Hemodialysis Catheter-related Masses Case Report the Pro Inflammatory State in Chronic Kidney Disease

Abstract

Indwelling venous catheters provide essential functional vascular access for patients requiring emergent or urgent hemodialysis, though their long-term use is practically limited by known complications including increased rates of infection as compared with surgically created arteriovenous (AV) fistulas. Converging lines of evidence also support that chronic kidney disease (CKD) represents a pro-inflammatory state, an environment with active cellular and inflammatory pathobiology. Accordingly, implantation of catheters for even short-term use is associated with a fibrinthrombin-cellular matrix often forming around the catheter. This “biomass” long considered innocuous, can cause occlusion of the catheter, contributing to reduced flow rates during dialysis. It may also result in embolic injury of downstream structures. This case report identifies a complex catheter-related biomass remaining after removal of the hemodialysis catheter and focuses on two concerns. First, intravenous masses associated with the catheter, or remaining after removal may provoke embolic and direct hemodynamic-related injury. But perhaps less obvious is their potential linkage to vascular immunoreactivity found in CKD. This latter potential may need to be part of the larger discussion surrounding the outcomes of such pathologic immunoresponsiveness in CKD patients on hemodialysis.