The Impact of Tunneled Central Venous Hemodialysis Catheter on Mortality of Elderly Hemodialysis Patients Hospitalized in a Long-Term Care Hospital

Abstract

Introduction: The association between tunneled central venous hemodialysis catheters (TCVCs) and mortality in hospitalized elderly hemodialysis (HD) patients remains unclear. Methods: This retrospective observational study was conducted in a long-term care hospital. We evaluated the association between TCVC and mortality in HD patients hospitalized between 2015 and 2020. Results: A total of 463 patients were compared: TCVC group (n = 53) and non-TCVC group (n = 410) including arteriovenous fistula (AVF, n = 369), arteriovenous graft (AVG, n = 30), and superficialized brachial artery (SBA, n = 11). The mean ages were 80 and 78 years in the TCVC and non-TCVC groups, respectively. Overall mortality rates for all-cause and cardiovascular diseases (CVDs) were higher in the TCVC group than in the non-TCVC group (log-rank, p = 0.01, and p = 0.009). Overall mortality was higher in the TCVC group than in the AVF group (p = 0.04), but there were no significant differences between the TCVC, AVG, and SBA groups. In Cox proportional hazards regression models, age, dialysis vintage, male sex, Charlson Comorbidity Index (CCI), and serum albumin level were associated with all-cause, CVD, and infectious disease (ID) mortalities, but TCVC was not associated with all-cause (hazard ratio, 1.31; 95% confidence interval, 0.95–1.80; p = 0.1), CVD (1.54; 0.99–2.39; p = 0.051), and ID (0.91; 0.48–1.70; p = 0.8) mortalities. Among patients aged ≥80 years, with dialysis vintage ≥7 years and CCI ≥10, the overall mortality rates were comparable between the two groups. Conclusions: Among elderly HD patients in the long-term care hospital, TCVC was not associated with mortality.