title: Long-term Tesio catheter access for hemodialysis can deliver high dialysis adequacy with low complication rates.
abstract: OBJECTIVE
  The use of central venous catheters for long-term hemodialysis has been associated with increased mortality and high prevalence of infection and venous stenosis. However, because central venous catheters still constitute a significant proportion of vascular access in prevalent populations, even in the Fistula-First era, the authors examined the long-term patient outcomes and performance of this vascular access type to inform current clinical practice.
  
  
  METHODS
  The authors conducted a retrospective cohort study of 433 patients on maintenance hemodialysis in a dialysis program from January 1999 through April 2008 all using twin-catheter Tesio Caths (TCs) (MedCOMP, Harleysville, Pennsylvania). Written and electronic records were examined with respect to laboratory indices as well as mortality, access-related infection, need for thrombolytic infusion, access revision and dialysis adequacy.
  
  
  RESULTS
  A total of 759 TCs were inserted with 552,035 catheter days follow-up. Thirty-six percent of insertions were in patients incident to dialysis (< 90 days). Mean single-pool Kt/V was 1.6 ± 0.3. Cumulative cohort survival rates were 85%, 72%, and 48% at 1, 2, and 5 years, respectively. No patients died as a result of lack of vascular access. Cumulative assisted primary access site patencies were 76%, 62%, and 42% at 1, 2, and 5 years, respectively. The prevalence of symptomatic central venous stenosis was 5%. Catheter-related bacteremia occurred at a rate of 0.34 per 1,000 catheter days.
  
  
  CONCLUSIONS
  Appropriate use of TCs with protocolized care can deliver effective long-term hemodialysis with good adequacy and rates of access-related infection approaching those seen with arteriovenous grafts.
authors.affiliation: Haemodialysis Research Group, Imperial College Kidney and Transplant Institute, West London Renal & Transplant Centre, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom. albert.power@nhs.net
authors.forename: Albert
authors.initials: A
authors.lastname: Power
authors.forename: Seema K
authors.initials: SK
authors.lastname: Singh
authors.forename: Damien
authors.initials: D
authors.lastname: Ashby
authors.forename: Tom
authors.initials: T
authors.lastname: Cairns
authors.forename: David
authors.initials: D
authors.lastname: Taube
authors.forename: Neill
authors.initials: N
authors.lastname: Duncan
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002408:Catheters, Indwelling / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008131:London; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents