Cargando…
Comparative Clinical Performances of Tunneled Central Venous Catheters versus Arterio-Venous Accesses in Patients Receiving High-Volume Hemodiafiltration: The Case for High-Flow DualCath, a Tunneled Two-Single-Lumen Silicone Catheter
Tunneled central venous catheters (CVC) are mainly considered as a rescue vascular access option in dialysis but are still used on approximately one quarter of prevalent patients worldwide even though they are associated with poor performances and higher risks. Study design: in this retrospective si...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10381463/ https://www.ncbi.nlm.nih.gov/pubmed/37510847 http://dx.doi.org/10.3390/jcm12144732 |
_version_ | 1785080450301034496 |
---|---|
author | Canaud, Bernard Leray-Moragues, H. Chenine, Leila Morena, Marion Miller, George Canaud, Ludovic Cristol, Jean Paul |
author_facet | Canaud, Bernard Leray-Moragues, H. Chenine, Leila Morena, Marion Miller, George Canaud, Ludovic Cristol, Jean Paul |
author_sort | Canaud, Bernard |
collection | PubMed |
description | Tunneled central venous catheters (CVC) are mainly considered as a rescue vascular access option in dialysis but are still used on approximately one quarter of prevalent patients worldwide even though they are associated with poor performances and higher risks. Study design: in this retrospective single-center study, we aimed to report on the clinical performances achieved with high-flow tunneled CVCs (DualCath or DCath) and compared them with arteriovenous accesses (AVAs, e.g., AV fistula, AV graft, and Thomas Shunt) in a hospital-based dialysis unit. Methods: Sixty-eight stage 5 chronic kidney disease dialysis-dependent patients (CKD5D) receiving high volume hemodiafiltration were followed-up with for 30 months. The study consisted of two phases: baseline cross-sectional and longitudinal follow-ups of key performance indicators. Clinical performances consisting of effective blood flow and blood volume, recirculation, urea and ionic Kt/V, total Kt, ultrafiltration volume, and percent reduction in β2-M were measured monthly as part of quality control in our unit. Results: At baseline, the effective blood flow using a DCath was close to 400 mL/min, similar to an AVA. Recirculation with a DCath (7%, 6–13%) was higher than with an AVA. The diffusive dialysis dose delivered with a DCath (spKt and eKt/V) and convective dialysis dose achieved with a DCath were slightly lower than those achieved with AVAs, but they were still much higher than is recommended by guidelines. The percent reduction in β2-M achieved with a DCath was also 4 to 10% lower than that achieved with an AVA. On longitudinal follow-up, the main clinical performance indicators of DCaths (total Kt and total ultrafiltration volume, L/session) were maintained as very stable over time and close to those achieved with AVAs. Conclusions: As shown in this study, high-flow DualCath tunneled two-single-lumen silicone catheters may be used to deliver high volume hemodiafiltration in a reliable and consistent manner without compromising clinical performance. These results relied on the specific design of the two silicone cannulas and the strict adherence to best catheter practices. |
format | Online Article Text |
id | pubmed-10381463 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-103814632023-07-29 Comparative Clinical Performances of Tunneled Central Venous Catheters versus Arterio-Venous Accesses in Patients Receiving High-Volume Hemodiafiltration: The Case for High-Flow DualCath, a Tunneled Two-Single-Lumen Silicone Catheter Canaud, Bernard Leray-Moragues, H. Chenine, Leila Morena, Marion Miller, George Canaud, Ludovic Cristol, Jean Paul J Clin Med Article Tunneled central venous catheters (CVC) are mainly considered as a rescue vascular access option in dialysis but are still used on approximately one quarter of prevalent patients worldwide even though they are associated with poor performances and higher risks. Study design: in this retrospective single-center study, we aimed to report on the clinical performances achieved with high-flow tunneled CVCs (DualCath or DCath) and compared them with arteriovenous accesses (AVAs, e.g., AV fistula, AV graft, and Thomas Shunt) in a hospital-based dialysis unit. Methods: Sixty-eight stage 5 chronic kidney disease dialysis-dependent patients (CKD5D) receiving high volume hemodiafiltration were followed-up with for 30 months. The study consisted of two phases: baseline cross-sectional and longitudinal follow-ups of key performance indicators. Clinical performances consisting of effective blood flow and blood volume, recirculation, urea and ionic Kt/V, total Kt, ultrafiltration volume, and percent reduction in β2-M were measured monthly as part of quality control in our