A Prospective Study on Catheter-Related Infections After De Novo Venipuncture versus Guidewire-Aided Exchange in Hemodialysis Patients from a Low- and Middle-Income Country.

BACKGROUND

The objectives of this study were to compare the incidence of 60-day catheter-related infections (CRI) between guidewire-aided exchange (GWE) and de novo venipuncture (DNV) techniques of tunneled dialysis catheter placement and to determine potential predictors associated with 60-day CRI.

METHODS

This prospective cohort study was conducted at Aga Khan University Hospital, Pakistan, over a duration of 6 months. Patients aged 18 years and above who underwent tunneled dialysis catheter placement both electively and in emergencies were included. Patients having congenital vascular or cardiac anomalies or ongoing infections were excluded. Categorical variables were compared using chi-squared or Fisher's exact test and continuous variables using t-test or Mann-Whitney U test. Logistic regression was employed to determine predictors of 60-day CRI. Odds ratios (OR) were reported.

RESULTS

A total of 155 patients with tunneled catheters placed were included (DNV = 58, GWE = 97). Catheter dysfunction was encountered in 3 (5.2%) DNV patients and 4 (6.9%) GWE patients. 60-day CRIs were higher in the GWE group (21.6% vs. 17.2% in DNV, P = 0.062). Two deaths occurred within 60 days only in the DNV group (3.4%). Association of GWE with 60-day CRI was not found to be statistically significant (OR: 0.944; 95% confidence interval [CI]: 0.366-2.433; P = 0.905) on multivariable logistic regression. Chronic kidney disease (OR: 9.961; 95% CI: 2.729-36.358; P = 0.001) and catheter dysfunction (OR: 12.686, 95% CI: 1.774-90.720, P = 0.011) were found to be significantly associated with 60-day CRI.

CONCLUSION

There was no significant difference in the incidence of 60-day CRI between GWE and DNV techniques of placing tunneled dialysis catheters in patients undergoing hemodialysis (HD) in this region. Catheter dysfunction was significantly associated with 60-day CRI.