Bacteremia e mortalidade entre pacientes com cateter de curta permanência e tunelizados para hemodiálise

Abstract

Introduction: Central venous catheters (CVC) for hemodialysis (HD) used as vascular access can be short-term (STC) or tunneled (TC) and the use of these devices has increased over time. Bacteremia and dysfunction are use-related complications and can impact morbidity and mortality. Objective: To compare infection and dysfunction rates between STC and TC for a minimum period of 180 days and patient survival in a period of 90 days. Method: Retrospective cohort to evaluate CVC implanted between January 2011 to December 2020 in a tertiary hospital. CVCs implanted in patients with end-stage chronic kidney disease were included and patients with acute kidney injury, with duration of use of less than 3 (three) HD sessions and patients who died up to one week after implantation were excluded. The rates of bacteremia and dysfunction, bacteremia-free and dysfunction-free survival were evaluated. Multivariate analysis was performed using a Cox proportional hazards regression model for patient survival at 90 days. Results: 670 catheters were analyzed in the period, implanted in 287 patients, being 422 STC (63%) and 248 TC (37%). The most common implant site was the right internal jugular vein (RIJV) in 46% of STC and 31.5% of TC (p<0.001). The rates of confirmed bacteremia per 1000 catheter-days were 1.19 for STC and 0.20 for TC (p<0.0001). The rates of confirmed or suspected bacteremia were 2.27 and 0.37 per 1000 catheter-days for STC and TC, respectively (p<0.0001). Dysfunction rates were 3.96 and 0.86 for STC and TC, respectively (p<0.0001). Patient survival at 90 days was higher in the TC group than in the STC group (96.8% vs 89.1%; p<0.0001). Age (RR 1.033: 95% CI 1.009-1.057), albumin (RR 0.278: 95% CI 0.154-0.505) and use of STC (RR 2.807: 95% CI 1.048-7.521) were the only variables that influenced the mortality at 90 days after implantation. Conclusion: We found lower rates of bacteremia and dysfunction for TC. In addition, the use of STC influences patient mortality.