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2017 ; 4
(ä): 40
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Vascular Access Site for Renal Replacement Therapy in Acute Kidney Injury: A Post
hoc Analysis of the ATN Study
#MMPMID28443283
Ng YH
; Ganta K
; Davis H
; Pankratz VS
; Unruh M
Front Med (Lausanne)
2017[]; 4
(ä): 40
PMID28443283
show ga
BACKGROUND: Acute kidney injury requiring renal replacement therapy (RRT) in the
intensive care unit portends a poor prognosis. The decisions regarding dialysis
catheter placement is based mainly on physician discretion with little evidence
to support the choice of dialysis catheter location. METHODS: The Veterans
Affairs/National Institutes of Health Acute Renal Failure Trial Network Study was
a multicenter, prospective, randomized trial of intensive vs. less intensive RRT
in critically ill patients with AKI. We assessed the association of dialysis
catheter location with dialysis catheter-related outcomes including
catheter-related complications, mortality, dialysis dependence, and dialysis dose
delivered. RESULTS: Of the 1,124 patients enrolled in the ATN study, catheter
data were available in 1,016 (90.39%) patients. A total of 91 (8.96%) subclavian,
387 (38.09%) internal jugular, and 538 (52.95%) femoral dialysis catheters were
inserted. The femoral group was younger (58.39?±?16.27), had greater bleeding
tendency [lower platelet count (96.00?±?109.35) with higher INR (2.01?±?2.19)],
and had a higher baseline sequential organ failure assessment score on admission
(14.59?±?3.61) compared to the other two groups. Dialysis catheter-related
complications were low in this study with no significant difference in the rates
of complications among all catheter locations. Mortality and dialysis dependence
was lowest in the subclavian group, while the dose of dialysis delivered (Kt/V)
remained lowest in the femoral group, after propensity score and center
adjustments. CONCLUSION: Patient characteristics influence the choice of dialysis
catheter location with a tendency to place femoral catheters in younger, sicker,
and more coagulopathic patients. There were no statistically significant
differences in complication rates among the three catheter locations, although
femoral catheters may be associated with a lower delivered dose of dialysis
during intermittent hemodialysis. CLINICAL TRIAL REGISTRATION:
www.ClinicalTrials.gov, identifier NCT00076219.