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June 2025 Articles of Interest

Posted By Abigail Falk, Wednesday, June 18, 2025

https://sites.google.com/site/abigailsarticles/june-2025-articles

 

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Anatole Besarab says...
Posted Wednesday, June 18, 2025
This article, Long-Term Durability of Tunneled Hemodialysis Catheters: Outcomes from a Single Institution 22-Year Experience by Scott's group at my alma mater HUP examines the shorter term and long term durability of THCs. Only 2 types of catheters are reported – the AshSplit accounting for the overwhelming fraction of catheters(~90%) placed.
Catheters that lasted less than 1 yr dominated those lasting more than 1 year dominatd at a ratio of 24 to 1.Fraction of catheter showin “catheter breakage” was 9-fold higher in the > 1 yr group compared to those used for < 1 yr., but this was probably expected.) In the loge r duration subgroup, .The rate of broken components was 5.0% for Ash SplitCath and 15.6% for Arrow-Clark Vector Flow. Catheters remove for “not needed anymore” (indicating permanent access constructed or transplant received ). Infections were slightly more common in thes< 1 yr group (33.8%) compared to the longer lasting catheters (24.2%). Removal for low flow occurred in 2%3 and 22% of cases. See table below:

Duration <1 vs >1 - N<1 6515 N>1 272 2 Ratio 24.0
BREAKS N<1 6.3% N>1 0.7%
NOT NEEDED N<1 33.8% N>1 1.4%
INFECTION N<1 32.4% N>1 24.2%
LOW FLOW N<1 23.5% N>1 22.3%

Authors acknowledge that their study is limited by its retrospective design. A large number of catheters was lost to follow-up, reflecting an urban care environment and multiple practitioners. I would have liked to have seen a breakdown in both subgroups as to those catheters denoted as “not needed anymore” according to alteration in therapy to another form of RRT (PD, KidneyTX , voluntary cessation of ant RRT), or death With a bit of effort such data would have been available. Just assign a fellow in nephrology and add person as co-author.

Perhaps they could have added some clinical data about their population of > 6000 to see if agem gender, Kt/V , presences of DM influenced catheter survival beyond the one I suspect were important. Suh data would be very helpful in managing catheter dependent patients.
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