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Catheter-related Complications In Undocumented Patients With ESRD On Dialysis
Cynthia Ramazani, Medical Student, Jaime Benarroch-Gampel, MD, Sarah Ann Johnson, MD, Manuel Garcia-Toca, MD, Ravi Rajani, MD, Christopher Ramos, MD.
Emory University School of Medicine, Atlanta, GA, USA.
Catheter-Related Complications in Undocumented Patients with ESRD on DialysisRamazani CA, Benarroch-Gampel J, Johnson S, Garcia-Toca M, Rajani RR, Ramos CR
OBJECTIVE: Dialysis care in the United States for undocumented immigrants remains challenging. Without a definitive method of dialysis access, undocumented patients must rely on tunneled central venous catheters (CVCs) for long-term dialysis. The extent of catheter-related complications in undocumented patients on dialysis is largely unknown.
METHODS: A retrospective chart analysis of undocumented ESRD patients who started dialysis from 2010 - 2021 was performed. Patients without adequate follow-up were excluded and the data set was divided based on dialysis access type (CVC only [CVC, n=65] vs. catheter followed by AV access [CAV, n=96]). Catheter complications were defined as mechanical malfunctions, infections, and central venous stenosis. Outcomes measured were differences in complications and hospitalizations between these two cohorts and timing to evaluation by vascular surgery.
RESULTS: Patients who received dialysis primarily via CVC experienced more complications overall (P = 0.029) though this difference was not reflected within the complications subcategories (Table 1). CVC patients were also hospitalized more often due to catheter-related complications (0.68 hospitalizations vs. 0.41 hospitalizations, P=0.049). CAV patients experienced their first complication of any type and their first mechanical malfunction significantly earlier than their CVC counterparts (Table 1). Additionally, linear regression analysis demonstrates that in CAV patients, longer catheter duration was associated with an increased overall number of catheter-related complications (P<0.01) and an increased number of hospitalizations (P=0.016). No difference was observed in timing to vascular surgery referral (CVC 51 days vs. CAV 111 days, P=0.778) and evaluation (CVC 234 days vs. CAV 337 days, P=0.638).
CONCLUSION: Prolonged use of tunneled CVC is known to increase the risk of catheter-related complications. In undocumented patients with ESRD, these complications are highly frequent and avoidable with earlier creation of AV access.
| | | | | | |
| Mean Number of Complications | Mean Number of Days before 1st complication |
| CVC | CAV | P-value | CVC | CAV | P-value |
| All complications | 1.31 | 0.844 | 0.0289* | 515 | 282 | 0.0115* |
| Mechanical malfunction | 0.739 | 0.479 | 0.0785 | 669 | 371 | 0.0183* |
| Infection | 0.462 | 0.292 | 0.133 | 581 | 496 | 0.584 |
| Central venous stenosis | 0.108 | 0.0729 | 0.521 | 962 | 770 | 0.729 |
Table1. Mean number of complications and mean number of days before 1
st dialysis complications. (CVC = dialysis via central venous catheter, CAV = dialysis via catheter then AV access)
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