Evaluating survival times based on the placement origin of permanent hemodialysis catheters

INTRODUCTION: The number of patients with chronic kidney disease and the associated need for dialysis is constantly increasing. Approximately 70% of all patients receiving renal replacement therapy are treated with maintenance hemodialysis. Hemodialysis requires a temporary or permanent vascular access to the bloodstream. A double lumen catheter is used for temporary access to the bloodstream. For permanent vascular access, an arteriovenous fistula, prosthetic graft or indwelling tunneled catheter can be used. The best vascular access for hemodialysis is the arterio-venous fistula because of its low infection rate and thrombotic complications. Acute or late complications may occur due to the application of a hemodialysis tunneled catheter. Acute complications such as vascular injury, hemorrhage/hematoma, pneumothorax depending on the site of insertion, infection, air and guidewire emboli, as well as late complications such as infection, arteriovenous fistulas, thrombosis of the intervening vein, and pulmonary emboli may occur. MATERIALS AND METHODS: A retrospective study was designed in patients who were admitted to the Interventional Radiology Clinic of Akdeniz University Faculty of Medicine Hospital between January 1, 2019 and December 31, 2021 and underwent permanent hemodialysis catheter placement procedure. Between January 1, 2019 and December 31, 2021, patients who underwent permanent hemodialysis catheter insertion for the first time in the existing catheter origin were included in the study, and patients with missing data and patients who were inserted for reasons other than hemodialysis indications such as apheresis, etc. were excluded. 282 patients above 18 years of age and 43 patients below 18 years of age were included in the study. Demographic characteristics (age, gender), weight, height, body mass index, comorbidities (diabetes mellitus, COPD, malignancy, cerebrovascular events, atherosclerotic heart disease, atherosclerotic peripheral vascular disease, atrial fibrillation, etc.), use of anticoagulants, and nephrotic syndrome and immunodeficiency in patients under 18 years of age were evaluated according to the origin of permanent hemodialysis catheter placement as risk factors. Vascular injury, hemorrhage/hematoma, pneumothorax, infection, arteriovenous fistulas, catheter dysfunction or occlusion, thrombosis in the intervening vein and pulmonary embolism were evaluated as complications according to the origin of indwelling hemodialysis catheter placement. RESULTS: In patients over 18 years of age, the mean duration of catheterization was 5.24 months, while in patients under 18 years of age, the mean duration of catheterization was 5.57 months. While 45.4% of patients over 18 years of age had complications, 67.42% of patients under 18 years of age had complications. The most common complications were catheter infection and permanent catheter dysfunction or occlusion. In the survival analysis performed in patients over 18 years of age, it was found that the probability of catheter survival was lower in the left internal jugular vein (p<0,001) and femoral vein (p<0,001) origin when the right internal jugular vein origin was taken as reference. In patients over 18 years of age, age was found to be statistically significantly effective in increasing the risk of catheter removal (p=0,006) and the absence of atherosclerotic peripheral vascular disease was found to statistically significantly reduce the risk of catheter removal (p=0,007), while in patients under 18 years of age, the absence of nephrotic syndrome was found to statistically significantly reduce the risk of catheter removal (p=0,012). In patients who developed complications, there was no statistical difference between the right and left internal jugular vein origin groups in terms of median catheter survival times in patients over 18 years of age (p=0,875) and patients under 18 years of age (p=0,599). In addition, in patients over 18 years of age, femoral origin patients had lower median catheter survival times than right (p<0,001) and left internal jugular (p<0,001) origin patients. CONCLUSIONS: Evaluation of patients comorbidities, risk factors and catheter placement origin before the indwelling hemodialysis catheter placement procedure is important to prevent catheter complications and prolong catheter survival. Key words: Indwelling Hemodialysis Catheter, Catheter Origin, Survival, Complications