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Published on: May 31, 2022
Central venous catheter-related complications in older haemodialysis patients: A multicentre observational cohort
Mathijs van Oevelen1, Boudewijn Dc Heggen2, Alferso C Abrahams3
1Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Older patients (aged ⩾70) using central venous catheters (CVC) for haemodialysis face similar risks of infection and malfunction compared to younger patients. This finding supports informed discussions on vascular access options for elderly haemodialysis patients.
Area of Science:
- Nephrology
- Vascular Access Management
- Geriatric Medicine
Background:
- Central venous catheters (CVC) are frequently used for haemodialysis, despite guidelines favoring arteriovenous fistulae.
- Previous research on CVC in older adults primarily focused on specific catheter types or infections, leaving a gap in understanding overall risks.
- This study addresses the need to compare all CVC-related complications in older versus younger haemodialysis patients.
Purpose of the Study:
- To compare catheter-related infections and malfunctions in haemodialysis patients aged ⩾70 years versus those <70 years.
- To analyze risks associated with all subtypes of central venous catheters (CVC) in different age groups.
- To provide evidence for optimizing vascular access decisions in elderly haemodialysis patients.
Main Methods:
- Utilized data from the DUCATHO multicentre observational cohort study (The Netherlands, 2012-2016).
- Included adult patients receiving CVC for haemodialysis, comparing those ⩾70 years with a reference group <70 years.
- Employed Cox proportional hazards and recurrent events modelling to assess catheter-related infections, malfunctions, and removal, adjusting for confounders. Analyzed non-tunnelled CVC (NTCVC) and tunnelled CVC (TCVC) separately.
Main Results:
- A total of 1595 patients and 2731 CVCs were analyzed, with 37.2% of patients aged ⩾70 years.
- No statistically significant differences were observed in catheter-related infections (adjusted HR 0.80; 95% CI 0.62-1.02).
- Catheter malfunction (adjusted HR 0.94; 95% CI 0.75-1.17) and removal due to infection or malfunction (adjusted HR 0.94; 95% CI 0.80-1.11) also showed comparable risks between age groups, consistent for NTCVC and TCVC.
Conclusions:
- Haemodialysis patients aged ⩾70 years exhibit comparable risks of catheter-related infections and malfunctions to younger patients.
- These findings can aid in clinical discussions regarding vascular access choices for older adults initiating haemodialysis.
- The results contribute to the ongoing discourse on the optimal vascular access strategy for the aging haemodialysis population.
Background:
Central venous catheters (CVC) remain a commonly used vascular access option in haemodialysis, despite guidelines advising to preferably use arteriovenous fistulae. Compared to younger patients, the risk-benefit ratio of CVC in older patients might be more beneficial, but previous studies mainly focussed on catheter-related bacteraemia and/or assessed tunnelled CVC (TCVC) only. This study's aim was to compare all catheter-related infections and malfunctions in older patients with younger patients using all CVC subtypes.
Materials And Methods:
We used data from DUCATHO, a multicentre observational cohort study in The Netherlands. All adult patients in whom a CVC was placed for haemodialysis between 2012 and 2016 were included. The primary endpoint was the occurrence of catheter-related infections, comparing patients aged ⩾70 years with patients aged <70 years (reference). As secondary endpoints, catheter malfunctions and catheter removal due to either infection or malfunction were assessed. Using Cox proportional hazards and recurrent events modelling, hazard ratios (HR) with 95% confidence intervals (CI) were calculated with adjustment of prespecified confounders. Additionally, endpoints were assessed for non-tunnelled CVC (NTCVC) and TCVC separately.
Results:
A total of 1595 patients with 2731 CVC (66.5% NTCVC, 33.1% TCVC) were included. Of these patients, 1001 (62.8%) were aged <70 years and 594 (37.2%) ⩾70 years. No statistically significant difference was found for the occurrence of catheter-related infections (adjusted HR 0.80-95% CI 0.62-1.02), catheter malfunction (adjusted HR 0.94-95% CI 0.75-1.17) and catheter removal due to infection or malfunction (adjusted HR 0.94-95% CI 0.80-1.11). Results were comparable when assessing NTCVC and TCVC separately.
Conclusion:
Patients aged ⩾70 to <70 years have a comparable risk for the occurrence of catheter-related infections and catheter malfunction. These findings may help when discussing treatment options with older patients starting haemodialysis and may inform the current debate on the best vascular access for these patients.
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