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A randomized controlled trial of catheters with different tips and lengths for patients requiring continuous renal
Zhifeng Zhou1, Chen Liu1, Peiyun Li1
1Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China.
Background:
The tip design and length of catheter impact catheter function. Two types of catheters with different tips, side-hole catheters and step-tip catheters, are commonly used during continuous renal replacement therapy (CRRT). However, there is insufficient evidence comparing their efficacy and safety in CRRT. In addition, whether the insertion of a longer catheter could enhance catheter function remains poorly studied and controversial.
Methods:
In this open-label, three-arm, randomized trial, critically ill patients receiving CRRT were randomized to three groups. Group A received 20 cm side-hole catheters (GDHK-1120), group B received 20 cm step-tip catheters (GDHK-1320) and group C received 25 cm step-tip catheters (GDHK-1325). The primary outcomes were the incidence of catheter dysfunction and catheter survival time.
Results:
A total of 351 patients were enrolled, with 116 in group A, 117 in group B, and 118 in group C. The incidence of catheter dysfunction in group A (35.7%, 51/143) was significantly higher than that in group B (17.7%, 22/124) (P = 0.001). However, there was no difference between group B and group C (15.6%, 23/147) (P = 0.744). The catheter survival time was comparable between group A (5.5 days, IQR 2.5-9.3) and group B (5.0 days, IQR 3.0-10.0) (P = 0.626). In contrast, group C (6.4 days, IQR 3.9-12.0) demonstrated a significantly longer catheter survival time compared to group B (P = 0.019). Cox regression analysis identified BMI (HR 1.052, 95% CI 1.003-1.103, P = 0.036) as an independent risk factor for catheter dysfunction. Results were not consistent across BMI tertiles, with similar results observed only in patients with a lower BMI (BMI < 24.2) (chi-square 13.65, P = 0.001). There was also a trend that patients in group C have a longer filter lifespan (36.5 h, IQR 16.9-68.1, P = 0.001) and a lower incidence of catheter-related thrombosis (10.40 per 1000 catheter-days, 95% CI 5.93, 17.83, P = 0.019). Other secondary outcomes were not significantly different among groups.
Conclusions:
Step-tip catheters may be preferable for CRRT, particularly for patients in the lower BMI tercile. Longer femoral vein catheterization demonstrated enhanced benefits in CRRT, especially among obese patients. Further high-quality, multicenter RCTs are essential to strengthen the evidence guiding catheter selection during CRRT.
Trial Registration:
ChiCTR2300075107. Registered 25 August 2023.
