Association of arrhythmia and catheter infection with nontunneled hemodialysis catheter failure

A BSTRACT Objectives: Nontunneled hemodialysis catheters (NTHCs) are commonly used for emergent renal replacement therapy (RRT); however, its failure remains a clinically challenging issue due to limited data available regarding associated risk factors. This study aims to investigate the risk factors associated with NTHC failure. Materials and Methods: Adult patients ( n = 303) undergoing NTHC insertion for RRT at a medical center between March 1, 2019, and February 28, 2020, were divided into two groups: Patients received NTHC insertion only once (single-insertion group, n = 256) and those who underwent two or more NTHC insertions (repeat-insertion group, n = 47). The repeat-insertion group was further classified into initial insertions and subsequent insertions groups. Baseline demographic and NTHC-related characteristics were compared between the groups, with binary logistic regression analysis conducted to identify the risk factors associated with repeat NTHC insertion. Results: The repeat-insertion group showed significantly higher arrhythmia prevalence, use of antiplatelets/anticoagulants, and longer duration of the initial NTHC than did the single-insertion group. Within the repeat-insertion group, the reasons for NTHC removal differed between the initial and subsequent insertions. The adjusted odds ratios (aOR) for repeated NTHC were 1.99 and 12.91 for patients with arrhythmia and catheter-related bloodstream infection (CRBSI) during hospitalization, respectively, compared to those without (95% confidence interval [CI]: 1.00–3.95 and 1.62–102.89, respectively). Patients with atrial fibrillation likely required repeated NTHC insertion (aOR: 2.06; CI: 0.96–4.43; P = 0.06). Conclusion: Arrhythmia and CRBSI were identified as risk factors for NTHC failure.