Central Venous Catheters in Hemodialysis: A Reasonable Alternative?

Background: Arteriovenous fistulas are the gold standard for access in dialysis patients; central venous catheters (CVC) provide a potential alternative, especially in multimorbid and elderly patients. CVCs are considered to be of elevated risk for complications; however, it remains unclear, if they have relevant impact on clinical outcome. The objective of this study was to provide a quantitative and qualitative analysis of CVC associated complications in hemodialysis patients. Additionally, estimated and actual mortality should be evaluated. Methods: In a retrospective study at the University Hospital Marburg, Germany, patients receiving hemodialysis via CVC between January 2015 and June 2021 were included. Data on duration of CVC use was collected, as well as reasons for catheter implantation and explantation, CVC related complications and comorbidities (diabetes, hypertension, heart failure, peripheral vascular disease, dementia). Additionally, estimated 6-month mortality at time of dialysis start was calculated by Cohen Modell and compared to actual death rate. Results: 478 CVCs were analyzed in 351 patients. Mean patient age was 66.5±, comparable with the average age of dialysis patients in Germany. Initiation of dialysis was the main reason for CVC implantation and catheters were used 309 days on average. Death was the most common reason for termination of CVC use (31.1%), followed by a change of mode in renal replacement therapy (hemodialysis via fistula, begin of peritoneal dialysis, kidney transplantation) or termination of dialysis (29.6%). No correlation was noted between age, type and frequency of complications (dysfunction, thrombi, infection, death). Overall, CVC infections were rare (0.6 per 1.000 catheter days). Complications were significantly associated with arterial occlusive disease, heart failure and dementia (p<0.05). Of note, actual 6-month mortality was lower than the predicted risk to die within half a year (14.3% vs. 19.6%, p<0.05). Conclusions: This study shows that (1) CVCs are predominantly implanted for initiation of hemodialysis; (2) serious complications are rare; (3) occurrence of complications is independent of age but associated with certain comorbidities; and (4) CVC patients survive longer than predicted. This data suggests that an individual approach for vascular access in hemodialysis patients is needed.