title: Natural history of tunneled dialysis catheters placed for hemodialysis initiation.
abstract: OBJECTIVE
  More than 80% of hemodialysis recipients in the United States initiate hemodialysis with a tunneled dialysis catheter (TDC). Published data on TDC outcomes are based on a case mix of prevalent and incident TDCs. The present study analyzes factors affecting patency and complications of first TDCs placed in a large cohort of incident hemodialysis recipients.
  
  
  METHODS
  A prospective, computerized vascular access database was retrospectively queried to identify 472 patients receiving a first-ever TDC. Multiple-variable survival analysis was used to identify clinical parameters affecting TDC patency (from placement to nonelective removal) and infection (from placement to first episode of catheter-related bacteremia [CRB]).
  
  
  RESULTS
  The median patency of all TDCs was 202 days. Left-sided placement of TDCs was the only variable associated with inferior TDC patency (hazard ratio, 1.98; 95% confidence interval, 1.39-2.81; P < .0001). The 6-month TDC patency rate was 37% for left internal jugular vein (LIJV) catheters, versus 54% for right internal jugular vein (RIJV) catheters. The 1-year patency rate was 6% for LIJV catheters, versus 35% for RIJV catheters. Catheter patency was not associated with patient age, sex, race, hypertension, diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, or heart failure. The median time to the first episode of CRB was 163 days. None of the clinical variables was associated with TDC infection.
  
  
  CONCLUSIONS
  TDCs are plagued by high rates of infection. RIJV TDCs should be used preferentially to maximize catheter patency.
authors.affiliation: Division of Nephrology, University of Alabama at Birmingham, PB, Room 226, 1530 Third Ave. S., Birmingham, AL 35294, USA.
authors.forename: Roman
authors.initials: R
authors.lastname: Shingarev
authors.forename: Jill
authors.initials: J
authors.lastname: Barker-Finkel
authors.forename: Michael
authors.initials: M
authors.lastname: Allon
mesh_terms: D000407:Alabama / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000401:mortality*; D002405:Catheterization, Central Venous / Q000379:methods / Q000401:mortality*; D015984:Causality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: CI; CRB; ESRD; HR; LIJV; RIJV; TDC; catheter-related bacteremia; confidence interval; end-stage renal disease; hazard ratio; left internal jugular vein; right internal jugular vein; tPA; tissue plasminogen activator; tunneled dialysis catheter