A prospective study of complications associated with cuffed, tunnelled haemodialysis catheters

Background. Despite the US Dialysis outcome Quality Initiative (DOQI) guide lines', for various reasons. increasing numbers of end-stage renal disease patients are becoming dependent on cuffed haemodialysis catheters (HCs) for chronic haemodialysis access. Their use is complicated by frequent failure due to thrombosis and catheter-related sepsis. In our unit, all HCs are pu t in place by the radiology department. Methods. In a prospective study we looked at the outcome of all HCs over a three-year period, during which time 573 consecutive HCs were placed in 336 patients. Each line was followed individually until it was removed or unti l the end of the study. Results. In a survival analysis of those HCs removed following HC failure. HC half-life was 312 days and one-year HC survival was 47.5%. The most freq uent indications for HC removal were non-function (36.6%), clinical suspici on of line sepsis (16.4%) and patient death (14.4%). Using a Cox proportion al hazards model, catheter number in a given patient and the presence of di abetes mellitus were found to be independent predictors of HC failure. The total incidence of HC-related sepsis was 1.3 episodes/1000 catheter days. T he probability of developing bacteraemic HC-related sepsis was 27.5% at one year. Conclusions. Less than half of the HCs were removed electively becau se of availability of a more permanent mode of renal replacement, thereby i llustrating the level of dependence that has developed on them as permanent access. Consequently, their limitations (infection and malfunction) are placing an ever increasing burden on the healthcare services.