Kalıcı diyaliz kateterlerinin uzun dönem sonuçları: tek merkez tecrübemiz

Amaç: Tünelli diyaliz kateterleri genellikle primer diyaliz erişim yolu olarak değil kalıcı bir diyaliz erişim yoluna erişene kadar köprü tedavisi olarak uygulanmaktadır. Fakat ihtiyaç duyulması halinde uzun dönem kullanımının uygun olabileceği belirtilmiştir. Çalışmamızda geniş bir hasta grubunda tünelli diyaliz kateterlerin uzun dönem açık kalım oranlarını ve kateter ilişkili hastalıkların sıklığını ortaya koymayı amaçladık. Gereç ve Yöntem: 2017-2022 yılları arasında merkezimize tünelli diyaliz kateteri takılması işlemi için başvuran hastaların kateter açık kalma süreleri retrospektif olarak incelendi. Hastaların kateter disfonksiyonu nedeniyle merkezimize tekrarlayan başvuruları arasındaki süre, disfonksiyonun nedeni ve açıklığı sağlamak için uygulanan prosedür not edildi. Kateterlerin açıklık oranlarını hesaplamak için Kaplan Meier sağkalım analizi kullanıldı. Bulgular: Merkezimize tünelli diyaliz kateteri takılması veya işlev bozukluğu nedeniyle başvuran 464 hastaya 1010 işlem yapıldı. Kısa süreli takip veya veri eksikliği nedeniyle 309 hasta çalışma dışı bırakıldı. Geri kalan155 hasta, 211 kateter bölgesi çalışmaya dahil edildi ve 467 girişimsel işlem verileri analiz edildi. Tünelli diyaliz kateterlerinin ortalama primer açık kalma süresi 10,50 ± 10,25 ay, sekonder açık kalma süresi ise 18,00 ± 13,77 ay idi. Tüm tünelli diyaliz kateterlerinin 6, 12 ve 24 aylık açık kalım oranları sırasıyla %91,1, %83,9 ve %77,9 olarak tespit edildi. Sonuç: Arteriyovenöz yol için ilk tercih olmaması gereken kalıcı diyaliz kateterleri, eşlik eden komorbiditelere sahip olmakla birlikte, diğer giriş yollarının uygun olmadığı durumlarda kullanılabilecek açıklık oranları tatmin edici olan bir yöntemdir.

Anahtar Kelimeler:

Dialysis, tunneled catheter, arteriovenous fistula, complications

Long-term outcome of permanent hemodialysis catheters: a single center experience

Aim: Tunneled dialysis catheters are generally not used as a primary dialysis access but as bridging therapy until a permanent dialysis access is available. However, it has been stated that long-term use may be appropriate if needed. In our study, we aimed to reveal the long-term patency rates of tunneled dialysis catheters and the frequency of catheter-related diseases in a large patient group. Material and Method: Patients who referred to our center for tunneled dialysis catheter insertion procedure between 2017 and 2022 were retrospectively analyzed with respect of catheter patency durations. The duration between the patients’ repetitive admissions to our center due to catheter dysfunction, the cause of the dysfunction and the procedure applied to achieve the patency were noted. Kaplan- Meier survival analysis was used to calculate patency rates of catheters. Results: 1010 procedures were performed on 464 patients who applied to our center for tunneled dialysis catheter creation or dysfunction. 309 patients were excluded from the study due to short-term follow-up or lack of data. Of the remaining 155 patients with 211 catheter sites included to the study and 467 interventional procedures data analyzed. The mean primary patency duration of the tunneled dialysis catheters was 10.50±10.25 months and the secondary patency duration was 18.00±13.77 months. The 6, 12, and 24-month patency rates of the overall tunneled dialysis catheters were 91.1 %, 83.9 % and 77.9% respectively Conclusion: Although permanent dialysis catheters, which should not be the first choice for arteriovenous access, have associated comorbidities, they are a method with satisfactory patency rates when other access types are not suitable.

Keywords:

Dialysis, tunneled catheter, arteriovenous fistula, complications,

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National Kidney Foundation: KDOQI clinical practice guidelines and clinical practice recommendations for 2006 updates: hemodialysis adequacy, peritoneal dialysis adequacy and vascular access. Am J Kidney Dis 2006; 48: 1-322
Lok C, Huber T, Lee T, et al, KDOQI Vascular Access Guideline Work Group: KDOQI clinical practice guidelines for vascular access: 2019 update. Am J Kidney Dis 2020; 75: 1-164
Fischer MJ, Stroupe KT, Kaufman JS, et al. Predialysis nephrology care and dialysis-related health outcomes among older adults initiating dialysis. BMC Nephrol 2016; 17: 103
Golestaneh L, Mokrzycki MH. Prevention of hemodialysis catheter infections: ointments, dressings, locks, and catheter hub devices. Hemodial Int 2018; 22: 75-82
Poinen K, Quinn RR, Clarke A, et al. Complications from tunneled hemodialysis catheters: a Canadian observational cohort study. Am J Kidney Dis 2019; 73: 467-75
Yap HY, Pang SC, Tan CS, et al. Catheter-related complications and survival among incident hemodialysis patients in Singapore. J Vasc Access 2018; 19: 602-8
Chiu CH, Wang CY, Moi SH, Wu CH, Yang CH, Chen JB. Comparison of tunneled central venous catheters and native arteriovenous fistulae by evaluating the mortality and morbidity of patients with prevalent hemodialysis. J Formos Med Assoc 2019; 118: 807-14
Lee T, Barker J, Allon M. Associations with predialysis vascular access management. Am J Kidney Dis 2004; 43: 1008-13
Al-Balas A, Shariff S, Lee T, Young C, Allon M. Clinical Outcomes and Economic Impact of Starting Hemodialysis with a Catheter after Predialysis Arteriovenous Fistula Creation. Am J Nephrol 2019; 50: 221-7
Peynircioglu B, Ozkan F, Canyigit M, Cil BE, Balkanci F. Tunneled internal jugular catheters in adult patients: comparison of outcomes in hemodialysis versus infusion catheters. Acta Radiol 2007; 48: 613-9
Alomari AI, Falk A. The natural history of tunneled hemodialysis catheters removed or exchanged: a single-institution experience. J Vasc Interv Radiol 2007; 18: 227-35
Kuhlmann MK. Do catheters harm the patient?. Contrib Nephrol 2011; 171: 80-83.
Liangos O, Gul A, Madias NE, Jaber BL. Long-term management of the tunneled venous catheter. Semin Dial 2006; 19: 158-64
Poinen K, Quinn RR, Clarke A, et al. Complications from tunneled hemodialysis catheters: a Canadian observational cohort study. Am J Kidney Dis 2019; 73: 467-75.
Yap HY, Pang SC, Tan CS, et al. Catheter-related complications and survival among incident hemodialysis patients in Singapore. J Vasc Access 2018; 19: 602-8
Farber A, Cheng TW, Nimmich A, et al. Femoral vein transposition is a durable hemodialysis access for patients who have exhausted upper extremity options. J Vasc Surg 2020; 71: 929-36
Pike SL, Farber A, Arinze N, et al. Patients with lower extremity dialysis access have poor primary patency and survival. J Vasc Surg 2019; 70: 1913-8.
Motin J, Fischer G, Evreux J. Interet de la voie sous-claviculaire en reanimation prolongee Lyon Med 1964; 40: 583-93