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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Translumbar and Transhepatic Catheters for Hemodialysis in Chronic Kidney Disease: A Systematic Review and
Rivaldo José Melo Tavares1, Mariana Póvoa-Corrêa2,3, Iandy de Souza Mateus Tarricone4
1Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
Insights
Translumbar hemodialysis access in chronic kidney disease (CKD) patients has fewer complications than transhepatic access. Transhepatic access remains a viable option for patients with exhausted options.
Area of Science:
- Nephrology
- Vascular Access
- Medical Interventions
Background:
- Patients with chronic kidney disease (CKD) often face limited hemodialysis access options.
- Transhepatic and translumbar catheter placement become alternatives when standard access is exhausted.
Purpose of the Study:
- To systematically review and compare the complication rates of transhepatic versus translumbar hemodialysis access catheters.
- To provide evidence-based insights into the safety and efficacy of these alternative access methods.
Main Methods:
- A comprehensive literature search was conducted across 11 databases (Medline/PubMed, Embase, Scopus) in 2021/2022.
- A meta-analysis of 18 observational studies involving 649 catheters was performed using a fixed-effect model.
- Data extraction was conducted by two independent researchers.
Main Results:
- The transhepatic group exhibited significantly higher rates of irreversible infections (0.085 vs 0.015 per 100 catheter-days) and irreversible dysfunction (0.259 vs 0.071 per 100 catheter-days) compared to the translumbar group.
- Total infections, thrombosis, and catheter displacement were also more frequent in the transhepatic group (P < 0.001 for all).
Conclusions:
- Translumbar hemodialysis access is associated with a lower prevalence of complications in CKD patients.
- Transhepatic access, despite higher complication rates, remains a valuable option as a bridge to definitive vascular access or kidney transplantation.
Rationale & Objective:
Patients with chronic kidney disease (CKD) often reach a point where their options for hemodialysis access are exhausted, when transhepatic and translumbar access becomes an option. The aim of this study is to compare the prevalence of complications associated with both types of catheters through a systematic review and meta-analysis.
Study Design:
Literature-based systematic review and meta-analysis were accomplished in 2021/2022. Studies were obtained from 11 registries, including Medline/PubMed, Embase, and Scopus.
Setting & Study Populations:
Included studies involved patients with CKD in access exhaustion who underwent translumbar or transhepatic catheter placement.
Selection Criteria For Studies:
Eligible designs included clinical trials, quasi-experimental studies, observational studies, and case series; case reports were excluded.
Data Extraction:
Two independent researchers used a tailored sheet to extract data from the studies.
Analytical Approach:
A fixed-effect model for proportions was used to assess complications across 18 observational studies involving 649 catheters.
Results:
Compared to the translumbar group, the transhepatic group showed significantly higher proportions per 100 catheter-days of irreversible infections (0.085 [95% CI, 0.051-0.118] vs 0.015 [95% CI, 0.007-0.023]; P < 0.001) and irreversible dysfunction (0.259 [95% CI, 0.205-0.313] vs 0.071 [95% CI, 0.054-0.089]; P < 0.001). Total infections (P < 0.001), thrombosis (P < 0.001), and catheter displacement (P < 0.001) were also significantly more frequent in the transhepatic group.
Limitations:
The main challenge was the variability in study designs and the lack of randomized clinical trials, which was expected given the nature of the intervention.
Conclusions:
Translumbar access in CKD is associated with fewer complications; however, transhepatic access remains a viable option as a bridge to definitive access or transplantation.
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