Evaluating the use of tunneled hemodialysis catheters in the treatment of acute kidney disease patients requiring hemodialysis: a case-control study.

Abstract

Purpose: 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.

Methods: 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.

Results: 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).

Conclusion: 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.