Abstract No. 97: [Cope] The Case for Primary Tunneled Dialysis Catheter Placement over Nontunneled Dialysis Catheters in Acute Renal Failure

Abstract

NTDC are widely used as initial hemodialysis access in new onset renal failure. The K/DOQI recommendations for hemodialysis access in acute renal failure (ARF) are that NTDC should be used for dialysis duration of less than 1 week, because of the increased risk of infection compared to TDC with longer use. However, estimation of when a patient will recover renal function is very difficult. We sought to determine whether primary placement of tunneled dialysis catheters (TDCs) in this setting is more appropriate. In our practice, by mutual consent of the dialysis access team, all patients referred to IR in whom no contraindications to TDC exist (i.e. uncorrectable coagulopathy, bacteremia) receive a TDC. Using a QA database, 74 patients who received primary TDCs for ARF and who eventually recovered renal function were retrospectively reviewed. Cause for renal failure, various renal function parameters, and demographics were collected, as were TDC dwell times, in an effort to determine predictors of recovery and/or extended duration of use. IRB approval was obtained. Mean TDC dwell time in patients who eventually recovered from ARF was 35 days; only 15/74 (20%) recovered within 1 week. At the time of TDC placement, the mean serum creatinine was 6.1 mg/dL, 24-hour urine volume was 788 ml, and duration of oliguria was 0.8 days. Mean platelet count was 200K and mean INR was 1.3. Subsets of patients who recovered in less than 1 week vs greater than 1 week were similar: the mean Cr was 6.0 vs 6.2 mg/dL, 24-hour urine volume was 751 vs 800 ml, and duration of oliguria was 1.3 vs 0.7 days, respectively. Mean platelet count was 219K vs 194K, and mean INR was 1.3 for both groups. Mean TDC dwell time for in patients recovering renal function is 4 weeks more than the K/DOQI maximum recommended NTDC dwell time of 1 week; 80% of patients did not recover by 1 week. This therefore argues for primary placement of TDC in patients with ARF who require hemodialysis and in whom no contraindications exist, as we were unable to identify any predictors of renal function recovery in less than 1 week.