Starting Hemodialysis with Catheter and Mortality Risk: Persistent Association in a Competing Risk Analysis

Roca-Tey, Ramón; Arcos, Emma; Comas, Jordi; Cao, Higini; Tort, Jaume

doi:10.5301/jva.5000468

Cited by 44 publications

(49 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Older age was associated with CVDs. Cardiovascular events and infections were major factors of death in our study, which was consistent with the findings of previous studies [3,8,11]. …”

Section: Discussionsupporting

confidence: 82%

See 1 more Smart Citation

Catheter Failure and Mortality in Hemodialysis Patients with Tunneled Cuffed Venous Catheters in a Single Center

Shi¹,

Cui²,

Ma³

et al. 2017

Blood Purif

View full text Add to dashboard Cite

Background: As of now, only a few studies have focused on the failure of tunneled cuffed venous catheter (tCVC) and mortality of hemodialysis (HD) patients using tCVC as long-term vascular access, whose vascular condition for arteriovenous fistula was not very satisfactory. In this study, we aimed to provide information about the first tCVC failure and survival rates of patients in this population. Methods: Fifty-nine patients who used tCVC from January 1, 2009 to December 31, 2014 in our HD center were analyzed in this retrospective study and followed up either until their death or until December 31, 2015. The first tCVC and patient survival rates were analyzed. Results: The incidence of catheter-related infections was 0.3 per 1,000 patient-days. The median survival duration of first tCVC was 45.0 (95% CI 29.3-69.7) months and the median survival time of all patients was 56.3 (95% CI 34.1-78.5) months by Kaplan-Meier analysis. Advanced age (hazard ratio [HR] 1.055, p < 0.05) and diabetic mellitus (HR 4.147, p < 0.05) at the initiation of HD were significant risk factors of first tCVC failure, while male (HR 2.712, p < 0.05) and cardiovascular diseases (CVDs; HR 4.139, p < 0.05) were significant risk factors for patient mortality as deduced by Cox proportional hazards methods. Conclusions: The study highlighted that first tCVC survival rates and patient survival rates were high in HD patients who were using tCVCs as long-term vascular access, with low incidence of catheter-related infections. In the study it was found that advanced age and diabetic mellitus at the initiation of HD influenced first tCVC failure, whereas male and CVDs seemed to be risk factors for patient mortality.

show abstract

“…Older age was associated with CVDs. Cardiovascular events and infections were major factors of death in our study, which was consistent with the findings of previous studies [3,8,11]. …”

Section: Discussionsupporting

confidence: 82%

“…Conversion of vascular access type was associated with mortality in incident dialysis patients [9,10]. Using a tCVC or non-tCVC at the initiation of HD was an independent risk factor for higher mortality than AVF [11]. Using non-tCVC in HD initiation would result in the occurrence of a side effect on a later permanent vascular access [12].…”

Section: Introductionmentioning

confidence: 99%

Catheter Failure and Mortality in Hemodialysis Patients with Tunneled Cuffed Venous Catheters in a Single Center

Shi¹,

Cui²,

Ma³

et al. 2017

Blood Purif

View full text Add to dashboard Cite

show abstract

“…Furthermore, compared to patients using AVFs, patients using TCs have higher risks of all‐cause mortality (RR = 1.53), fatal infections (RR 2.12), and cardiovascular events (RR 1.38) . These mortality rates are even greater in the first 120 days for patients who initiate hemodialysis with a TC compared to those with an AVF: Crude all‐cause mortality rate (deaths/100 patient‐years; OR = 2.97, 95% CI:2.17‐4.06), cardiovascular causes (OR 1.84, 95% CI:1.17‐2.89), and for infection‐related causes 4.58 (95% CI: 2.00‐10.52) …”

