Cumming School of Medicine, Department of Community Health Sciences, and Department of Family Medicine, University of Calgary, Calgary, Canada.
Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Canada.
Am J Kidney Dis. 2019 Apr;73(4):467-475. doi: 10.1053/j.ajkd.2018.10.014. Epub 2019 Jan 12.
RATIONALE & OBJECTIVE: Clinical practice guidelines discourage the use of central venous catheters (CVCs) for vascular access in dialysis. However, some patients have inadequate vessels for arteriovenous fistula creation or choose to use a dialysis catheter. The risks associated with CVC use and their relationship to patient age are poorly characterized.
Observational retrospective cohort study.
SETTING & PARTICIPANTS: Cohort of 1,041 patients older than 18 years from 5 Canadian dialysis programs who initiated outpatient maintenance hemodialysis therapy with a tunneled CVC between 2004 and 2012 and who had no creation of an arteriovenous fistula or arteriovenous graft.
Age, sex, body size, initiating dialysis therapy in the hospital, and comorbid conditions.
CVC-related procedures, hospitalization, and death.
Complications were reported as a cumulative risk at 1 and 2 years. Cox proportional hazards regression for recurrent events was used to evaluate risk factors for study outcomes.
At 1 year, risks for CVC-related bacteremia, malfunction, and central stenosis were 9%, 15%, and 2%, respectively. Risks for any CVC-related complication at 1 and 2 years were 30% and 38%, respectively. Death related to CVC complications occurred in 6 of 1,041 (0.5%) patients. Compared with patients younger than 60 years, patients aged 70 to 79 and those 80 years or older experienced lower rates of CVC complications: HRs of 0.67 (95% CI, 0.52-0.85; P = 0.001) and 0.69 (95% CI, 0.52-0.92; P = 0.01), respectively.
This Canadian dialysis population may not be representative of populations in other countries. CVC use was not compared with other types of hemodialysis vascular access.
Approximately one-third of hemodialysis patients who used tunneled CVCs during 1 to 2 years experienced complications. Bacteremia occurred in ∼9% of patients at 1 year and were the most common cause of CVC-related hospitalizations. CVC-related death was infrequent. This information could be used to communicate the risk for CVC complications to patients treated with this type of hemodialysis vascular access.
临床实践指南不鼓励将中心静脉导管（CVC）用于透析的血管通路。然而，一些患者的血管条件不适宜进行动静脉瘘造瘘术，或者选择使用透析导管。CVC 使用相关风险及其与患者年龄的关系尚未得到充分描述。
观察性回顾性队列研究。
这项研究纳入了来自加拿大 5 个透析项目的 1041 名年龄大于 18 岁的患者，他们在 2004 年至 2012 年间接受了隧道式 CVC 进行门诊维持性血液透析治疗，并且没有进行动静脉瘘或动静脉移植物的建立。
年龄、性别、体型、在医院开始透析治疗以及合并症。
CVC 相关操作、住院和死亡。
并发症按 1 年和 2 年的累积风险进行报告。采用复发性事件的 Cox 比例风险回归评估研究结局的风险因素。
在 1 年时，CVC 相关菌血症、功能障碍和中心狭窄的风险分别为 9%、15%和 2%。1 年和 2 年时任何 CVC 相关并发症的风险分别为 30%和 38%。6 例（0.5%）患者因 CVC 并发症相关死亡。与年龄小于 60 岁的患者相比，年龄为 70 至 79 岁和 80 岁及以上的患者发生 CVC 并发症的风险更低：风险比分别为 0.67（95%CI，0.52-0.85；P=0.001）和 0.69（95%CI，0.52-0.92；P=0.01）。
加拿大的这个透析人群可能无法代表其他国家的人群。未比较 CVC 与其他类型的血液透析血管通路。
在 1 至 2 年期间，大约有三分之一接受隧道式 CVC 的血液透析患者出现并发症。菌血症在 1 年时发生于约 9%的患者，是导致 CVC 相关住院的最常见原因。CVC 相关死亡较为罕见。这些信息可用于向接受这种类型血液透析血管通路治疗的患者传达 CVC 并发症的风险。
