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Complications From Tunneled Hemodialysis Catheters: A Canadian Observational Cohort Study
Krishna Poinen1, Robert R Quinn1, Alix Clarke1
1Cumming School of Medicine, Department of Community Health Sciences, and Department of Family Medicine, University of Calgary, Calgary, Canada.
Insights
Central venous catheters (CVCs) are used for dialysis access when other options fail. While about one-third of patients experience CVC complications within two years, older patients showed lower complication rates.
Area of Science:
- Nephrology
- Vascular Access
- Dialysis
Background:
- Clinical guidelines discourage central venous catheters (CVCs) for dialysis vascular access.
- However, CVCs are necessary for patients with inadequate vessels or those who prefer catheter use.
- Risks of CVC use, particularly in relation to patient age, are not well understood.
Purpose of the Study:
- To characterize the risks associated with tunneled central venous catheter (CVC) use in hemodialysis patients.
- To investigate the relationship between patient age and CVC-related complications.
Main Methods:
- Observational retrospective cohort study of 1,041 hemodialysis patients initiated on tunneled CVCs.
- Data collected on CVC-related procedures, hospitalizations, and death over 1-2 years.
- Cox proportional hazards regression used to identify risk factors for complications.
Main Results:
- At 1 year, risks were 9% for CVC-related bacteremia, 15% for malfunction, and 2% for central stenosis.
- Overall CVC complication risk was 30% at 1 year and 38% at 2 years.
- Older patients (70-79 and 80+ years) had significantly lower rates of CVC complications compared to those younger than 60.
Conclusions:
- Approximately one-third of hemodialysis patients using tunneled CVCs experience complications within 1-2 years.
- CVC-related bacteremia is common, leading to hospitalizations, but CVC-related death is infrequent.
- Findings can inform patient communication regarding CVC risks in hemodialysis.
Rationale & Objective:
Clinical practice guidelines discourage the use of central venous catheters (CVCs) for vascular access in dialysis. However, some patients have inadequate vessels for arteriovenous fistula creation or choose to use a dialysis catheter. The risks associated with CVC use and their relationship to patient age are poorly characterized.
Study Design:
Observational retrospective cohort study.
Setting & Participants:
Cohort of 1,041 patients older than 18 years from 5 Canadian dialysis programs who initiated outpatient maintenance hemodialysis therapy with a tunneled CVC between 2004 and 2012 and who had no creation of an arteriovenous fistula or arteriovenous graft.
Exposures:
Age, sex, body size, initiating dialysis therapy in the hospital, and comorbid conditions.
Outcomes:
CVC-related procedures, hospitalization, and death.
Analytical Approach:
Complications were reported as a cumulative risk at 1 and 2 years. Cox proportional hazards regression for recurrent events was used to evaluate risk factors for study outcomes.
Results:
At 1 year, risks for CVC-related bacteremia, malfunction, and central stenosis were 9%, 15%, and 2%, respectively. Risks for any CVC-related complication at 1 and 2 years were 30% and 38%, respectively. Death related to CVC complications occurred in 6 of 1,041 (0.5%) patients. Compared with patients younger than 60 years, patients aged 70 to 79 and those 80 years or older experienced lower rates of CVC complications: HRs of 0.67 (95% CI, 0.52-0.85; P = 0.001) and 0.69 (95% CI, 0.52-0.92; P = 0.01), respectively.
Limitations:
This Canadian dialysis population may not be representative of populations in other countries. CVC use was not compared with other types of hemodialysis vascular access.
Conclusions:
Approximately one-third of hemodialysis patients who used tunneled CVCs during 1 to 2 years experienced complications. Bacteremia occurred in ∼9% of patients at 1 year and were the most common cause of CVC-related hospitalizations. CVC-related death was infrequent. This information could be used to communicate the risk for CVC complications to patients treated with this type of hemodialysis vascular access.
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