Adequacy of haemodialysis with cuffed central-vein catheters.

CuVed central-venous haemodialysis cath- as well as the control population with AV access (mean blood flow 437 ml/min, reliability 96%, P<0.005). eters are emerging as an alternative permanent haemo- dialysis vascular access. There is limited data regarding Recirculation rates were 3.7% for PermCath 3.9% for Tesio, and 4% for VasCath. All patients weighing less the adequacy of dialysis with prolonged used of these catheters. We conducted a prospective study comparing than 85 kg acheived a Kt/V of 1.2 with a 4-h treatment. For comparison purposes when Kt/V was normalized three commonly used cuVed central-venous haemodia- lysis catheters: (1) PermCathTM, Quinton Instrument to a 70-kg patient the results were PermCath 1.42. Tesio 1.44, VasCath 1.19, AV access 1.64. with AV access. Methods. All patients were dialysed with identical tested catheters. machines and kidneys. Maximal eVort were made with Key words: adequacy; catheter; ESRD; haemodialysis; every catheter to optimize achievable blood flow. Kt/V; recirculation; renal failure; PermCath Catheters with mechanical problems were treated first with urokinase and then fibrin sheath catheter stripping. The mean blood flow was determined by averaging mean blood flows from 30 consecutive treat- Introduction ments. Reliability of catheter was defined as percentage of treatments that were performed at a median Haemodialysis requires reliable access to the circula- blood flow of 350 ml/min or above during these tion. This access to the circulation has traditionally 30 treatments. Kt/V was measured monthly and been provided by native arteriovenous (AV ) fistulae calculated using the single-pool Daugirdas formula. and synthetic AV grafts (AV access) (1-3). Temporary Haemodialysis prescription were adjusted for Kt/V access for haemodialysis has been provided by bedside above 1.2. Recirculation was measured using two- inserted dual-lumen haemodialysis catheters (1-5). needle low-blood-flow technique. Unfortunately, unsuitable vascular anatomy may pre- Results. The mean blood flows were (PermCath clude AV access formation in some patients. In other 383.6 ml/min, Tesio 396.3 ml/min, VasCath 320.4 ml/ patients comorbid conditions and or haemodynamic min). PermCath and Tesio had comparable mean blood instability may preclude AV access formation. In this flows and were significantly higher than VasCath group of patients, cuVed central-venous haemodialysis (P<0.005). Reliability of catheters were (PermCath catheters are emerging as permanent vascular access 86.9%, Tesio 81.6%, VasCath 42.3%). Tesio and (6-13). PermCath were equally reliable and both were more CuVed tunnelled central-venous haemodialysis cath- reliable than VasCath (P<0.005). Had the target for eters have longer use-life than dual-lumen acute haemo- reliability been 300 ml/min all three catheters would dialysis catheters. These catheters inserted into the have been equally reliable. Negative arterial pressure internal or external jugular veins were originally in excess of 300 mmHg prevented faster blood flows described in 1987-1988 as a means of prolonged tem- in 98% of instances. None of the catheters performed porary access (6-10). Shortly thereafter several groups