#2609 Complications associated with tunneled hemodialysis catheters: a retrospective study

Abstract Background and Aims The most recommended vascular access for chronic hemodialysis is the arteriovenous fistula (AVF). In some cases, access via a tunneled catheter (TC) is required, which has a higher complication rate. The objective of our study is to analyze the complications related to the TC (bacteremias and mechanical complications) in patients undergoing chronic hemodialysis in our healthcare area. Method A retrospective cohort study was conducted, including patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) with a TC implanted from 2005 to 2021 at the HUVM. Clinical-demographic variables related to the catheter and complications (catheter-related bacteremias (CRBs) and mechanical complications) were recorded. The patients were followed up from catheter implantation until death, loss to follow-up, or the end of the study (December 31, 2023). Results The sociodemographic, clinical characteristics, and TC types are summarized in Table 1. Complications: 84 patients (22%) CRB: 65 (19% of total patients with TCs) Mechanical complications: 25 (7% of total): 10 stenosis (15% of total) 14 thrombosis (22% of total) 1 superior vena cava syndrome (2%) Bacteremia rate: 0.39/1000 days of TC use. Median time until first bacteremia: 518 days (95% CI: 492–774). Time until first mechanical complication: 922 days (95% CI: 791-1768). The most frequently isolated microorganisms: S. epidermidis (41.1%) S. aureus (31.6%), of which 83.3% were methicillin-sensitive S. marcescens (5.3%) P. aeruginosa (3.5%) Corynebacterium spp. (3.5%) A total of 173 (49.1%) TCs were removed. The reasons were: Use of AVF: 56 (15.9%) Independence from HD: 52 (14.8%) TC dysfunction: 24 (6.8%) Complications (CRB or mechanical): 42 (11.9%). Of these, 32 (9.1%) were specifically due to CRB. Conclusion In our sample, the incidence of complications related to TC was low after a long follow-up period, with the bacteremia rate being considerably lower than described in other studies. The percentage of stenosis and thrombosis was also lower in our series compared to other studies. This is likely to be underreported, as imaging tests would be needed to confirm a mechanical complication in cases of catheter dysfunction.