Athirakul K, Conlon P, Schwab S
Cuffed central venous hemodialysis catheters and
adequacy of dialysis
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1402 1996
Sixty four patients were randomized to one of 3 commonly used cuffed
implantable venous HD catheters: PermCath (PC), Tesio (TS) or VasCath
SoftCell (VC). Seventy two percent were in the right IJ; 222 control
patients had an AV access. High flux dialysis was performed with F80
dialyzers on Cobe C3 machines.
Maximal achievable blood flow (MABF)
calculated as the median of 30 treatments (limited by arterial pressure
< -300 mmHg) was 384 ml/min for PC, 396 ml/min for TS and 320 ml/min
for VC.
MABF was statistically similar with PR and TS; both were higher than the
VC. Reliability (percentage of treatments performed at blood flow > 350
ml/min) was also higher with the PC (87%) and TS (83%) than with VC (42%).
The AV access patients had the highest blood flow (437 ml/min) and
reliability. Recirculation percentage was comparable with all 3 catheters
(about 4%). All patients less than 85 kg achieved KT/V > 1.2 within a 4
hour treatment; 6 patients > 85 kg required > 4 hours.
Comment: This study adds important information regarding an
increasing
number of patients who are dialyzing long-term with implanted dialysis
catheters. I agree with the authors that minimally adequate KT/V (1.2) can
be provided with the venous catheters given enough dialysis time.
Unfortunately, many patients dialyzing with catheters do not have their
times increased enough to permit adequate dialysis. Data comparing the
exact time required to achieve KT/V of 1.2 in the catheter patients,
compared with the AV access patients would be helpful. Also, information
regarding catheter longevity and ability to achieve KT/V higher than 1.2
would be of interest. Confirmation of the superiority of PermCath and
Tesio brand catheters requires further study, but these data are quite
suggestive -- particularly the decreased reliability of the VasCath
SoftCell catheter.
(Stephen Pastan, M.D., Emory Clinic, Atlanta, GA)
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Am Soc Nephrol
Basic hemodialysis :
Vascular Access: venous