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Lazarus B, Kotwal S, Gallagher M, Gray NA, Coggan S, Talaulikar G, Polkinghorne KR. Replacement Strategies for Tunneled Hemodialysis Catheters with Complications: A Nationwide Cohort Study. Clin J Am Soc Nephrol 2024; 19:01277230-990000000-00413. [PMID: 38913437 PMCID: PMC11390028 DOI: 10.2215/cjn.0000000000000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
Key Points
Replacement strategies for hemodialysis catheters with mechanical failure differed widely between services, which suggests clinical equipoise.For mechanical hemodialysis catheter failure, exchange did not result in more dysfunction or infection than removal and separate replacement.In Australia, infected catheters were almost universally removed and then replaced through a separate tunnel tract.
Background
Tunneled hemodialysis catheters often have infectious or mechanical complications that require unplanned removal and replacement, but the optimal replacement strategy is unknown. This study described the real-world use of two strategies in Australia and compared the survival of replacement catheters inserted by either strategy.
Methods
Observational data from the REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach trial, which enrolled a nationwide cohort of 6400 adults who received an incident hemodialysis catheter (2016–2020), was used for this secondary analysis. Tunneled catheters were replaced by either catheter exchange through the existing tunnel tract or removal and replacement through a new tract. The effect of the replacement strategy on the time to catheter removal because of infection or dysfunction was estimated by emulating a hypothetical pragmatic randomized trial among a subset of 434 patients with mechanical tunneled catheter failure.
Results
Of 9974 tunneled hemodialysis catheters inserted during the trial, 380 had infectious and 945 had mechanical complications that required replacement. Almost all infected hemodialysis catheters (97%) were removed and separately replaced through a new tunnel tract, whereas nephrology services differed widely in their replacement practices for catheters with mechanical failure (median=50% guidewire exchanged, interquartile range=30%–67%). Service-level differences accounted for 29% of the residual variation after adjusting for patient factors. In the target trial emulation cohort of patients with mechanical catheter failure (n=434 patients), catheter exchange was not associated with lower complication-free survival at 1, 6, or 12 months (counterfactual survival difference at 1 month=5.9%; 95% confidence interval, −2% to 14%).
Conclusions
Guidewire exchange for mechanical failure of catheter was not associated with lower catheter survival and may be preferable for patients.
Trial registration and protocol:
The trial was registered in the Australia and New Zealand clinical trials registry on the June 23, 2016 (ACTRN12616000830493).
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Affiliation(s)
- Benjamin Lazarus
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Sradha Kotwal
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
- Prince of Wales Hospital, UNSW Sydney, Sydney, New South Wales, Australia
| | - Martin Gallagher
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
- South Western Sydney Campus, UNSW Sydney, Sydney, New South Wales, Australia
| | - Nicholas A Gray
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Sarah Coggan
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Girish Talaulikar
- Department of Nephrology, The Canberra Hospital, Garran, Australian Capital Territory, Australia
- Australian National University School of Medicine, Acton, Australian Capital Territory, Australia
| | - Kevan R Polkinghorne
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia
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Prasad P, Vachharajani TJ. Dialysis Catheter Tip Design and Dysfunction: An Unsolved Challenge. Am J Kidney Dis 2024; 83:429-431. [PMID: 38363257 DOI: 10.1053/j.ajkd.2024.01.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Pallavi Prasad
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India; Department of Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Tushar J Vachharajani
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan; Wayne State University School of Medicine, Detroit, Michigan.
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