Inzidenz und Komplikationen von Vorhofkathetern an der Dialyse - Daten aus einem universitären Patientenkollektiv

Central venous catheters (CVCs) are a common vascular access for hemodialysis patients but are considered inferior when compared to arteriovenous fistulas. It remains controversial if CVCs have a relevant impact on patients’ mortality and morbidity. The objective of the present study was to determine morbidity and mortality in dialysis patients with CVCs in a university hospital setting. In a retrospective analysis, CVC-associated complications and their relationship with comorbidities und catheter type were assessed. In addition, the time of CVC use and the predicted and actual 6-month mortality were studied. Overall, 33,393 dialysis sessions were performed within 78 months. Of those, CVC were used in 13,543 sessions as dialysis access, with a total of 478 catheters in 351 patients. Thus, the proportion of CVC use in the present study was significantly higher than in the average dialysis population in Germany. This underscores the specific patient population in the setting of a university hospital. The average age at the time of CVC implantation was 66.5 years with a male predominance, comparable with the national average. As expected, glomerulonephritis as well as hypertensive and/or diabetic nephropathy were the main reasons for end-stage renal disease. Accordingly, hypertension (81.2%) and diabetes (43.9%) were the most common comorbidities. About one third of patients presented with additional artificial material in their cardiovascular system, e.g., artificial heart valves. Initiation of hemodialysis was the main reason for CVC implantation (56.7%), followed by complications with the previous CVC (22.8%). About three quarters of patients had double lumen catheters, while in the remaining cases single lumen catheters had been inserted in another medical facility. The average time of CVC use was relatively long (309 days) and did not correlate with patients´ age. Death was the main reason for termination of CVC use (29.2%), catheter infection was also common (17.9%). With respect to time of CVC use, complication rate was 0.6 infections/1,000 catheter days and 0.1 catheter-associated deaths per 1,000 catheter days. In fact, the rate of infection was comparably low; however, we observed that CVC-associated death was always the result of catheter-associated infections. The most common germ was Staph aureus (40.6%) as a well-known risk factor for infection of artificial material, often requiring long-term antibiotic treatment. Of interest, patients with diabetes or malignancy showed higher complication rates. Peripheral arterial disease was associated with more CVC-associated infections; the number of comorbidities correlated with the incidence of infections, endocarditis and catheter-associated mortality. Single lumen catheters were used for longer time but the infection rate was comparable. Of note, the actual 6-month mortality was significantly lower than expected, suggesting that CVCs per se do not lead to an impaired outcome. However, CVC associated infections are often severe and result in death in one of five cases. Overall, CVCs may be a practicable and valid vascular access especially for elderly patients and those in need of dialysis start. In conclusion, an individual approach should be made in the choice for vascular access in hemodialysis patients, taking into account comorbidities and life expectency.