Hemodialysis catheter survival and complications in children and adolescents

Abstract

Venous catheters have become an indispensable form of hemodialysis access. We evaluated catheter performance as temporary and long-term access in children with end-stage renal disease (ESRD). We assessed the survival rates and causes of catheter failure in 78 catheters used for hemodialysis access in 23 pediatric patients (aged 10 months to 22 years) with ESRD over a 5-year period. Median survival was 31 days for 56 uncuffed catheters. One- and 2-month actuarial survival was 69% and 48%, respectively. Reasons for removal were: elective (39%), kinking (36%), trauma (11%), infection (7%), and other (5%). Smaller catheters (7 or 9 French) were more likely to be removed for kinking (P = 0.003). One-year actuarial survival for 22 cuffed catheters was 27%. Cuffed catheters were removed due to: infection (36%), kinking (14%), elective (9%), trauma (9%) and other (9%). Twelve catheters were removed for infection. Infection rates leading to removal were 0.58 and 0.71 per patient-year for uncuffed and cuffed catheters, respectively. Staphylococcus species were cultured most commonly. We conclude that uncuffed catheters function well for short-term hemodialysis access of up to 2 months' duration and cuffed catheters are successful for long-term access in children and adolescents with ESRD.

Avaliação do acesso vascular para hemodiálise em crianças e adolescentes: um estudo de coorte retrospectivo de 10 anos

“…Studies have pointed to Staphylococcus as the main cause of CVC infection, followed by Gramnegative bacteria, such as E.coli, Enterobacter and Xanthomonas. 16 We could not detect the causative agent in our study, because in most cases the bacteriological results had not been entered in the medical records. Weijmer et al 18 reported a longdwelling CVC infection rate of 2.9/1,000 catheters/day, significantly lower than the short-dwelling CVC infection rate (12.8/1,000 catheters/day; p < 0.001).…”

“…Biofilm, which is produced by a combination of host-derived factors (fibrinogen, fibrin, fibronectin and extracellular polysaccharides) and microbial products (glycocalix), plays a pivotal role in bacterial resistance. 15 Goldstein et al 16 evaluated 23 patients using 78 CVCs (56 short-dwelling and 22 long-dwelling), during a 5-year period. The catheters were mostly (39%) electively removed in their study, when an AVF became the vascular access or when the patient underwent kidney transplantation.…”

“…(Figure 2), exposing the patients to higher morbidity and mortality. Literature reports 16,17 indicate that short-dwelling catheters should be used for a short period of time, preferably less than one month. This hampers comparison with our study, in which a large number of patients (36%) had the loss of their CVC as reason for the insertion of another CVC, indicating that, in these cases, the CVC was not being used with the perspective of a change to a permanent access.…”

Low Infection Rates and Prolonged Survival Times of Hemodialysis Catheters in Infants and Children

“…It is possible that factors such as angiographic catheter insertions by a very proficient and experienced invasive radiology team (which has become our routine for CVC insertion, including in infants), our preferential placement of catheters in the internal jugular vein rather than the subclavian vein (the latter associated with an increased risk of stenosis) (7,17,18), and the preferential use of specific CVC brands suited to patient's age and size could have contributed to our favorable findings. The relative role of each of these factors in CVC outcome remains to be determined.…”

“…Several studies (4,(7)(8)(9)(10)(11)(12) (Table 1) have reported a rate of bacterial infection in CVCs used for HD in children with ESRD in the range of 1.5 to 4.8 episodes/1000 catheter days. Reported CVC survival times have varied between 84 and 290 days (4,(7)(8)(9)(10). The few studies that address potential measures to improve these unfavorable data focus on prophylactic (topical, catheter lock, or systemic) antibiotics (13,14).…”