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

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Date

2021-07-14

Authors

Crespo-Montero, Rodolfo
Gomez-Lopez, Victoria E
Guerrero-Pavon, Fatima
Carmona-Muñoz, Andres
Romero-Saldaña, Manuel
Ranchal-Sanchez, Antonio
Aljama-Garcia, Pedro

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MDPI
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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.

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MeSH Terms

Aged
Arteriovenous shunt, surgical
Central venous catheters
Humans
Inflammation
Prospective studies
Renal Dialysis

DeCS Terms

Anciano
Catéteres venosos centrales
Derivación arteriovenosa quirúrgica
Diálisis renal
Estudios prospectivos
Inflamación

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Keywords

Central venous catheter, Fistula, Hemodialysis, Inflammatory status, Mortality

Citation

Crespo-Montero R, Gómez-López VE, Guerrero-Pavón F, Carmona-Muñoz A, Romero-Saldaña M, Ranchal-Sanchez A, et al. Influence of Tunneled Hemodialysis-Catheters on Inflammation and Mortality in Dialyzed Patients. Int J Environ Res Public Health. 2021 Jul 16;18(14):7605