Influence of Tunneled Hemodialysis-Catheters on Inflammation and Mortality in Dialyzed Patients

Rodolfo Crespo-Montero, Victoria E. Gómez-López, Fátima Guerrero-Pavón, Andrés Carmona-Muñoz, Manuel Romero-Saldaña, Antonio Ranchal-Sanchez and Pedro Aljama-García
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Rodolfo Crespo-Montero: Department of Nursing, Faculty of Medicine and Nursing, University of Córdoba, 5000 Córdoba, Spain
Victoria E. Gómez-López: Nephrology Service, Reina Sofía University Hospital, 5000 Córdoba, Spain
Fátima Guerrero-Pavón: Maimonides Institute of Biomedical Research of Cordoba, 5000 Córdoba, Spain
Andrés Carmona-Muñoz: Maimonides Institute of Biomedical Research of Cordoba, 5000 Córdoba, Spain
Manuel Romero-Saldaña: Department of Nursing, Faculty of Medicine and Nursing, University of Córdoba, 5000 Córdoba, Spain
Antonio Ranchal-Sanchez: Department of Nursing, Faculty of Medicine and Nursing, University of Córdoba, 5000 Córdoba, Spain
Pedro Aljama-García: Maimonides Institute of Biomedical Research of Cordoba, 5000 Córdoba, Spain

IJERPH, 2021, vol. 18, issue 14, 1-13

Abstract: Older age and comorbidities in hemodialysis patients determines the use of tunneled catheters as vascular access despite their reported clinical and mortality disadvantages. This prospective matched study analyzes the impact of permanent catheters on inflammation and mortality in hemodialysis patients; We studied 108 patients, 54 with AV-fistula (AVF) and 54 with indwelling hemodialysis catheters (HDC) matched by sex, age, diabetes and time under renal-replacement therapy comparing dialysis efficacy, inflammation and micro-inflammation parameters as well as mortality. Cox-regression analysis was applied to determine predictors of mortality, HDC patients presented higher C-reactive-protein (CRP) blood levels and percentage of pro-inflammatory lymphocytes CD14+/CD16+ with worse dialysis-efficacy parameters. Thirty-six-months mortality appeared higher in the HDC group although statistical significance was not reached. Age with a Hazard Ratio (HR) = 1.06, hypoalbuminemia (HR = 0.43), hypophosphatemia (HR = 0.75) and the increase in CD14+/CD16+ monocyte count (HR = 1.02) were predictors of mortality; elder patients dialyzing through HDC show increased inflammation parameters as compared with nAVF bearing patients, although they do not present a significant increase in mortality when matched by covariates. Increasing age and percentage of pro-inflammatory monocytes as well as decreased phosphate and serum-albumin were predictors of mortality and indicate the main conclusions or interpretations.

Keywords: central venous catheter; fistula; hemodialysis; inflammatory status; mortality (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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