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12 months patency of tunneled hemodialysis catheter using two different insertion techniques
4th Baltic Meeting in conjunction with the EAU, 26-27 May 2017, Vilnius, Lithuania
61
12 months patency of tunneled hemodialysis catheter using two different insertion techniques Eur Urol Suppl 2017; 16(5);e2226
Sakalauskaitė G.1, Rimkus A.1, Kripaitytė R.2, Tyla R.3, Miglinas M.2 1
Vilnius University, Medical Faculty, Vilnius, Lithuania, 2Vilnius University, Dept. of Nephrology, Vilnius, Lithuania, 3Vilnius University, Dept. of Urology, Vilnius, Lithuania INTRODUCTION & OBJECTIVES: The amount of people receiving renal replacement therapy because of end stage kidney disease is more than 1,4 million worldwide. This number is increasing by approximately 8% annualy. There are 1328 hemodialysis patients in Lithuania, 15,5% of them use tunneled hemodialysis catheters (TDC) for permanent vascular access. As a result of limited central vein access sites, there is a need to search for ways to enhance vascular access longevity. Objectives: To compare central venous TDC functioning time by performing an insertion in two different ways and to evaluate the influence of preoperative inflammatory markers on the TDC patency. MATERIAL & METHODS: A retrospective study based on the data collected from 2010-2016, was conducted in the Nephrology Center at Vilnius University Hospital Santariskiu clinics among the patients with TDC. 171 patients were divided into 2 groups: Group A included patients, who underwent de novo implantation, Group B included patients, whose old catheter was replaced with a new TDC using catheter over the guidewire technique on the same central vein. Group A and B were compared by TDC patency, inflammatory markers and causes of TDC dysfunction. The longevity of TDC ≥12 months was defined as success, while longevity of TDC <12 month was defined as failure in both groups. The data was analysed using SPSS 23.0 and P<0.05 was considered statistically significant. RESULTS: A study was carried on 69 (40,4%) men and 102 (59,6%) women, mean age 63,28 ± 14,55 years. No statistically significant differences were found between sex and age. Group A consisted of 74 (43,3%) patients, while group B consisted of 97 (56,7%) patients. Group A success rate was 68,9% (51 patients), while failure rate was 31,1% (23 patients), which consisted of 11 catheter-related sepsis, 4 tunnelitis, 3 thrombosis, 6 mechanical dysfunction cases. Group B success rate was 66,0% (64 patients), while failure rate was 34,0% (33 patients), which consisted of 10 catheter-related sepsis, 2 tunnelitis, 15 thrombosis, 9 mechanical dysfunction cases. Statistically significant difference between failure due to thrombosis and catheter replacement method was found. Group A mean WBC 6,89 ± 2,37 x 109/L, CRP minimal value – 0,30 mg/l, maximal value – 133,80 mg/l. Group B mean WBC 7,84 ± 3,46 x 109/L, CRP minimal value – 0,60 mg/l, maximal value – 135,60 mg/l. No statistically significant difference was found between preoperative inflammatory markers and TDC patency. CONCLUSIONS: TDC replacement method is as safe as de novo insertion technique, because in both groups no statistically significant differences between insertion method, preoperative inflammatory markers and TDC patency were found. There is a statistically significant difference between failure caused by thrombosis and TDC replacement method. TDC replacement using over the guidewire
Eur Urol Suppl 2017; 16(5);e2226
4th Baltic Meeting in conjunction with the EAU, 26-27 May 2017, Vilnius, Lithuania
61
12 months patency of tunneled hemodialysis catheter using two different insertion techniques Eur Urol Suppl 2017; 16(5);e2227
technique is an excellent way to enhance a vascular access longevity and to save alternative vascular access sites for future use.
Eur Urol Suppl 2017; 16(5);e2227 Powered by TCPDF (www.tcpdf.org)
61
12 months patency of tunneled hemodialysis catheter using two different insertion techniques Eur Urol Suppl 2017; 16(5);e2226
Sakalauskaitė G.1, Rimkus A.1, Kripaitytė R.2, Tyla R.3, Miglinas M.2 1
Vilnius University, Medical Faculty, Vilnius, Lithuania, 2Vilnius University, Dept. of Nephrology, Vilnius, Lithuania, 3Vilnius University, Dept. of Urology, Vilnius, Lithuania INTRODUCTION & OBJECTIVES: The amount of people receiving renal replacement therapy because of end stage kidney disease is more than 1,4 million worldwide. This number is increasing by approximately 8% annualy. There are 1328 hemodialysis patients in Lithuania, 15,5% of them use tunneled hemodialysis catheters (TDC) for permanent vascular access. As a result of limited central vein access sites, there is a need to search for ways to enhance vascular access longevity. Objectives: To compare central venous TDC functioning time by performing an insertion in two different ways and to evaluate the influence of preoperative inflammatory markers on the TDC patency. MATERIAL & METHODS: A retrospective study based on the data collected from 2010-2016, was conducted in the Nephrology Center at Vilnius University Hospital Santariskiu clinics among the patients with TDC. 171 patients were divided into 2 groups: Group A included patients, who underwent de novo implantation, Group B included patients, whose old catheter was replaced with a new TDC using catheter over the guidewire technique on the same central vein. Group A and B were compared by TDC patency, inflammatory markers and causes of TDC dysfunction. The longevity of TDC ≥12 months was defined as success, while longevity of TDC <12 month was defined as failure in both groups. The data was analysed using SPSS 23.0 and P<0.05 was considered statistically significant. RESULTS: A study was carried on 69 (40,4%) men and 102 (59,6%) women, mean age 63,28 ± 14,55 years. No statistically significant differences were found between sex and age. Group A consisted of 74 (43,3%) patients, while group B consisted of 97 (56,7%) patients. Group A success rate was 68,9% (51 patients), while failure rate was 31,1% (23 patients), which consisted of 11 catheter-related sepsis, 4 tunnelitis, 3 thrombosis, 6 mechanical dysfunction cases. Group B success rate was 66,0% (64 patients), while failure rate was 34,0% (33 patients), which consisted of 10 catheter-related sepsis, 2 tunnelitis, 15 thrombosis, 9 mechanical dysfunction cases. Statistically significant difference between failure due to thrombosis and catheter replacement method was found. Group A mean WBC 6,89 ± 2,37 x 109/L, CRP minimal value – 0,30 mg/l, maximal value – 133,80 mg/l. Group B mean WBC 7,84 ± 3,46 x 109/L, CRP minimal value – 0,60 mg/l, maximal value – 135,60 mg/l. No statistically significant difference was found between preoperative inflammatory markers and TDC patency. CONCLUSIONS: TDC replacement method is as safe as de novo insertion technique, because in both groups no statistically significant differences between insertion method, preoperative inflammatory markers and TDC patency were found. There is a statistically significant difference between failure caused by thrombosis and TDC replacement method. TDC replacement using over the guidewire
Eur Urol Suppl 2017; 16(5);e2226
4th Baltic Meeting in conjunction with the EAU, 26-27 May 2017, Vilnius, Lithuania
61
12 months patency of tunneled hemodialysis catheter using two different insertion techniques Eur Urol Suppl 2017; 16(5);e2227
technique is an excellent way to enhance a vascular access longevity and to save alternative vascular access sites for future use.
Eur Urol Suppl 2017; 16(5);e2227 Powered by TCPDF (www.tcpdf.org)