title: Replacement tunnelled dialysis catheters for haemodialysis access: Same site, new site, or exchange - a multivariate analysis and risk score.
abstract: OBJECTIVE
  To identify variables related to complications following tunnelled dialysis catheter (TDC) replacement and stratifying the risk to reduce morbidity in patients with end-stage renal disease.
  
  
  METHODS
  One hundred and forty TDCs (Split Cath, medCOMP) were replaced in 140 patients over a 5 year period. Multiple variables were retrospectively collected and analysed to stratify the risk and to predict patients who were more likely to suffer from complications. Multivariate regression analysis was used to identify variables predictive of complications.
  
  
  RESULTS
  There were six immediate complications, 42 early complications, and 37 late complications. Multivariate analysis revealed that variables significantly associated to complications were: female sex (p = 0.003; OR 2.9); previous TDC in the same anatomical position in the past (p = 0.014; OR 4.1); catheter exchange (p = 0.038; OR 3.8); haemoglobin <11 g/dl (p = 0.033; OR 3.6); albumin <30 g/l (p = 0.007; OR 4.4); prothrombin time >15 s (p = 0.002; OR 4.1); and C-reactive protein >50 mg/l (p = 0.007; OR 4.6). A high-risk score, which used the values from the multivariate analysis, predicted 100% of the immediate complications, 95% of the early complications, and 68% of the late complications.
  
  
  CONCLUSIONS
  Patients can now be scored prior to TDC replacement. A patient with a high-risk score can be optimized to reduce the chance of complications. Further prospective studies to confirm that rotating the site of TDC reduces complications are warranted as this has implications for current guidelines.
authors.affiliation: Department of Radiology, Hull Royal Infirmary, UK.
authors.forename: C R
authors.initials: CR
authors.lastname: Tapping
authors.forename: P M
authors.initials: PM
authors.lastname: Scott
authors.forename: R
authors.initials: R
authors.lastname: Lakshminarayan
authors.forename: D F
authors.initials: DF
authors.lastname: Ettles
authors.forename: G J
authors.initials: GJ
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000706:statistics & numerical data*; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D015897:Comorbidity; D020878:Device Removal / Q000706:statistics & numerical data; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D017678:Sex Distribution; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology