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      Tunneled catheters in hemodialysis patients: reasons and subsequent outcomes.

      American Journal of Kidney Diseases

      Treatment Outcome, Time Factors, etiology, epidemiology, Thrombosis, statistics & numerical data, instrumentation, Renal Dialysis, Prospective Studies, Peripheral Vascular Diseases, Middle Aged, Male, therapy, complications, Kidney Failure, Chronic, Humans, Female, Equipment Design, Diabetes Complications, adverse effects, Catheters, Indwelling, Bacteremia, Arteriovenous Shunt, Surgical, Aged

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          Reducing the use of tunneled catheters in hemodialysis patients requires concerted efforts to convert them to a usable permanent vascular access. The goal of this study is to evaluate the reasons for tunneled catheter use in our prevalent hemodialysis population and the success in converting them to a permanent vascular access. We identified all catheter-dependent hemodialysis patients at our center on a single date. These patients were followed up prospectively during a 1-year period to evaluate access procedures and conversion to permanent access use. Of 458 prevalent hemodialysis patients, 108 patients (23.6%) were dialyzing through cuffed tunneled catheters: 18.5% had no further options for creation of a permanent vascular access, 28.7% had an immature access, 43.5% had access placement pending, and 9.2% had repeatedly refused access surgery. For 78 catheter-dependent patients (excluding patients with no access options and those who refused permanent access surgery), the likelihood of using a permanent access was 53% by 6 months and 80% by 1 year. In patients with an immature access, 50% were using a permanent access at 3 months, and 80%, at 6 months. Of patients with access surgery pending, 45% had access surgery performed within 3 months, and 70%, at 6 months. Finally, of all patients, the likelihood of catheter-related bacteremia was 48% at 6 months. On multivariable analysis, only duration of catheter dependence predicted subsequent use of a permanent access (hazard ratio, 3.11; 95% confidence interval, 1.70 to 5.68; P = 0.0002) for catheter dependence less than versus greater than 6 months. Almost one quarter of our hemodialysis population is catheter dependent. Despite concerted efforts, there remain very long delays in achieving a usable permanent access, attributable to delays in both surgical access placement and access maturation. In the interim, this patient population developed a high frequency of catheter-related bacteremia.

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