Section: Catheter Access Rates For Patients On Hemodialysis and The Rmentioning

confidence: 99%

“…6 These mortality rates are even greater in the first 120 days for patients who initiate hemodialysis with a TC compared to those with an AVF: Crude all-cause mortality rate (deaths/100 patient-years; OR = 2.97, 95% CI:2.17-4.06), cardiovascular causes (OR 1.84, 95% CI:1.17-2.89), and for infection-related causes 4.58 (95% CI: 2.00-10.52). 7,8…”

Section: Catheter Access Rates For Patients On Hemodialysis and The Rmentioning

confidence: 99%

Prevention of hemodialysis catheter infections: Ointments, dressings, locks, and catheter hub devices

Golestaneh

Mokrzycki

2018

Hemodialysis International

View full text Add to dashboard Cite

Tunneled central venous catheters used for the provision of hemodialysis are associated with excess morbidity and mortality. Catheter related exit site and blood stream infections are major risks of their use. Although catheter‐avoidance is the best strategy to reduce infections and mortality in the hemodialysis population, the use of catheters remains unacceptably high. In this review, the existing clinical practice guidelines for the prevention of hemodialysis catheter associated infections are outlined, and a comprehensive evidenced‐based summary of interventions is provided. This includes details about the use of topical antimicrobial ointments and dressings, intranasal ointment application, prophylactic use of antibiotic and non‐antibiotic catheter lock solutions, and catheter hub devices for the prevention of catheter blood stream infections.

show abstract

“…These "semipermanent" catheters have the advantage of retaining themselves in the subcutaneous tissue by a Dacron "cuff" eliciting soft tissue growth and scarring and have lesser propensity to suffer from exit site infections (13). Nonetheless, they represent an inferior access modality compared with conventional AV fistulas and grafts (14)(15)(16)(17)(18) and their utilization is associated with increased mortality (19)(20)(21). The current literature on TDCs is focused around circumstances of placement (22)(23)(24), malfunction and maintenance of catheter patency (25)(26)(27), as well as prevention of infections (28)(29)(30)(31).…”

mentioning

confidence: 99%

Bedside Tunneled Dialysis Catheter Removal-A Lesson Learned From Nephrology Trainees

et al. 2016

View full text Add to dashboard Cite

Semi-permanent dual-lumen tunneled (or tunneled-cuffed) hemodialysis catheters (TDC) are increasingly utilized during renal replacement therapy, while awaiting permanent access maturation or renal recovery. Although there is a wealth of literature focused on placement, infection prevention, and maintenance of catheter patency, circumstances and indications for TDC removal are less well understood. Timely removal of these catheters is an important management decision, with the length of TDC duration representing the largest cumulative risk factor for catheter-associated blood stream infections. Waiting for assistance from surgical or radiological services-which may not be available in all hospitals-may result in delays in services and potential harm to the patients. Imparting and maintaining procedural skills to remove infected TDC may be very valuable for training programs in clinical nephrology. In this article the current literature on bedside TDC removal, including potential anticipated complications during removal, are reviewed. To date, the authors have documented successful implementation of bedside TDC removal in training programs from two different settings, including both in- and outpatients and with trainee involvement. In summary, training general nephrologists for bedside TDC removal will afford immediate removal of infected hardware in ill patients and avoid potential delays in outpatient setting.

show abstract

Starting Hemodialysis with Catheter and Mortality Risk: Persistent Association in a Competing Risk Analysis

Abstract: Half of all incident patients in Catalonia are exposed to excessive mortality risk related to catheter and this scenario can be improved by early fistula placement.

Cited by 44 publications

References 32 publications

Catheter Failure and Mortality in Hemodialysis Patients with Tunneled Cuffed Venous Catheters in a Single Center

Catheter Failure and Mortality in Hemodialysis Patients with Tunneled Cuffed Venous Catheters in a Single Center

Prevention of hemodialysis catheter infections: Ointments, dressings, locks, and catheter hub devices

Bedside Tunneled Dialysis Catheter Removal-A Lesson Learned From Nephrology Trainees

Contact Info

Product

Resources

About