Does heparin coating improve patency or reduce infection of tunneled dialysis catheters?
OBJECTIVE
Tunneled dialysis catheters are prone to frequent malfunction and infection. Catheter thrombosis occurs despite prophylactic anticoagulant locks. Catheter thrombi may also serve as a nidus for catheter infection, thereby increasing the risk of bacteremia. Thus, heparin coating of catheters may reduce thrombosis and infection. This study evaluated whether heparin-coated hemodialysis catheters have fewer infections or greater cumulative survival than noncoated catheters.


METHODS
We retrospectively queried a prospective access database to analyze the outcomes of 175 tunneled dialysis catheters placed in the internal jugular vein, including 89 heparin-coated catheters and 86 noncoated catheters. The primary outcome was cumulative catheter survival, and the secondary outcome was infection-free catheter survival.


RESULTS
The two patient groups were similar in demographics and clinical and catheter features. Catheter-related bacteremia occurred less frequently with heparin-coated catheters than with noncoated catheters (34 versus 60%, P < 0.001). Cumulative catheter survival was similar in heparin-coated and noncoated catheters (hazard ratio, 0.87; 95% confidence interval, 0.55 to 1.36; P = 0.53). On multiple variable survival analysis including catheter type, age, sex, diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, catheter location, and previous catheter, only catheter location predicted cumulative catheter survival (hazard ratio, 2.03; 95% CI, 1.27 to 3.25, with the right internal jugular location being the reference group, P = 0.003). The frequency of thrombolytic instillation was 1.8 per 1000 catheter-days in both groups.


CONCLUSIONS
Heparin coating decreases the frequency of catheter-related bacteremia but does not reduce the frequency of catheter malfunction.
Jain
Gaurav
G
Division of Nephrology, Interventional Nephrology Section, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Allon
Michael
M
Saddekni
Souheil
S
Barker
Jill-Finkel
JF
Maya
Ivan D
ID
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000517:prevention & control*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D014654:Vascular Patency
D000925:Anticoagulants; D006493:Heparin