Summary of Complications in Maintenance Hemodialysis Using Tunneled Cuffed Catheters (TCC) in Our Hospital

Background: With increasingly older populations, the number of patients using TCC in the long-term is on rising, in contrast to its use as an interim, or bridge, technique in the recent past. We suggest TCC as a vascular access (VA) equivalent to arteriovenous fistula (AVF) and arteriovenous graft (AVG) not only for in-center dialysis (ICHD) but also for patients who are considering home hemodialysis (HHD). In this study, we examined whether TCC can be used as safely as ICHD in HHD, where self-management is more important. Methods: Patients who underwent maintenance dialysis for at least three months using TCC at our hospital from September 2010 to the end of February 2024 were included in the study. Exit/tunnel infection and bloodstream infection events were extracted retrospectively from the medical records, respectively. The evaluation period was from the date of TCC insertion, and the infection rate was calculated as the number of infections/total number of dialysis days × 1000. The patency rate was evaluated from the date of insertion to the date of first removal due to complications, excluding bridge use cases. Results: Among the study participants,20 were treated with ICHD (TCC inserted age: 61.4 ± 15.2; man:woman ratio: 9:11; insertion period: mean 7.4 years; original disease: diabetes mellitus (DM); non-DM: 11:9) and 11 with HHD (TCC inserted age: 56.5 ± 11.3; man:woman ratio: 8:3; inserted period: mean 4.4 years; original disease: DM; non-DM: 4:7). The exit site/tunnel infection rate in TCC-ICHD was 1.27/1000 dialysis days and the bloodstream infection rate was 1.11/1000 dialysis days.Similarly,for TCC-HHD, the exit site/tunnel infection rate was 0.53/1000 dialysis days and the bloodstream infection rate was 0.91/1000 dialysis days, which were lower than those for TCC-ICHD, although not significantly different. Coagulase-negative Staphylococci and Staphylococcus aureus accounted for 70-80% of the bacteria detected in the blood cultures for both TCC-ICHD and TCC-HHD.The time to the onset of bloodstream infection was longer for TCC-HHD, averaging 0.5 years for TCC-ICHD and 2.3 years for TCC-HHD, suggesting that a long-term strategy for infection prevention was needed. Catheter patency rates did not differ between TCC-ICHD and TCC-HHD. Conclusion: TCC represents a safe and effective option as a VA in HHD.