title: [Clinical and economic repercussions of the use of tunneled haemodialysis catheters in a health area].
abstract: BACKGROUND
  Tunneled catheters in hemodialysis are associated with poor prognosis, however, few prospective studies have been designed to specifically evaluate this aspect. The objective has been evaluate the impact of tunneled catheter in patient mortality and costs attributable to this procedure.
  
  
  METHODS
  A seven years prospective cohort study was performed in all patients starting hemodialysis in our health care area adjusting for comorbidity and albumin. The study comprised 260 patients with Charlson index 7.05 +/- 2.8 (age 65.5 years, 62.3% males, 25% with diabetes mellitus and 37.7% with a previous cardiovascular event.
  
  
  RESULTS
  The first vascular access was a catheter in 47.3%, PTFE in 11.2% and native arteriovenous fistula in 41.5%. Minimum follow-up was one year, with an average of 2.31 years/patient. The mortality risk adjusted for comorbidity was greater among the patients that started with catheterization, HR: 1.86 [1.11-3.05]. This negative effect was observed in 57.30% of those subjected to catheterization at any stage (HR: 1.68 [1.00-2.84] and proved to be time dependent, i.e., the longer catheterization, the greater the risk: HR: 7.66 [3.34-17.54] third versus first tertil. The cost directly attributable to catheter use was 563.31 euros/month. All poor prognosis groups showed lower albumin and hemoglobin levels, without differences in efficacy.
  
  
  CONCLUSIONS
  Tunneled catheter use at any time is associated with an increased risk of death. This effect increases with the duration of catheterization, both circumstances are independent of patient comorbidity at time start of hemodialysis and implies a higher net cost.
authors.affiliation: Servicio de Nefrología, Fundación Hospital Alcorcón, Madrid, Spain. egruss@ono.com
authors.forename: E
authors.initials: E
authors.lastname: Gruss
authors.forename: J
authors.initials: J
authors.lastname: Portolés
authors.forename: A
authors.initials: A
authors.lastname: Tato
authors.forename: T
authors.initials: T
authors.lastname: Hernández
authors.forename: P
authors.initials: P
authors.lastname: López-Sánchez
authors.forename: P
authors.initials: P
authors.lastname: Velayos
authors.forename: M C
authors.initials: MC
authors.lastname: Gago
authors.forename: S
authors.initials: S
authors.lastname: Martínez
authors.forename: M M
authors.initials: MM
authors.lastname: Andrés
authors.forename: J
authors.initials: J
authors.lastname: Sánchez Tornero
authors.forename: P
authors.initials: P
authors.lastname: Jiménez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000453:epidemiology; D001166:Arteriovenous Shunt, Surgical / Q000191:economics; D002318:Cardiovascular Diseases / Q000401:mortality; D002408:Catheters, Indwelling / Q000191:economics; D015897:Comorbidity; D003928:Diabetic Nephropathies / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000191:economics / Q000295:instrumentation* / Q000401:mortality; D012306:Risk; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D055815:Young Adult