Abstract: FR-PO759
Incidence and Risk Factors for Central Venous Stenosis in Haemodialysis Patients
Session Information
- Hemodialysis: Vascular Access - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Authors
- Adwaney, Anamika, Imperial College, London, United Kingdom
- Duncan, Neill D., Imperial College Renal and Transplant Centre, London, lONDON, United Kingdom
- Ashby, Damien, Imperial College, London, United Kingdom
Background
Central venous catheters have traditionally provided haemodialysis access when a fistula is declined or not achieved, but are increasingly advocated as an acceptable option for older or more comorbid patients. Adverse effects of this type of dialysis access include central vein stenosis (CVS), which can lead to significant morbidity including access dysfunction or failure. The pathogenesis and risk factors for CVS are incompletely understood.
Methods
All patients starting haemodialysis in a single centre between December 2005 and February 2015 were prospectively identified. From this cohort, a random sample of patient records were retrospectively analysed for the presence of CVS, defined by cross-sectional or angiographic imaging.
Results
Out of 300 patients (aged 19 - 91, 64.7% male) followed for up to 10 years, CVS developed in 23 (7.67%). All CVS patients had a history of tunneled dialysis catheter use.
Compared to those unaffected, patients with CVS had a larger number of previous catheters (2.3 vs 1.2, p<0.001) but not a greater duration of previous catheter use (28.7 vs 32.1 months). Non-dialysis risk factors, more frequent in patients with CVS, included pacemakers (13.0 vs 2.2%, p=0.024) and prior intensive care admission (56.5 vs 11.9%, p<0.001).
There was no significant effect of ethnicity, but in older patients (over 70 at dialysis initiation, 35.0% of the group) the development of CVS was much less common (2.9 vs 10.3%, p=0.023).
Conclusion
In haemodialysis patients with prior tunneled catheter use, a significant minority may develop CVS, with the number of catheters, rather than catheter duration, being the primary risk factor, though non-dialysis risk factors are also important. The finding that patients over 70 at dialysis initiation are less likely to develop CVS, supports the selective use of tunneled catheters in some older patients.