unit. Results: At baseline, the effective blood flow using a DCath was close to 400 mL/min, similar to an AVA. Recirculation with a DCath (7%, 6–13%) was higher than with an AVA. The diffusive dialysis dose delivered with a DCath (spKt and eKt/V) and convective dialysis dose achieved with a DCath were slightly lower than those achieved with AVAs, but they were still much higher than is recommended by guidelines. The percent reduction in β2-M achieved with a DCath was also 4 to 10% lower than that achieved with an AVA. On longitudinal follow-up, the main clinical performance indicators of DCaths (total Kt and total ultrafiltration volume, L/session) were maintained as very stable over time and close to those achieved with AVAs. Conclusions: As shown in this study, high-flow DualCath tunneled two-single-lumen silicone catheters may be used to deliver high volume hemodiafiltration in a reliable and consistent manner without compromising clinical performance. These results relied on the specific design of the two silicone cannulas and the strict adherence to best catheter practices. MDPI 2023-07-17 /pmc/articles/PMC10381463/ /pubmed/37510847 http://dx.doi.org/10.3390/jcm12144732 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Canaud, Bernard Leray-Moragues, H. Chenine, Leila Morena, Marion Miller, George Canaud, Ludovic Cristol, Jean Paul Comparative Clinical Performances of Tunneled Central Venous Catheters versus Arterio-Venous Accesses in Patients Receiving High-Volume Hemodiafiltration: The Case for High-Flow DualCath, a Tunneled Two-Single-Lumen Silicone Catheter |
title | Comparative Clinical Performances of Tunneled Central Venous Catheters versus Arterio-Venous Accesses in Patients Receiving High-Volume Hemodiafiltration: The Case for High-Flow DualCath, a Tunneled Two-Single-Lumen Silicone Catheter |
title_full | Comparative Clinical Performances of Tunneled Central Venous Catheters versus Arterio-Venous Accesses in Patients Receiving High-Volume Hemodiafiltration: The Case for High-Flow DualCath, a Tunneled Two-Single-Lumen Silicone Catheter |
title_fullStr | Comparative Clinical Performances of Tunneled Central Venous Catheters versus Arterio-Venous Accesses in Patients Receiving High-Volume Hemodiafiltration: The Case for High-Flow DualCath, a Tunneled Two-Single-Lumen Silicone Catheter |
title_full_unstemmed | Comparative Clinical Performances of Tunneled Central Venous Catheters versus Arterio-Venous Accesses in Patients Receiving High-Volume Hemodiafiltration: The Case for High-Flow DualCath, a Tunneled Two-Single-Lumen Silicone Catheter |
title_short | Comparative Clinical Performances of Tunneled Central Venous Catheters versus Arterio-Venous Accesses in Patients Receiving High-Volume Hemodiafiltration: The Case for High-Flow DualCath, a Tunneled Two-Single-Lumen Silicone Catheter |
title_sort | comparative clinical performances of tunneled central venous catheters versus arterio-venous accesses in patients receiving high-volume hemodiafiltration: the case for high-flow dualcath, a tunneled two-single-lumen silicone catheter |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10381463/ https://www.ncbi.nlm.nih.gov/pubmed/37510847 http://dx.doi.org/10.3390/jcm12144732 |
work_keys_str_mv | AT canaudbernard comparativeclinicalperformancesoftunneledcentralvenouscathetersversusarteriovenousaccessesinpatientsreceivinghighvolumehemodiafiltrationthecaseforhighflowdualcathatunneledtwosinglelumensiliconecatheter AT leraymoraguesh comparativeclinicalperformancesoftunneledcentralvenouscathetersversusarteriovenousaccessesinpatientsreceivinghighvolumehemodiafiltrationthecaseforhighflowdualcathatunneledtwosinglelumensiliconecatheter AT chenineleila comparativeclinicalperformancesoftunneledcentralvenouscathetersversusarteriovenousaccessesinpatientsreceivinghighvolumehemodiafiltrationthecaseforhighflowdualcathatunneledtwosinglelumensiliconecatheter AT morenamarion comparativeclinicalperformancesoftunneledcentralvenouscathetersversusarteriovenousaccessesinpatientsreceivinghighvolumehemodiafiltrationthecaseforhighflowdualcathatunneledtwosinglelumensiliconecatheter AT millergeorge comparativeclinicalperformancesoftunneledcentralvenouscathetersversusarteriovenousaccessesinpatientsreceivinghighvolumehemodiafiltrationthecaseforhighflowdualcathatunneledtwosinglelumensiliconecatheter AT canaudludovic comparativeclinicalperformancesoftunneledcentralvenouscathetersversusarteriovenousaccessesinpatientsreceivinghighvolumehemodiafiltrationthecaseforhighflowdualcathatunneledtwosinglelumensiliconecatheter AT cristoljeanpaul comparativeclinicalperformancesoftunneledcentralvenouscathetersversusarteriovenousaccessesinpatientsreceivinghighvolumehemodiafiltrationthecaseforhighflowdualcathatunneledtwosinglelumensiliconecatheter |