Bridge of Tunneled Cuffed Catheter as a Risk for Future Arteriovenous Fistulae Failure

Background: A clinically tunneled cuffed catheter (TCC) for hemodialysis (HD) is often inserted into end-stage renal disease patients, who have an immature or no arteriovenous fistula (AVF), for the performance of HD to relieve uremic syndrome or to solve uncontrolled fluid overload, hyperkalemia, or metabolic acidosis. The catheter is primarily regarded as a bridge until the AVF matures and can be cannulated for HD. However, the effect of the bridge of the TCC on the future patency of AVFs remains elusive. Methods: This nationwide population-based observational study compared the hazards of AVF failure and the time to AVF failure. We enrolled 24,142 adult incident patients on HD, who received HD via AVFs for at least 90 days between 1 January 2010 and 31 December 2015. The subjects were divided into two groups, according to the history of TCC, and were followed-up until the failure of the AVF, mortality, or the end of the study. A propensity score-matched analysis based on 1:1 matching of age, sex, and baseline comorbidities was utilized to reduce bias and confounding variables. Results: A Kaplan−Meier survival curve revealed that patients with and without a history of TCC had significantly better AVF survival rates (log-rank test; p < 0.001). A history of TCC was independently associated with a higher risk of new AVF or AVG creation due to AVF failure, after the adjustment of the Charlson comorbidity index score (corresponding adjusted hazard ratios of 2.17 and 1.52; 95% confidence intervals of 1.77−2.67 and 1.15−1.99). For the impact of time on AVF failure, patients with a TCC bridge had a significantly higher incidence of new AVF creation during the first year after the AVF cannulation. Conclusion: A history of a TCC bridge was an independent risk factor for AVF failure and the time of AVF failure was significantly higher during the first year after the fistula cannulation in the TCC bridge group.