Nephrology Dialysis Transplantation, Vol 13, Issue 3 745-749, Copyright © 1998 by Oxford University Press
K Atherikul, S Schwab and P Conlon
Cuffed central-venous haemodialysis catheters are emerging as an
alternative permanent haemodialysis vascular access. There is limited data
regarding the adequacy of dialysis with prolonged use of these catheters.
We conducted a prospective study comparing three commonly used cuffed
central-venous haemodialysis catheters: (1) PermCath™, Quinton
Instrument Co, Seattle, (2) Tesio™, Med Comp, Inc, Harleysville
PA; (3) VasCath Soft Cell™, Bard Instrument Company, Toronto, and
compared them with control patients dialysing with arteriovenous access
(AV) access. We randomly assigned 64 patients who needed prolonged
temporary vascular access to placement of one of three catheters. The
control group comprised 222 patients dialysing simultaneously in the same
units with AV access. Methods: All patients were
dialysed with identical machines and kidneys. Maximal effort were made with
every catheter to optimize achievable blood flow. Catheters with mechanical
problems were treated first with urokinase and then fibrin sheath catheter
stripping. The mean blood flow was determined by averaging mean blood flows
from 30 consecutive treatments. Reliability of catheter was defined as
percentage of treatments that were performed at a median blood flow of 350
ml/min or above during these 30 treatments. Kt/V was measured monthly and
calculated using the single pool Daugirdas formula. Haemodialysis
prescription were adjusted for Kt/V above 1.2. Recirculation was measured
using two-needle low-blood-flow technique. Results:
The mean blood flows were (PermCath 383.6 ml/min, Tesio 396.3 ml/min,
VasCath 320.4 ml/min). PermCath and Tesio had comparable mean blood flows
and were significantly higher than VasCath (P<0.05). Reliability of
catheters were (PermCath 86.9%, Tesio 81.6%, VasCath 42.3%). Tesio and
PermCath were equally reliable and both were more reliable than VasCath
(P<0.005). Had the target for reliability been 300 ml/min all three
catheters would hae been equally reliable. Negative arterial pressure in
excess of 300 mmHg prevented faster blood flows in 98% of instances. None
of the catheters performed as well as the control population with AV access
(mean blood flow 437 ml/min, reliability 96%, P<0.005).
Recirculation rates were 3.7% for PermCath 3.9% for Tesio, and 4% for
VasCath. All patients weighing less than 85 kg achieved a Kt/V of 1.2 with
a 4-h treatment. For comparison purposes when Kt/V was normalized to a
70-kg patient the results were PermCath 1.42, Tesio 1.44, VasCath 1.19, AV
access 1.64. Summary: All three catheters are capable
of providing adequate haemodialysis although large patients will need
extended treatment times. The PermCath™ and Tesio™
provide blood flow and reliability superior to the VasCath™ Blood
flow is limited in all catheters by inflow, as evidenced by negative
arterial pressure. All catheters had acceptable recirculation. AV access is
superior in terms of blood flow and reliability to all tested catheters.
Key words: adequacy; catheter; ESRD; haemodialysis;
Kt/V; recirculation; renal failure; PermCath
TECHNICAL REPORT
Adequacy of haemodialysis with cuffed central-vein catheters
Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Corresponding author at; Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland
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