Influence of Tunneled Hemodialysis-Catheters on Inflammation and Mortality in Dialyzed Patients.

Rodolfo Crespo-Montero,Victoria E Gómez-López,Antonio Ranchal-Sanchez,Pedro Aljama-García,Manuel Romero-Saldaña,Andrés Carmona-Muñoz,Fátima Guerrero-Pavón

doi:10.3390/ijerph18147605

Abstract

Older age and comorbidities in hemodialysis patients determines the use of tunneled catheters as vascular access despite their reported clinical and mortality disadvantages. This prospective matched study analyzes the impact of permanent catheters on inflammation and mortality in hemodialysis patients; We studied 108 patients, 54 with AV-fistula (AVF) and 54 with indwelling hemodialysis catheters (HDC) matched by sex, age, diabetes and time under renal-replacement therapy comparing dialysis efficacy, inflammation and micro-inflammation parameters as well as mortality. Cox-regression analysis was applied to determine predictors of mortality, HDC patients presented higher C-reactive-protein (CRP) blood levels and percentage of pro-inflammatory lymphocytes CD14+/CD16+ with worse dialysis-efficacy parameters. Thirty-six-months mortality appeared higher in the HDC group although statistical significance was not reached. Age with a Hazard Ratio (HR) = 1.06, hypoalbuminemia (HR = 0.43), hypophosphatemia (HR = 0.75) and the increase in CD14+/CD16+ monocyte count (HR = 1.02) were predictors of mortality; elder patients dialyzing through HDC show increased inflammation parameters as compared with nAVF bearing patients, although they do not present a significant increase in mortality when matched by covariates. Increasing age and percentage of pro-inflammatory monocytes as well as decreased phosphate and serum-albumin were predictors of mortality and indicate the main conclusions or interpretations.

Highlights

The vascular access (VA) for hemodialysis (HD) constitutes a critical issue in end-stage renal failure (ESRF) patients
It is commonly accepted that native arterio-venous fistulae are the elective VAs to their reduced infection ratios and better longterm permeability [1,2] but, the use of indwelling venous central catheters (VCCs) has increased progressively [3,4], especially in elderly comorbid patients [5]
NAVFs are not always feasible: increasing age, greater cardiovascular comorbidity and the presence of diabetes mellitus in the dialysis patient population yields significant percentages of patients nowadays dialyzing through indwelling VCCs [7]

Summary

Introduction

The vascular access (VA) for hemodialysis (HD) constitutes a critical issue in end-stage renal failure (ESRF) patients. It is commonly accepted that native arterio-venous fistulae (nAVF) are the elective VAs to their reduced infection ratios and better longterm permeability [1,2] but, the use of indwelling venous central catheters (VCCs) has increased progressively [3,4], especially in elderly comorbid patients [5]. NAVFs are not always feasible: increasing age, greater cardiovascular comorbidity and the presence of diabetes mellitus in the dialysis patient population yields significant percentages of patients nowadays dialyzing through indwelling VCCs [7]. Besides the “fistula first” initiative, several vascular access guidelines recommend minimizing HDC use for chronic dialysis [8] These best practice recommendations rely in the evidence of VCC use in hemodialysis as an independent mortality predictor [9]

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Discussion

Conclusion