Variety of factors influence long-term catheter outcomes in children on hemodialysis
DALLAS — The long-term outcomes and complications of tunneled hemodialysis access in children with ESRD depend on a variety of factors, with infection rarely being an indication of replacement, according to findings presented at the Annual Dialysis Conference.
“It’s important to place the first catheter well for dialysis,” Juan M. Delgado, MD, of the department of diagnostic radiology at Baylor College of Medicine, told Healio/Nephrology. “The most significant result of our study was that the first catheter had longer survival outcomes than subsequent ones.”
To examine the long-term outcomes and complications of catheters in a pediatric population, researchers conducted a single-institution retrospective review of data for 113 children with a tunneled hemodialysis catheter placed between 2010 and 2018 (346 inserted), considering demographics, ESRD diagnosis, pro-thrombotic conditions, age and weight at time of placement (mean age, 10.9 years; mean weight, 40.7 kg), time from last catheter replacement and indications for replacement. Risk factors that could influence catheter outcomes and predict the need for intervention were analyzed.
Researchers found that initial catheter life was significantly better than subsequent catheter life (initial catheter half-life, 260 days). It was also determined that the most common causes of catheter replacement were dysfunction and cuff/catheter extrusion, with the risk of extrusion increasing by 22% with each replacement (HR = 1.22).
Predictors of catheter dysfunction included prior catheter intervention (HR = 1.2) and catheter size (HR = 0.82), while predictors of cuff/catheter extrusion included if the patient was of the male gender (HR = 0.44), if the etiology of ESRD was hereditary (HR = 2.85) and catheter size (HR = 0.7). Larger-sized catheters had a lower risk of requiring interventions.
“In the future, it would be important to identify the mechanisms to improve catheter patency and to reduce cuff and catheter extrusions,” Delgado said. – by Melissa J. Webb
Delgado JM, et al. Long-term outcomes of tunneled hemodialysis catheters in pediatric patients maintained on chronic hemodialysis. Presented at: the Annual Dialysis Conference; March 16-19, 2018; Dallas.
Disclosure: Delgado reports no relevant financial disclosures.