Factors influencing the long-term outcome of tunneled hemodialysis catheters

Abstract

Purpose:To review the incidence and type of tunneled hemodialysis catheter (THC) complications in a large cohort of patients with end-stage renal disease. Additionally, the longevity of the THC and factors predicting high risk for catheter complications were assessed.Material and methods:Between August 2009 and December 2016, a cohort of 538 patients underwent primary THC insertion; in 119 patients, THC was inserted after failed arteriovenous fistula or graft. Patients without available clinical follow-up data (n = 67) were excluded for further analysis. The Charlson comorbidity index (CCI) was calculated for each patient. The cumulative incidence function (CIF) was used for THC overall longevity, while Cox proportional hazards models were used for risk factor analysis.Results:In 352 patients, THC was inserted in a virgin neck. THC-related complications were observed in n = 104 (29.55%) of the patients. Infection occurred in n = 38 (10.80%) and malfunction, related to thrombosis or mechanical damage, in n = 45 (12.78%). Removal of the THC for the purpose of switching to alternative dialysis methods was planned in n = 135 (38.4%). The remaining patients were still alive with a functioning THC (n = 18; 5.11%) or died (n = 95; 27%) with a functioning THC. The THC survival rate was 82.67%, 78.13%, 74.15%, 72.96%, 71.02%, and 70.63% on follow-up after 6 months, and after 1-5 years, respectively. Gender, CCI, age, and site of placement of the catheter were found not to affect the life of the catheter.Conclusion:The overall complication rate in primary inserted THC was nearly 30% and mainly related to infection and malfunction. THC survival was more than 70% after 5 years, which supports its use for permanent dialysis access, irrespective of gender, CCI, age, and jugular side of THC placement.