Relationship between hemodialysis catheter tip design and catheter dysfunction
Abstract:
Rationale & objective: Hemodialysis catheter dysfunction is an important problem for patients with kidney failure. The optimal design of the tunneled catheter tip is unknown. This study evaluated the association of catheter tip design with the duration of catheter function.
Study design: Observational cohort study using data from the nationwide REDUCCTION trial.
Setting: & Participants: 4722 adults who each received hemodialysis via one or more tunneled central venous catheters in 37 Australian nephrology services from December 2016 to March 2020.
Exposure: Design of tunneled hemodialysis catheter tip, classified as symmetrical, step, or split.
Outcome: Time to catheter dysfunction requiring removal due to inadequate dialysis blood flow assessed by the treating clinician.
Analytical approach: Mixed, three-level accelerated failure time model, assuming a log-normal survival distribution. Secular trends, the intervention, and baseline differences in service, patient, and catheter factors were included in the adjusted model. In a sensitivity analysis, survival times and proportional hazards were compared among participants’ first tunneled catheters.
Results: 355 of 3871 (9.2%), 262 of 1888 (13.9%), and 38 of 455 (8.4%) tunneled catheters with symmetrical, step, and split tip designs, respectively, required removal due to dysfunction. Step tip catheters required removal for dysfunction at a rate 52% faster than symmetrical (adjusted time ratio = 0.48, 95% CI = 0.34-0.69), and 76% faster than split tip catheters (adjusted time ratio = 0.24, 95% CI = 0.11-0.52) in the adjusted accelerated failure time models. Only symmetrical tip catheters had performance superior to step tip catheters in unadjusted and sensitivity analyses. Split tip catheters were infrequently used and had risks of dysfunction similar to symmetrical tip catheters. The cumulative incidence of other complications requiring catheter removal, routine removal, and death prior to removal were similar across the three tip designs.
Limitations: Tip design was not randomized.
Conclusions: Symmetrical and split tip catheters had a lower risk of catheter dysfunction requiring removal than step tip catheters.
Funding: Grants from government (Queensland Health, Safer Care Victoria, Medical Research Future Fund, National Health and Medical Research Council, Australia), academic (Monash University), and not-for-profit (ANZDATA Registry, Kidney Health Australia) sources.
Trial registration: Registered at ANZCTR with study number ACTRN12616000830493.
Reference:
Lazarus B, Polkinghorne KR, Gallagher M, Coggan S, Gray NA, Talaulikar G, Kotwal S; REDUCCTION Investigators. Tunneled Hemodialysis Catheter Tip Design and Risk of Catheter Dysfunction: An Australian Nationwide Cohort Study. Am J Kidney Dis. 2023 Dec 5:S0272-6386(23)00937-X. doi: 10.1053/j.ajkd.2023.09.021. Epub ahead of print. PMID: 38061534.