Long-term Tunneled Dialysis Catheter Use Is Not Associated With Mortality but Is Associated With Increased Morbidity

Abstract

Tunneled dialysis catheters (TDCs) are used as temporary means to provide hemodialysis until permanent arteriovenous (AV) access is established. However, some patients may have TDC long term. Our objective was to evaluate patient characteristics and the reasons for and mortality associated with long-term TDC use. A retrospective single-institution analysis was performed. Long-term TDC use was defined as >180 days without more than a 7-day temporary removal time. Reasons for long-term TDC use and complications were recorded. Summary statistics were performed. Multivariable analysis was completed that compared mortality between patients with long-term TDC use with a comparison cohort who underwent AV access creation with subsequent TDC removal. We identified 50 patients with long-term TDC use from 2013 to 2018. The average age was 63 years, 44% were male, and 76% were African American. Previous TDC use was found in 42%. Median TDC duration was 333 days (range, 185-2029 days). The primary reasons for long-term TDC use were failed AV access (34%), nonmaturing AV access (32%), delayed AV access placement (14%), no AV access options (10%), patient refusal for AV access placement (6%), and medically high risk for AV access placement (4%). In 46% of patients, TDC complications occurred, including central venous stenosis (33.4%), TDC-related infections (29.6%), TDC displacement (27.8%), and thrombosis (7.9%). Overall, 47.6% required a catheter exchange. The majority (76.4%) had their catheter removed during follow-up. The long-term TDC group, in relation to the comparator group (n = 201), had fewer men (44% vs 61.2%; P = .028) and higher proportion of congestive heart failure (66% vs 40.3%; P = .001). Kaplan-Meier analysis showed no significant difference in survival at 24 months for the long-term TDC to the comparator group (93.6% vs 92.7%; P = .28). In multivariable analysis, long-term TDC use was not associated with mortality (hazard ratio, 0.72; 95% confidence interval, 0.29-1.8; P = .48). As expected, patients with long-term TDCs experienced significant TDC-related morbidity; however, long-term TDC use was not associated with increased mortality. Whereas permanent access is preferable, some patients may require long-term TDC use because of difficulty in establishing a permanent access, limited access options, and patient preference.