Patterns of Hemodialysis Catheter Dysfunction Defined According to National Kidney Foundation Guidelines As Blood Flow <300 mL/min

Abstract

Blood flow rate (BFR) <300 mL/min commonly is used to define hemodialysis catheter dysfunction and the need for interventions to prevent complications. The objective of this study was to describe patterns of unplanned BFR <300 mL/min during catheter hemodialysis using data from DaVita dialysis facilities and the United States Renal Data System. Patients were included if they received at least eight weeks of hemodialysis exclusively through a catheter between 08/04 and 12/06, and catheter hemodialysis was the first treatment modality following diagnosis of end-stage renal disease (first access), or it immediately followed at least one 30-day period of dialysis exclusively through a fistula or graft (replacement access). Actual BFR <300 mL/min despite a planned BFR ≥300 mL/min defined catheter dysfunction during each dialysis session. There were 3,364 patients, 268,363 catheter dialysis sessions, and 19,118 (7.1%) sessions with catheter dysfunction. Almost two-thirds of patients had ≥1 catheter dysfunction session, and 30% had ≥1 catheter dysfunction session per month. Patients with catheter as a replacement access had a higher rate of catheter dysfunction than those with a catheter as first access (hazard ratio: 1.13; P = 0.04). Catheter dysfunction affects almost one-third of catheter dialysis patients each month and two-thirds overall.

Predicting tissue plasminogen activator use and success in in-center hemodialysis patients

“…Our findings that patient variables are associated with both predicting the time to first TPA use (i.e., increasing body mass index and black race) and its success after TPA administration (i.e., decreasing body mass index and having diabetes) are consistent with the findings of other studies (13)(14)(15). While the biologic mechanisms for these associations have not yet been studied, prior clinical studies have found that being male (13), being black (vs. white) (13) and having diabetes (14,15) were associated with a higher risk of catheter malfunction and previous catheter use (14) was associated with decreased time to catheter removal.…”

Risk Factors Associated with Hemodialysis Central Venous Catheter Malfunction; A Retrospective Analysis of a Randomized Controlled Trial

“…While CVC location has been identified as a risk factor for malfunction, this study examined non-tunnelled catheters only [ 24 ]. An observational cohort study of 3,364 incident and prevalent HD patients with a CVC in the United States reported the risk of CVC malfunction (blood flow <300 mL/min) was lower for males and black race (compared with white) and higher if CVC was not the first access modality [ 25 ]. Male patients in our study were also at decreased risk but, possibly due to small numbers, we saw no significant effect of first CVC ever or ethnicity.…”

Self-Centering Split-Tip Catheter versus Conventional Split-Tip Catheter in Prevalent Hemodialysis Patients

“…Catheter dysfunction is defined by the KDOQI as the inability to reach a BFR of 300 mL/min within the first hour of dialysis; whereas the most serious causes of catheter dysfunction are loss of blood flow due to sheathing and clotting, dysfunction may also be caused by bends, kinks, holes, or cracks in the tubing (4, 13). Despite optimal implantation techniques, TDCs tend to lose effective blood flow with time due to fibrin sheath formation and the eventual development of thromboses within the sheath, catheter, or the vein.…”