Catheter-related bacteremia and mortality in frequent nocturnal home hemodialysis

Abstract

Frequent nightly home hemodialysis (NHHD) has emerged as an attractive alternative to thrice weekly in-center hemodialysis, albeit with preponderant long-term hemodialysis catheter used. Sixty-three NHHD patients from University of Virginia Lynchburg Dialysis Facility were matched 1:2 with 121 conventional hemodialysis patients admitted to Fresenius Medical Care North America facilities from January 1, 2007 to December 31, 2010. Matching considered age (± 5 years), gender, race, dialysis vintage, and diabetes. The primary end-point was the combined incidence of bacteremia/sepsis, for up to 20 months or upon changing to a fistula/graft (with catheter removal), transferring to peritoneal dialysis (PD), or at the time of kidney transplant or death. No significant differences were observed in rate of fistula/graft conversion, transfer to PD, transplant, or death between NHHD and in-center hemodialysis (IHD) groups. For the first catheter used, the rate of catheter-related sepsis was not significantly different between the NHHD (1.77 per 100 patient months) and IHD (2.03 per 100 patient months; P = 0.21). Combining all catheters, the rate of bacteremia/sepsis per 100 patient months in the NHHD group was 1.51 and in the IHD group was 2.01 (P = 0.35). Median catheter lifespan for the first catheter was 5.6 (1.7∼19.0) for NHHD and 4.6 (2.7∼7.8) for the IHD group (P = 0.64), and for all catheters used was 5.2 (Q1∼Q3 = 1.5∼15.2) months in NHHD group, and 4.1 (2.0∼6.8) months in IHD group (P = 0.20). The rate of bacteremia and death is not different for up to 20 months in catheter users who dialyze via frequent NHHD vs. thrice weekly IHD.

Keywords: Nocturnal hemodialysis; catheter infections; catheter mortality; catheter survival; home hemodialysis.