Risk of Cardiac Implantable Electronic Device Infection With Temporary Tunneled Hemodialysis Catheters

Compared to permanent surgically created hemodialysis (HD) vascular access, tunneled vascular access catheters for HD may pose an even higher risk of blood stream infection (BSI). For patients with transvenous cardiac implantable electronic devices (CIEDs), the risk of device infection associated with tunneled HD catheter is not well-characterized.

The Nationwide Readmissions Database (NRD) 2016-2021 was used for analysis. Patients with end-stage kidney disease (ESKD) and a CIED who were admitted for any reason were identified by ICD-10 codes and stratified based on whether a new tunneled HD catheter was placed during the index admission. Readmissions with CIED infection within 180 days were compared between the two groups (new tunneled HD catheter during index admission vs. ESKD without need for new dialysis access).

We identified 117 573 index admissions in patients with ESKD and a CIED, out of whom 8677 (7.4%) underwent placement of a new, tunneled HD catheter during the index admission. Readmission within 180 days occurred in 531 patients (6.1%) among those who required a new, HD catheter during index admission, compared to 3572 (3.3%) among those who did not. In multivariable models, a new, HD catheter during index admission was associated with a significantly increased risk of readmission with CIED infection within 180 days (adjusted odds ratio [aOR]: 1.92, 95% confidence interval [CI]: 1.66-2.22, p < 0.001). During the readmission, patients with a new tunneled catheter were more likely to present with blood stream infection (57.8 vs. 45.8%, p < 0.001), infectious endocarditis (13.4 vs. 10.1%, p < 0.001), and to experience in-hospital major adverse cardiovascular events (MACE) (10.5 vs. 9.9%, p = 0.006).

Among patients with CIEDs, placement of a new tunneled vascular access catheter for HD was associated with a roughly twofold increased risk of readmission with CIED infection within 180 days, compared to patients with ESKD who did not require new vascular access. Readmissions with CIED infection were associated with significantly worse outcomes, including higher in-hospital MACE. To the extent possible, temporary tunneled HD catheters should be avoided in ESKD patients with CIEDs.