Ratio of Extracellular to Intracellular Water Is Associated with Permanent Catheter Patency Survival in Patients Receiving Maintenance Hemodialysis

Abstract

Patients undergoing dialysis through a permanent catheter often experience infection or malfunction. However, few studies have clarified the predictors of permanent catheter patency survival in patients undergoing hemodialysis. We assessed the relationship between the parameters of body composition monitoring (BCM), determined before the initiation of dialysis, and the patency survival of the permanent catheters inserted in 179 patients who commenced hemodialysis between 14 January 2020 and 31 August 2021. The relationships between permanent catheter patency at 6 weeks and BCM parameters, laboratory tests, age, sex, comorbidities, and medications at baseline were studied using Kaplan–Meier survival curves. Permanent catheter patency was observed to be superior at high extracellular-to-intracellular (ECW/ICW) ratio (p < 0.005). After adjustment for covariates, the ECW/ICW ratio remained an independent factor associated with permanent catheter patency survival. When patients with non-patent catheters were subdivided into infection and malfunction groups, and the associations of BCM parameters were evaluated in those groups, the ECW/ICW ratio was not significantly associated with permanent catheter patency survival in the infection group (p = 0.327); instead, a significant association was found for the lean tissue index (p < 0.001). In the malfunction group, the ECW/ICW ratio remained significantly associated with permanent catheter patency survival (p < 0.001).

Relationship between Permanent Catheter Patency and Nutrient Score in Patients Aged >75 Years Requiring Renal Replacement Therapy

“…The results of the BCM parameters were not statistically significant in this study but showed a similar trend to previous studies [ 14 , 15 , 16 ] which showed the association with an ICW decrease and inflammation. Kim et al reported that the parameters ECW/ICW ratio <1.2 and LTI ≥ 10.2 could be useful predictors whether malfunction or infection might affect permanent catheter patency [ 17 ]. The study targeted patients who required dialysis and had a permanent catheter insertion at that time.…”

“…The patient population in this study was 75 to 97 years old, with a median age of 82 years. In the study published by Kim et al, the study was not conducted only on elderly people over 75 years of age and did not show statistical significance between permanent catheter patency and nutritional status [ 17 ]. In the case of elderly patients over 75 years of age, nutritional status, especially CONUT score, was shown to be an important factor affecting permanent catheter patency.…”