Deep venous thrombosis following placement of temporary hemodialysis catheters in patients with chronic kidney disease

Abstract

Background The prevalence of chronic kidney disease (CKD) is high in India, with 50% of patients presenting with stage 5 CKD and undergoing hemodialysis primarily via central venous catheters (CVCs). Catheter occlusion may occur due to mechanical twisting, thrombosis, or drug use. The CKD spectrum is a risk for catheter-related thrombosis (CRT). Deep venous thrombosis (DVT) is less often studied in CKD with CVCs. We aimed to determine the incidence rates of DVT (limb extremity and deep thoracic veins) and their contributing factors. Materials and methods The study was prospective and observational for three years in a tertiary care government teaching hospital. Patients with ESRD and temporary hemodialysis catheters (HDCs) placed for maintenance hemodialysis (on an emergency basis or until the maturation of arteriovenous fistula [AVF]) were followed up for three months. Those already undergoing hemodialysis elsewhere, either through HDC or AVF, were excluded. Incidence rates of DVT per 1000 catheter-days were calculated. Results The mean age was 46.6±13.47 years;190/278 were males. A total of 140 patients had CKD for < 6 months. A total of 103 patients had at least one risk factor for DVT. 24/278 (8.6%) developed DVT giving an incidence rate of 0.95/1000 catheter days. A median of 7 sessions of hemodialysis and a mean of 19.8±6.4 days before the development of DVT was seen. The odds ratio for developing DVT for right IJV, left IJV, right femoral, and left femoral were 0.2, 5.0, 1.1, and 4.3, respectively. Thirty-one developed catheter-related blood stream infection (CRBSI); six had both coexisting DVT and CRBSI. Conclusion The incidence of DVT was low. Patients with CKD need diagnosis and planning for hemodialysis earlier. Screening patients with HDCs may enable quicker diagnosis of DVT since many are asymptomatic.