Tunneled catheters in hemodialysis patients: reasons and subsequent outcomes.
BACKGROUND
Reducing the use of tunneled catheters in hemodialysis patients requires concerted efforts to convert them to a usable permanent vascular access. The goal of this study is to evaluate the reasons for tunneled catheter use in our prevalent hemodialysis population and the success in converting them to a permanent vascular access.


METHODS
We identified all catheter-dependent hemodialysis patients at our center on a single date. These patients were followed up prospectively during a 1-year period to evaluate access procedures and conversion to permanent access use.


RESULTS
Of 458 prevalent hemodialysis patients, 108 patients (23.6%) were dialyzing through cuffed tunneled catheters: 18.5% had no further options for creation of a permanent vascular access, 28.7% had an immature access, 43.5% had access placement pending, and 9.2% had repeatedly refused access surgery. For 78 catheter-dependent patients (excluding patients with no access options and those who refused permanent access surgery), the likelihood of using a permanent access was 53% by 6 months and 80% by 1 year. In patients with an immature access, 50% were using a permanent access at 3 months, and 80%, at 6 months. Of patients with access surgery pending, 45% had access surgery performed within 3 months, and 70%, at 6 months. Finally, of all patients, the likelihood of catheter-related bacteremia was 48% at 6 months. On multivariable analysis, only duration of catheter dependence predicted subsequent use of a permanent access (hazard ratio, 3.11; 95% confidence interval, 1.70 to 5.68; P = 0.0002) for catheter dependence less than versus greater than 6 months.


CONCLUSIONS
Almost one quarter of our hemodialysis population is catheter dependent. Despite concerted efforts, there remain very long delays in achieving a usable permanent access, attributable to delays in both surgical access placement and access maturation. In the interim, this patient population developed a high frequency of catheter-related bacteremia.
Lee
Timmy
T
Division of Nephrology, University of Alabama, Birmingham, AL, USA.
Barker
Jill
J
Allon
Michael
M
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000706:statistics & numerical data*; D048909:Diabetes Complications / Q000453:epidemiology; D004867:Equipment Design; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation* / Q000706:statistics & numerical data; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome