Central venous catheter outcomes in nocturnal hemodialysis

Central venous catheter (CVC) as hemodialysis (HD) access is associated with great morbidity and mortality in the end-stage renal disease population. Quotidian, nocturnal HD (NHD) is a novel dialysis modality associated with cardiovascular and quality of life benefits, yet there is a concern of a potential increase in vascular access-related complications through patient-directed access cannulation. We aimed to determine catheter incidence and prevalence in the NHD population and to compare rates of catheter-related: infection, thrombolytic administration, hospitalization, survival, and reasons for their loss before and after conversion to NHD. This observational cohort consisted of incident and prevalent NHD patients between 1 November 1993 and 31 May 2005. Rate comparisons were determined by Poisson analysis and catheter survival by Kaplan-Meier curves. Eighty-one CVCs in 33 patients accounted for 17 150 CVC days (CVCD); 40 CVCs were exclusively used for conventional three times weekly HD (CHD) and 25 CVCs were exclusively used during NHD. The incidence and prevalence of CVC use in our NHD population was 35 and 25%, respectively. Comparing CHD to NHD, no significant differences were seen in total rates of infection, thrombolytic administration, or access-related hospitalization. Catheter survival was superior in NHD vs CHD (P=0.03). Adverse terminal catheter events were higher during CHD than NHD (5.84 vs 2.92/1000 CVCD; P=0.03). CVC use and complications in NHD is comparable to that in CHD with the benefit of longer cumulative survival. More frequent CVC use should not be a deterrent to NHD.