Shigidi Mazin M T
Department of Internal Medicine, College of Medicine, Jouf University, 72388, Al Jouf, Saudi Arabia.
Nephrology Division, Department of Medicine, Baraha Medical City, Khartoum North, Khartoum State, Sudan.
Int Urol Nephrol. 2025 May;57(5):1609-1614. doi: 10.1007/s11255-024-04292-2. Epub 2024 Nov 21.
Tunneled hemodialysis catheters (TDCs) are increasingly used in the emergency management of severe acute kidney disease (AKD). This study aimed to evaluate the effectiveness of TDCs in AKD patients requiring hemodialysis.
A case-control study was conducted in Khartoum, Sudan between February and September 2020. Adult patients admitted to the Baraha Medical City Intensive Care Unit with AKD due to non-infectious causes, and requiring hemodialysis were enrolled. Patients were randomly assigned to undergo hemodialysis using either tunneled or non-tunneled hemodialysis catheters (NTDCs). The performance and complications associated with TDCs were assessed during the hospital stay, after discharge, and until catheter removal. Data were analyzed using SPSS.
A total of 122 patients with a mean age of 60.4 ± 5.7 years were included. AKD was primarily due to acute tubular necrosis (67.2%) and interstitial nephritis (16.4%). Indications for hemodialysis were mostly acute pulmonary edema (64.8%) and symptomatic uremia (27.9%). TDCs were used in 54 (44.3%) patients, while NTDCs were used in 68 (55.7%). The right internal jugular vein was the most common insertion site (95.9%). TDCs were associated with significantly higher blood flow (P < 0.0001) and lower rates of exit site infections (P = 0.034), catheter-related bacteremia (P = 0.011), and catheter malfunction (P = 0.001). They showed a significantly longer functional duration compared to NTDCs (P < 0.0001).
TDCs appear to be a safer and more effective option for AKD patients requiring urgent and prolonged hemodialysis, with fewer complications and longer catheter function.
隧道式血液透析导管（TDC）在重症急性肾损伤（AKD）的紧急处理中应用越来越广泛。本研究旨在评估TDC在需要血液透析的AKD患者中的有效性。
2020年2月至9月在苏丹喀土穆进行了一项病例对照研究。纳入因非感染性原因入住巴拉哈医疗城重症监护病房且需要血液透析的成年AKD患者。患者被随机分配接受使用隧道式或非隧道式血液透析导管（NTDC）进行血液透析。在住院期间、出院后以及直至导管拔除期间评估与TDC相关的性能和并发症。使用SPSS分析数据。
共纳入122例患者，平均年龄为60.4±5.7岁。AKD主要由急性肾小管坏死（67.2%）和间质性肾炎（16.4%）引起。血液透析的指征主要是急性肺水肿（64.8%）和有症状的尿毒症（27.9%）。54例（44.3%）患者使用了TDC，68例（55.7%）患者使用了NTDC。右颈内静脉是最常见的置管部位（95.9%）。TDC与显著更高的血流量（P<0.0001）以及更低的出口部位感染率（P=0.034）、导管相关菌血症（P=0.011）和导管故障发生率（P=0.001）相关。与NTDC相比，它们的功能持续时间显著更长（P<0.0001）。
对于需要紧急和长期血液透析的AKD患者，TDC似乎是一种更安全、更有效的选择，并发症更少，导管功能持续时间更长。
