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Comparative Study
. 2013 Sep;24(9):1289-94.
doi: 10.1016/j.jvir.2013.05.034. Epub 2013 Jul 18.

Natural history of tunneled dialysis catheters placed for hemodialysis initiation

Roman Shingarev  1 , Jill Barker-Finkel, Michael Allon
Affiliations
Comparative Study

Natural history of tunneled dialysis catheters placed for hemodialysis initiation

Roman Shingarev et al. J Vasc Interv Radiol. 2013 Sep.

Abstract

Purpose: More than 80% of hemodialysis recipients in the United States initiate hemodialysis with a tunneled dialysis catheter (TDC). Published data on TDC outcomes are based on a case mix of prevalent and incident TDCs. The present study analyzes factors affecting patency and complications of first TDCs placed in a large cohort of incident hemodialysis recipients.

Materials and methods: A prospective, computerized vascular access database was retrospectively queried to identify 472 patients receiving a first-ever TDC. Multiple-variable survival analysis was used to identify clinical parameters affecting TDC patency (from placement to nonelective removal) and infection (from placement to first episode of catheter-related bacteremia [CRB]).

Results: The median patency of all TDCs was 202 days. Left-sided placement of TDCs was the only variable associated with inferior TDC patency (hazard ratio, 1.98; 95% confidence interval, 1.39-2.81; P < .0001). The 6-month TDC patency rate was 37% for left internal jugular vein (LIJV) catheters, versus 54% for right internal jugular vein (RIJV) catheters. The 1-year patency rate was 6% for LIJV catheters, versus 35% for RIJV catheters. Catheter patency was not associated with patient age, sex, race, hypertension, diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, or heart failure. The median time to the first episode of CRB was 163 days. None of the clinical variables was associated with TDC infection.

Conclusions: TDCs are plagued by high rates of infection. RIJV TDCs should be used preferentially to maximize catheter patency.

Keywords: CI; CRB; ESRD; HR; LIJV; RIJV; TDC; catheter-related bacteremia; confidence interval; end-stage renal disease; hazard ratio; left internal jugular vein; right internal jugular vein; tPA; tissue plasminogen activator; tunneled dialysis catheter.

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Figures

Figure 1
Figure 1
Patency of tunneled dialysis catheters placed in right vs. left internal jugular vein. Catheter patency was decreased for left IJ vs right IJ catheters (p<0.0001).
Figure 2
Figure 2
Time to first catheter-related bacteremia in patients with tunneled dialysis catheters.
See this image and copyright information in PMC

References

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