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155 NATURAL HISTORY OF VASCULAR ACCESS CATHETERS IN HEMODIALYSIS PATIENTS.
  1. V. Lopez de Mendoza1,
  2. S. Reddy1,
  3. R. Sullivan1,
  4. C. Le1,
  5. N. Naik1,
  6. R. Zaiden1,
  7. I. Alexandraki1,
  8. B. Cuhaci1,
  9. N. S. Nahman Jr1
  1. 1Department of Medicine, University of Florida-Jacksonville, Jacksonville, FL.

Abstract

Double-lumen vascular access catheters (D-VACs) are the primary mode of vascular access in ≈ 20% of hemodialysis (HD) patients in the United States. For many, D-VACs are the primary form of access and are associated with mechanical or infectious complications. In this regard, we have shown that gram-negative infections in the blood and exit site are increased (Alexandraki, JASN 2005;16:453A; Sullivan, JASN in press). To further address risk factors for catheter loss, we performed a cross-sectional study of catheter survival in HD patients with D-VAC, identified in our previous work (in press).

Results The records of 87 HD patients with D-VAC from 2/06, were updated and all catheter and patient survival data gathered as of 9/06. Patients were 36% male, age (mean ± SEM) 59 ± 1.6 years and 76% African American. Fifty-six (64%) patients had the same catheter that was present in 2/06 (SAME). For all patients, the mean catheter age was 340 ± 19 days (range 38-796).

When compared to SAME, patients who lost their catheters (LOST) had a significantly shorter catheter life span (274± 30 vs 376 ± 22 days for LOST vs SAME, respectively, p < .05). Catheter losses were due to infection, mechanical problems, or both in 20 (23%), 9 (10%), and 2 (2.3%) patients, respectively. Additional characteristics are shown in the Table. There were no significant differences between the groups, bu mechanical problems in females were numerically more common, and patient death was numerically more common in patients with a catheter lost to infection. In summary, these data indicate that D-VACs are in use for long periods, in some cases over 2 years. Catheter failure may result from infectious or mechanical problems and is associated with a shorter catheter life span.

Conclusions D-VACs are at risk of failure within 8 to 9 months in approximately 36% of patients and may result from infectious or mechanical problems. Although internal fistulae and grafts are the preferred form of access for HD, identifying risk factors for catheter loss may help prolong catheter life span in patients totally dependent on D-VAC.

TABLE

Clinical Characteristics of Patients by Catheter Outcome (%)

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