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Kidney Week

Abstract: PO1045

Incidence of De Novo Central Vein Stenosis in Hemodialysis Patients Following Their First Tunneled Central Vein Catheter (CVC) Placement

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Albalas, Alian, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Madi, Salam, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Almehmi, Ammar, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Allon, Michael, The University of Alabama at Birmingham, Birmingham, Alabama, United States
Background

Central vein stenosis is a common complication in hemodialysis patients following tunneled CVC insertion. Little is known about its incidence, association with patient characteristics, or relationship with duration of CVC placement. We systematically evaluated central vein stenosis in hemodialysis patients receiving their first CVC at a large medical center.

Methods

All new hemodialysis patients underwent an ultrasound prior to their internal jugular tunneled CVC placement, to exclude venous stenosis or thrombosis. If they were subsequently referred for CVC exchange, a catheterogram/venogram was performed to assess for hemodynamically significant (>50%) central vein stenosis. During a five-year period (January 2016 to January 2021), we quantified the incidence of central vein stenosis in patients undergoing CVC exchange. We also evaluated the association of central vein stenosis with patient demographics, comorbidities, and duration of CVC dependence prior to exchange.

Results

During the study period, 273 patients underwent exchange of a tunneled internal jugular vein CVC preceded by a catheterogram/venogram. Of these, hemodynamically significant central vein stenosis was observed in 36 patients (13%). Central vein stenosis was not associated with patient age, sex, race, diabetes, hypertension, coronary artery disease, peripheral artery disease or CVC laterality (Table 1). The frequency of central vein stenosis was progressively higher with greater duration of CVC dependence, being 10%, 12%, 24%, and 28% in patients with <3 months, 3 to 6 months, 6 to 9 months and >9 months of catheter dependence, respectively (p=0.025).

Conclusion

Among incident hemodialysis patients receiving their first tunneled internal jugular CVC, the overall incidence of hemodynamically significant central vein stenosis was 13%. The likelihood of central vein stenosis was directly associated with the duration of CVC dependence.

Funding

  • NIDDK Support