Right intra-atrial catheter placement for hemodialysis in patients with multiple venous failure

Prevalence of thrombosis in patients undergoing dialysis treatment: A systematic review and meta-analysis

AIM

to determine the prevalence of thrombosis in dialysis patients.

BACKGROUND

Thrombosis is the most common cause of vascular access dysfunction in dialysis patients. Various studies have reported different prevalence rates of thrombosis, and no systematic study provides a comprehensive result on this subject.

METHODS

In this systematic review and meta-analysis, a search of available texts was conducted until the end of December 2023, using keywords such as Thrombosis, end-stage renal disease, end-stage kidney disease, hemodialysis, and dialysis in databases including Web of Science, PubMed, Scopus, ProQuest, Ovid, Science Direct, Clinical Key, EMBASE, CINAHL, SID, and MagIran. The random-effects model was used, and the heterogeneity of the studies was assessed using the I2 index. The quality of the selected studies was evaluated using the STROBE checklist. Meta-analysis was performed using CMA version 2 and STATA version 14 software. The study adhered to the guidelines stated in the PRISMA statement.

RESULTS

Out of 12,604 articles found, after removing duplicates and conducting evaluations, the full text of 415 articles was examined, and ultimately, 141 articles were included in the study. The overall prevalence of thrombosis was 14.2% (95% CI: 11.5-17.2). The prevalence of thrombosis was higher in dialysis patients under 50 years of age (17.1%, 95% CI: 11.3-23.8) and patients with vascular access (16.2%, 95% CI: 13.1-19.5), especially arteriovenous grafts (22.8%, 95% CI: 14.5-32.4). Additionally, the prevalence of late thrombosis was higher than that of early thrombosis (15.0% vs. 5.3%) (95% CI: 7.7-24.2 vs. 95% CI: 2.7-8.5).

CONCLUSIONS

The results indicate a relatively high prevalence of thrombosis in dialysis patients. The prevalence of thrombosis in patients with arteriovenous grafts was notable. Considering the risks of thrombosis, the adoption of preventive measures in hemodialysis patients, such as the use of anticoagulant drugs, is recommended.

The Tunnelled Atrial Catheter: A Promising Solution for Vascular Capital Depletion in Dialysis despite Associated Thrombi

Introduction

Longer survival in dialysis led to a higher incidence of vascular access complications and failure. With the limited access to kidney transplantation programs and peritoneal dialysis, exhaustion of vascular access for hemodialysis is an increasingly common situation. Among the available options, atrial tunneled dialysis catheter (ATDC) has been reported as an effective vascular access in this population. Methodology. We report the experiences of two nephrology centers in Tunis with ATDC as an ultimate vascular access for dialysis. Case Reports. Two patients with exhausted vasculature underwent ATDC insertion in 2020 and 2022, respectively, as a vascular access of last resort. Both patients underwent CRBI, which resolved with favorable outcomes. One case was complicated by post-operative thrombosis and was successfully treated with thrombolysis. Both patients are currently on dialysis via their ATDC with a catheter patency of 29 months.

Conclusion

ATDC is a life-saving and safe vascular access in cases of depleted vasculature. Little more than 50 cases have been reported in the literature during the last 30 years. As the frequency of vasculature exhaustion is expected to increase, preservation of veinous access in patients at risk of chronic kidney disease have never been more crucial.

Systematic Review of Atrial Vascular Access for Dialysis Catheter

Introduction

The last decade has seen a steady increase worldwide in the prevalence of end-stage renal disease (ESRD). Hemodialysis is the major modality of renal replacement therapy (RRT) in 70% to 90% of patients, who require well-functioning vascular access for this procedure. The recommended access for hemodialysis is an arteriovenous fistula or a vascular graft. However, recourse to central venous catheters remains essential for patients whose chronic renal disease is diagnosed at the end stage or in whom an arteriovenous fistula cannot be created or maintained. Tunneled dialysis catheter (TDC) exposure can induce venous stenosis and occlusions and can result in superior vena cava syndrome and/or vascular access loss. Exhaustion of conventional vascular accesses is 1 of the greatest challenges that nephrologists and patients have to face. Several unconventional salvage-therapy routes for TDC placement in patients with exhausted upper body venous access have been reported in the literature.

Methods

We report 2 new cases of intra-atrial TDC placement for patients with exhausted vascular access and perform a meta-analysis of cases from the literature.

Results

A total of 51 patients were included. The TDC was inserted by a cardiovascular surgeon in all cases. At the end of follow-up, 75% patients were alive. The median survival time was 25 months. Survival time of hemodialysis patients with intra-atrial TDC was lower than that observed with conventional TDC.

Conclusions

This unconventional technique is safe and functional for hemodialysis patients with exhausted venous access. Atrial vascular access for TDC placement is salvage therapy and is therefore potentially lifesaving.

[Exhaustion of vascular capital in patients on hemodialysis: what will be the outcome?]

Despite advances in the treatment of chronic renal failure, vascular access remains the weakest link in renal replacement therapy (RRT) and the leading cause of morbidity in patients on hemodialysis We report the case of a young female patient with chronic renal insufficiency secondary to vascular nephropathy on periodic hemodialysis and whose vascular capital was early exhausted due to iterative thromboses in arteriovenous fistulas and failure in peritoneal dialysis. Protein C deficiency was objectified. The patient underwent tunneled hemodialysis catheter insertion at the level of the right atrium via a right anterolateral thoracotomy with cannulation of the inferior vena cava, with poor functional outcome after three months of use. Since then she has been dialyzed using puncture of the external jugular veins.