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Hemodialysis catheter survival and complications in children and adolescents

S L Goldstein1, C T Macierowski, K Jabs

  • 1Division of Nephrology, Children's Hospital, Boston, Massachusetts 02115, USA.

Pediatric Nephrology (Berlin, Germany)
|February 1, 1997
PubMed

Insights

Uncuffed venous catheters are effective for short-term hemodialysis in pediatric patients with end-stage renal disease (ESRD) for up to two months. Cuffed catheters demonstrate success for long-term hemodialysis access in this population.

Area of Science:

  • Pediatric Nephrology
  • Vascular Access
  • Renal Replacement Therapy

Background:

  • Venous catheters are crucial for hemodialysis, especially in pediatric patients with end-stage renal disease (ESRD).
  • Evaluating the performance of different catheter types is essential for optimizing treatment outcomes in children requiring renal replacement therapy.

Purpose of the Study:

  • To assess the survival rates and identify causes of failure for both uncuffed and cuffed venous catheters used for hemodialysis access in pediatric patients with ESRD.
  • To compare the efficacy of temporary versus long-term hemodialysis access strategies in this specific patient group.

Main Methods:

  • A retrospective analysis of 78 venous catheters in 23 pediatric patients (aged 10 months to 22 years) with ESRD over a 5-year period.
  • Assessment of catheter survival rates, reasons for removal (elective, kinking, trauma, infection, other), and infection rates.
  • Statistical comparison of catheter performance based on cuff presence and catheter size.

Main Results:

  • Median survival for uncuffed catheters was 31 days, with 1- and 2-month actuarial survival rates of 69% and 48%, respectively. Kinking was a common reason for removal in smaller uncuffed catheters.
  • One-year actuarial survival for cuffed catheters was 27%, with infection being the primary cause for removal (36%).
  • Infection rates leading to removal were 0.58 and 0.71 per patient-year for uncuffed and cuffed catheters, respectively. Staphylococcus species were the most frequent isolates.

Conclusions:

  • Uncuffed venous catheters provide effective short-term hemodialysis access (up to 2 months) in pediatric ESRD patients.
  • Cuffed venous catheters are a successful option for long-term hemodialysis access in children and adolescents with ESRD, despite a higher rate of infection-related removal.
  • Catheter kinking is a significant concern, particularly with smaller diameter uncuffed catheters in the pediatric population.

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