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Comparative Clinical Performances of Tunneled Central Venous Catheter Versus Arterio-Venous Accesses in Patients Receiving High Volume Hemodiafiltration: The Case for High-Flow DualCath, a Tunneled Two Single Lumen Silicone Catheter
Canaud, B.; Leray-Moragues, H.; Chenine, L.; Morena, M.; Miller, G.; Canaud, L.; Cristol, J.P. 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. J. Clin. Med.2023, 12, 4732.
Canaud, B.; Leray-Moragues, H.; Chenine, L.; Morena, M.; Miller, G.; Canaud, L.; Cristol, J.P. 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. J. Clin. Med. 2023, 12, 4732.
Canaud, B.; Leray-Moragues, H.; Chenine, L.; Morena, M.; Miller, G.; Canaud, L.; Cristol, J.P. 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. J. Clin. Med.2023, 12, 4732.
Canaud, B.; Leray-Moragues, H.; Chenine, L.; Morena, M.; Miller, G.; Canaud, L.; Cristol, J.P. 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. J. Clin. Med. 2023, 12, 4732.
Abstract
Tunneled central venous catheters (CVC) are mainly considered as rescue vascular access option in dialysis but still used in about one quarter of prevalent patients worldwide as being associated with poor performances and higher risks.
Study design. In this retrospective single-center study, we aimed to report on clinical performances achieved with high-flow tunneled CVC (DualCath, DCath) and compared it with arteriovenous accesses (AVAs; AV fistula, AV graft, 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 for 30 months.
The study consisted of two phases: baseline cross-sectional and longitudinal follow-up of key performance indicators. Clinical performances consisting of effective blood flow and blood volume, recirculation, urea and ionic Kt/V and total Kt, ultrafiltration volume and percent reduction of ß2-M were measured monthly as part of quality control in our unit.
Results. At baseline, effective blood flow with DCath was close to 400 ml/min, similar to AVAs. Recirculation with DCath (7%, 6-13%) was higher than AVAs. Diffusive dialysis dose delivered with DCath (spKt and eKt/V) and convective dialysis dose achieved with DCath were slightly lower than AVAs, but still much higher than recommended by guidelines. Percent reduction of ß2-M achieved with DCath was also 4 to 10% lower than AVAs. On longitudinal follow-up, main clinical performance indicators of DCath (total Kt and total ultrafiltration volume, L/session) were maintained 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 performances. These results rely from the specific design of the two silicone cannulas and the strict adherence to best catheter practices.
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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