Venous Hemodialysis Catheters and Cardiac Implantable Electronic Devices: Avoiding a High‐Risk Combination

Abstract

End-stage renal disease is frequently accompanied by cardiac comorbidity that warrants treatment with a cardiovascular implantable electronic device (permanent pacemaker or implantable cardioverter-defibrillator). In the United States, chronic hemodialysis (HD) population, cardiac implantable devices are present in up to 10.5% of patients; a venous HD catheter is utilized for blood access in 18% of prevalent patients. The concomitant presence of a venous HD catheter and cardiovascular implantable device creates a high-risk circumstance, with potential for causing symptomatic central venous stenosis, and for developing complicated endovascular infection. This dangerous combination may be avoided for many patients by utilizing nondialysis methods for management of advanced chronic kidney disease, initiating dialysis without venous catheter access, or managing cardiac rhythm disorders without use of transvenous cardiac implantable electronic devices. In those situations where the combination of a venous HD catheter and cardiac implantable device is unavoidable, there are strategies to minimize duration of venous catheter access, and to reduce risks for infectious complications. It is essential for nephrologists and cardiologists to understand the indications, alternatives, and risks involved with venous HD access and cardiac implantable devices. Coordinated management of renal disease and cardiac rhythm disorders has potential to minimize risks, improve outcomes, and substantially reduce the cost of care.

Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

“…This technique is preferred in patients who cannot have their CIED replaced, as well as in patients for whom surgery is not possible, or where treatment with conventional antibiotics does not work [167]. Saad and Weiner (2017) noted that it is necessary to avoid the usage of venous hemodialysis catheters in terminal renal disease patients, for who the insertion of a CIED is unavoidable, as it exponentially increases the risk to the patient. In such situations, the use of alternative dialysis methods is to be practiced, resulting in a reduced risk of infectious complications [168].…”

“…Saad and Weiner (2017) noted that it is necessary to avoid the usage of venous hemodialysis catheters in terminal renal disease patients, for who the insertion of a CIED is unavoidable, as it exponentially increases the risk to the patient. In such situations, the use of alternative dialysis methods is to be practiced, resulting in a reduced risk of infectious complications [168]. Another strategy is the usage of drug-eluting antibiotic beads that are inserted directly into the wound, where the antibiotics can perform in the infected location.…”

Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients—An Experience-Based Narrative Review

“…Unexpectedly, according to recently published retrospective studies, both ipsilateral and contralateral VA and CIED placement were related to similar long-term VA patency [72,73]. Nonetheless, because of an increased incidence of systemic complications (e.g., central vein stenosis) [74], we prefer to avoid ipsilateral CIED and VA whenever possible.…”

How does a CIED presence influence chances and safety of haemodialysis access? Conclusions from over 3000 thoracic venografies

“…Another series of reports is dedicated to the designed coexistence of CIED system and haemodialysis (Hickson et al, 2014;Lin et al, 2016;Urja et al, 2019), especially in patients dialysed with permanent catheters (Guha et al, 2015;Saad & Weiner, 2017;23) infection, catheter-related infection, catheter infection, postoperative venous access occlusion, central vein stenosis, catheter damage or dysfunction, thrombotic occlusion of the catheter) (Asif et al, 2012;Bozzetto et al, 2022;Guha et al, 2015;Jeong et al, 2018;Kusztal & Nowak, 2018;Lin et al, 2016;Nowak & Kusztal, 2021;Saad & Weiner, 2017;Saad et al, 2013;Saad et al, 2015;Sgroi et al, 2019;Sohail et al, 2021;Spatola et al, 2021;Tan et al, 2013;Urja et al, 2019). Most of the above-mentioned reports concern infection prevention and management.…”