The case for primary placement of tunneled hemodialysis catheters in acute kidney injury.
OBJECTIVE
Nontunneled hemodialysis catheters (NTDCs) are widely used for initial hemodialysis access in new-onset renal failure. The National Kidney Foundation recommends NTDC use for hemodialysis duration of less than 1 week in acute kidney injury because of the increased infection risk compared with tunneled hemodialysis catheters (TDCs) with longer use. The present study was performed to determine whether primary placement of TDCs in this setting is more appropriate, and whether there are predictors of recovery of renal function in less than 1 week.


METHODS
In the authors' practice, patients referred to the interventional radiology unit in whom no contraindications exist receive a TDC; 76 patients who received a primary TDC for acute kidney injury and who eventually recovered renal function were retrospectively reviewed herein. Causes of renal failure, various renal function parameters, and demographics were collected, as were TDC dwell times, in an effort to determine predictors of recovery and/or extended duration of use.


RESULTS
Mean TDC dwell time in patients who eventually recovered from acute kidney injury was 34 days; only 15 of 76 (20%) recovered within 1 week. At TDC placement, there were no significant differences between patients who recovered in less than (vs greater than) 1 week.


CONCLUSIONS
The present results support primary placement of TDCs in patients with acute kidney injury who require hemodialysis and in whom no contraindications exist, as no predictors of recovery of renal function in less than 1 week were identified.
Coryell
Lee
L
Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Lott
Jason P
JP
Stavropoulos
S William
SW
Mondschein
Jeffrey I
JI
Patel
Aalpen A
AA
Kwak
Andrew
A
Soulen
Michael C
MC
Solomon
Jeffrey A
JA
Shlansky-Goldberg
Richard D
RD
Nemeth
Alexander A
AA
Kobrin
Sidney
S
Rudnick
Michael
M
Trerotola
Scott O
SO
D000208:Acute Disease; D055499:Catheter-Related Infections / Q000209:etiology; D002408:Catheters, Indwelling / Q000009:adverse effects; D004867:Equipment Design; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007668:Kidney / Q000293:injuries* / Q000503:physiopathology; D007674:Kidney Diseases / Q000503:physiopathology / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D020127:Recovery of Function; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome