title: Comparison of Tesio and LifeCath twin permanent hemodialysis catheters: the VyTes randomized trial.
abstract: OBJECTIVE
  Central venous catheters for maintenance hemodialysis (HD) are designed to attain the required dialysis dose through sustained high blood flow rates (BFR). The authors studied the immediate and long-term performance and complications of two twin-catheter systems, the Tesio catheter (TC) and the LifeCath Twin (LC), to inform clinical practice.
  
  
  METHODS
  This single-center randomized controlled parallel-group trial allocated 80 incident patients (1:1) to receive either a TC (MedComp) or LC (Vygon). Patients were dialyzed to target BFR 450 mL/min and followed up for 12 months. The primary outcome was achievement of target BFR during the first HD session. Secondary outcomes included thrombotic dysfunction, displacement and catheter-related infection. Catheter dysfunction was defined by a BFR ≤ 250 mL/min.
  
  
  RESULTS
  More LCs reached the primary endpoint (44% vs. 10%, p=0.001) delivering a higher BFR (mean 383±82 vs. 277±79 mL/min, p<0.001). Significant differences in BFR persisted until the fourth dialysis session. Rates of catheter-related bacteremia (0.40 vs. 0.51/1,000 catheter days, p=0.7) and exit site infection were similar between groups (0.24 vs. 0.09/1,000 catheter days, p=0.4). Overall rates of catheter dysfunction were 2.8/1,000 catheter days (95% CI 2.1-3.5), with no differences in thrombolytic lock use although the LC group required more thrombolytic infusions (6 vs. 0, p=0.01).
  
  
  CONCLUSIONS
  The LC can deliver greater BFRs in the first three HD sessions following insertion although this did not translate into differences in performance, dialysis adequacy or complication rates with long-term use. Both catheter types can consistently deliver high BFRs over an extended period of time.
authors: Hemodialysis Research Group, Imperial College Renal and Transplant Center, Hammersmith Hospital, London - UK.
authors: Albert
authors: A
authors: Power
authors: Peter
authors: P
authors: Hill
authors: Seema K
authors: SK
authors: Singh
authors: Damien
authors: D
authors: Ashby
authors: David
authors: D
authors: Taube
authors: Neill
authors: N
authors: Duncan
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D055499:Catheter-Related Infections / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D062905:Central Venous Catheters; D004867:Equipment Design; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012307:Risk Factors; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000188:drug therapy / Q000209:etiology