title: High incidence of severe twin hemodialysis catheter infections in elderly women. Possible roles of insufficient nutrition and social support.
abstract: BACKGROUND
  Cuffed-tunneled hemodialysis (HD) catheters are recommended as a bridging therapy until peripheral access is available, but their long-term use is controversial.
  
  
  OBJECTIVE
  To evaluate the complications and lifetime of twin-tunneled HD catheters and to identify parameters which could predict their outcome.
  
  
  METHODS
  29 chronic HD patients (19 female and 10 male) were inserted with twin hemodialysis catheters (28 Tesio, 1 Schon Duoflow), followed for up to 9 months or until catheter loss, and evaluated for severe catheter-related complications necessitating catheter removal. Since the most common severe complication was catheter-related infection, we retrospectively examined whether parameters such as age, gender, duration of end-stage renal disease, delivered dose of dialysis, nutrition, diabetes and indices of social support correlate with this outcome.
  
  
  RESULTS
  Severe catheter infection requiring catheter removal occurred in 11 patients (10 female). Of these infected female patients, 9 were elderly (> or =67 years) and in 6 of those, catheter infection was fatal (54% of infected cases). At 9 months, severe catheter infection and related patient death rates were 38 and 21%, respectively. Severe catheter infection was significantly related to less social support (p < 0.005), older age, female gender, lower nPCR (all p < 0.05), and tended to be related to shorter end-stage renal disease duration prior to catheter insertion (p = 0.06).
  
  
  CONCLUSIONS
  This study demonstrated that twin HD catheters are associated with a high incidence of severe catheter-related infections which was most significantly related to social-support as well as inadequate nutrition, older age and female gender. Therefore, we suggest early removal of the catheter, enhancement of social support and dietary counseling for the elderly and lonely HD patients using this type of catheter.
authors.affiliation: Department of Nephrology, Soroka Medical Center, Ben Gurion University of the Negev, Beer Sheva, 84101 Israel. dtovbin@bgumail.bgu.ac.il
authors.forename: D
authors.initials: D
authors.lastname: Tovbin
authors.forename: A
authors.initials: A
authors.lastname: Mashal
authors.forename: M
authors.initials: M
authors.lastname: Friger
authors.forename: R
authors.initials: R
authors.lastname: Landver
authors.forename: T
authors.initials: T
authors.lastname: Jan
authors.forename: A
authors.initials: A
authors.lastname: Markowitz
authors.forename: M
authors.initials: M
authors.lastname: Mostoslavsky
authors.forename: Y
authors.initials: Y
authors.lastname: Gidron
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000382:microbiology* / Q000523:psychology / Q000628:therapy*; D008132:Loneliness; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*; D012189:Retrospective Studies; D017678:Sex Distribution; D012772:Shock, Septic / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D012944:Social Support; D016896:Treatment Outcome