared to the early-phase group (50 TCCs).
- Catheter insertion shifted towards femoral vein placement and was increasingly performed by nephrologists.
- No significant differences were found in catheter survival, complication rates, reasons for removal, or catheter-related infections between the two groups.
Conclusions:
- The findings suggest an expanding role for TCCs in managing vascular access for an aging ESRD population with complex comorbidities.
- The increased acceptance of TCCs for bridge vascular access indicates a shift in practice patterns for managing challenging vascular access cases.
Introduction:
As the number of elderly end-stage renal disease patients lacking suitable vessels for arteriovenous fistula (AVF) is increasing, indications for tunnel cuffed catheters (TCCs) may be expanding. This study aimed to clarify changes over time in the number of patients with TCC and indications for TCCs.
Methods:
This single-center retrospective study analyzed 143 catheters for 95 patients who inserted TCCs between July 2005 and July 2017. Patients were divided into two groups (early- and late-phase groups) based on the median observational period. Demographic data and clinical information were then compared.
Findings:
Fifty TCCs were inserted in the early phase group, and 93 TCCs were inserted in the late-phase group. The late-phase group was older (77 vs. 70 years; P = 0.003) and showed a higher frequency of hypertensive nephropathy (29% vs. 14%; P < 0.05) and a lower frequency of a history of cardiovascular disease (52.7% vs. 70.0%; P = 0.045). In the late-phase group, indications for bridge vascular access (0% vs. 11.8%; P < 0.05) or severe cardiac dysfunction (8.0% vs. 20.5%; P < 0.05) were increased. In addition, the late-phase group showed increases in percentage of patients with the catheter inserted in the femoral vein (10.0% vs. 23.7%; P = 0.047), nephrologists performing catheter insertion (56.0% vs. 87.1%; P < 0.001), and the patients who underwent superficialization of the brachial artery (28.0% vs. 46.2%; P = 0.034). Significant differences in catheter survival, incidence of complications, reasons for catheter removal, or incidence of catheter-related infection were not observed between groups.
Discussion:
Patients with indications for TCC may be increasing due to an increase in elderly end-stage renal disease patients whose activities of daily living have decreased. In addition, indications for bridge vascular access were widely accepted in the late-phase group.
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