Abstract:

Objectives: Tunneled dialysis catheters (TDC) are generally used as temporary means to provide hemodialysis until permanent arteriovenous (AV) access is established. However, some patients may end up having long-term catheter-based hemodialysis due to the lack of alternatives for other dialysis access. Our objective was to evaluate patient characteristics, reasons for, and mortality associated with long-term TDC use.

Methods: A retrospective single institution analysis was performed. Long-term TDC use was defined as >180 days without more than a 7-day temporary removal time. Reasons for long-term TDC use and complications were recorded. Summary statistics were performed. Kaplan-Meier analysis compared mortality between patients with long-term TDC use to a comparison cohort who underwent AV access creation with subsequent TDC removal.

Results: We identified 50 patients with long-term TDC use from 2013-2018. The average age was 63 years, 44% were male, and 76% were African American. Previous TDC use was found in 42% of patients with subsequent removal after alternative access was established. Median TDC duration was 333 days (range 185-2029). The primary reasons for long-term TDC use were failed (occluded) AV access (34%), non-maturing AV (non-occluded) access (32%), delayed AV access placement (14%), no AV access options (10%), patient refusal for AV access placement (6%), and medically high-risk for AV access placement (4%). In 46% of patients, TDC complications occurred including central venous stenosis (33.4%), TDC-related infections (29.6%), TDC displacement (27.8%), and thrombosis (7.9%). Overall 47.6% required a catheter exchange during the prolonged TDC period. The majority (76.4%) had their catheter removed due to established alternative access during follow-up. The long-term TDC group, in relation to the comparator group (n=201), had fewer males (44% vs. 61.2%, P=.028) and higher proportion of congestive heart failure (66% vs. 40.3%, P=.001). Kaplan-Meier analysis showed no significant difference in survival at 24 months for the long-term TDC to the comparator group (93.6% vs. 92.7%, P=.28).

Conclusions: Patients with long-term TDCs experienced significant TDC-related morbidity. While permanent access is preferable, some patients may require long-term TDC use due to difficulty establishing a permanent access, limited access options, and patient preference. There was no difference in survival between the two groups.

Reference:

Castro V, Farber A, Zhang Y, et al. Reasons for Long-Term Tunneled Dialysis Catheters Use and Associated Morbidity [published online ahead of print, 2020 Jul 21]. J Vasc Surg. 2020;S0741-5214(20)31693-1. doi:10.1016/j.jvs.2020.06.121