Vascular access and complications in renal replacement therapy: a Meta-analysis_West China Medical Journal

Authors：

WEI Tiantian , LI Peiyun ,  ZHANG Ling , FU Ping

Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZHANG Ling, Email: zhanglinglzy@163.com

Keywords：

Renal replacement therapy; Vascular access; Complication; Meta-analysis

DOI：

10.7507/1002-0179.201806120

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ObjectiveTo compare dialysis catheter function and complications according to catheter site in patients undergoing hemopurification.MethodsLiteratures were searched from PubMed, Medline, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Database according to the inclusion and exclusion criteria. Publication years of these literatures ranged from April 1998 to April 2018. Meta-analysis was performed with RevMan 5.3 software. The odds ratio (OR) and 95% confidence intervals (CI) were calculated for uncontinuous outcomes, and the weighted mean difference (WMD) and 95%CI were calculated for continuous outcomes. The incidence of catheter related infection, other complications and patients outcome were compared between different sites for dialysis vascular access.ResultsA total of 9 articles were included, including 2 randomized controlled trials and 7 observational clinical studies, and 5 220 adult patients undergoing renal replacement therapy. Meta-analysis showed that there was no significant difference in incidences of catheter colonization or catheter-related bloodstream infection, as well as arterial puncture, local thrombosis, catheter dysfunction and spontaneous catheter withdrawal, between femoral and non-femoral (jugular or subclavian) catheterization (P≥0.05). Whereas the incidence of bleeding and local hematoma was lower in femoral catheterization [OR=0.44, 95%CI (0.23, 0.82), P=0.009], and the duration of catheters was shorter in femoral catheterization [WMD=–1.40 d, 95%CI (–2.17, –0.62) d, P=0.000 4]. The blood flow rate, filters clotting incidence and patients intensive case unit mortality were similar in different catheterization.ConclusionsIn patients undergoing renal replacement therapy, the bleeding and local hematoma incidence is lower in femoral catheterization but the duration of catheters is shorter. Nevertheless the patients have similar clinical outcome. This result may provide reference for clinical decision-making.

Citation： WEI Tiantian, LI Peiyun, ZHANG Ling, FU Ping. Vascular access and complications in renal replacement therapy: a Meta-analysis. West China Medical Journal, 2018, 33(7): 860-868. doi: 10.7507/1002-0179.201806120 Copy

1.	Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl, 2012, 2: 1-138.
2.	Souweine B, Traore O, Aublet-Cuvelier B, et al. Dialysis and central venous catheter infections in critically ill patients: results of a prospective study. Crit Care Med, 1999, 27(11): 2394-2398.
3.	張滌華, 鄭智華, 許元文, 等. 深靜脈置管行血液凈化治療臨床病例分析. 中國血液凈化, 2006, 5(2): 72-74, 78.
4.	Parienti JJ, Thirion M, Mégarbane B, et al. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA, 2008, 299(20): 2413-2422.
5.	Parienti JJ, Mégarbane B, Fischer MO, et al. Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: a randomized controlled study. Crit Care Med, 2010, 38(4): 1118-1125.
6.	Sch?nenberger M, Forster C, Siegemund M, et al. Catheter related blood stream infections in critically ill patients with continuous haemo(dia)filtration and temporary non-tunnelled vascular access. Swiss Med Wkly, 2011, 141: w13294.
7.	梁華般, 梁馨苓, 王文健, 等. 1028例危重血液凈化患者血管通路相關感染回顧分析. 中國血液凈化, 2012, 11(10): 523-526.
8.	Chua HR, Schneider AG, Sherry NL, et al. Initial and extended use of femoral versus nonfemoral double-lumen vascular catheters and catheter-related infection during continuous renal replacement therapy. Am J Kidney Dis, 2014, 64(6): 909-917.
9.	Bellomo R, M?rtensson J, Lo S, et al. Femoral access and delivery of continuous renal replacement therapy dose. Blood Purif, 2016, 41(1/2/3): 11-17.
10.	Ng YH, Ganta K, Davis H, et al. Vascular access site for renal replacement therapy in acute kidney injury: a post hoc analysis of the ATN Study. Front Med (Lausanne), 2017, 4: 40.
11.	周保純, 徐波, 朱建軍, 等. ICU 血液凈化治療患者導管相關性感染臨床研究. 中華醫院感染學雜志, 2015(7): 1584-1586.
12.	李如意, 張美君, 陳紅梅, 等. 血液透析時幾種臨時血管通路的對比分析. 海南醫學, 2009(1): 60-61.
13.	Kairaitis LK, Gottlieb T. Outcome and complications of temporary haemodialysis catheters. Nephrol Dial Transplant, 1999, 14(7): 1710-1714.
14.	侯靜, 溫向瓊, 郭道云, 等. 358例血液透析患者臨時中心靜脈導管近期并發癥及失功原因分析. 中國醫學創新, 2010(14): 16-18.
15.	Oliver MJ, Callery SM, Thorpe KE, et al. Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: a prospective study. Kidney Int, 2000, 58(6): 2543-2545.
16.	Brain M, Winson E, Roodenburg O, et al. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis. BMC Nephrol, 2017, 18(1): 69.
17.	Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med, 2012, 40(8): 2479-2485.

1. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl, 2012, 2: 1-138.
2. Souweine B, Traore O, Aublet-Cuvelier B, et al. Dialysis and central venous catheter infections in critically ill patients: results of a prospective study. Crit Care Med, 1999, 27(11): 2394-2398.
3. 張滌華, 鄭智華, 許元文, 等. 深靜脈置管行血液凈化治療臨床病例分析. 中國血液凈化, 2006, 5(2): 72-74, 78.
4. Parienti JJ, Thirion M, Mégarbane B, et al. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA, 2008, 299(20): 2413-2422.
5. Parienti JJ, Mégarbane B, Fischer MO, et al. Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: a randomized controlled study. Crit Care Med, 2010, 38(4): 1118-1125.
6. Sch?nenberger M, Forster C, Siegemund M, et al. Catheter related blood stream infections in critically ill patients with continuous haemo(dia)filtration and temporary non-tunnelled vascular access. Swiss Med Wkly, 2011, 141: w13294.
7. 梁華般, 梁馨苓, 王文健, 等. 1028例危重血液凈化患者血管通路相關感染回顧分析. 中國血液凈化, 2012, 11(10): 523-526.
8. Chua HR, Schneider AG, Sherry NL, et al. Initial and extended use of femoral versus nonfemoral double-lumen vascular catheters and catheter-related infection during continuous renal replacement therapy. Am J Kidney Dis, 2014, 64(6): 909-917.
9. Bellomo R, M?rtensson J, Lo S, et al. Femoral access and delivery of continuous renal replacement therapy dose. Blood Purif, 2016, 41(1/2/3): 11-17.
10. Ng YH, Ganta K, Davis H, et al. Vascular access site for renal replacement therapy in acute kidney injury: a post hoc analysis of the ATN Study. Front Med (Lausanne), 2017, 4: 40.
11. 周保純, 徐波, 朱建軍, 等. ICU 血液凈化治療患者導管相關性感染臨床研究. 中華醫院感染學雜志, 2015(7): 1584-1586.
12. 李如意, 張美君, 陳紅梅, 等. 血液透析時幾種臨時血管通路的對比分析. 海南醫學, 2009(1): 60-61.
13. Kairaitis LK, Gottlieb T. Outcome and complications of temporary haemodialysis catheters. Nephrol Dial Transplant, 1999, 14(7): 1710-1714.
14. 侯靜, 溫向瓊, 郭道云, 等. 358例血液透析患者臨時中心靜脈導管近期并發癥及失功原因分析. 中國醫學創新, 2010(14): 16-18.
15. Oliver MJ, Callery SM, Thorpe KE, et al. Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: a prospective study. Kidney Int, 2000, 58(6): 2543-2545.
16. Brain M, Winson E, Roodenburg O, et al. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis. BMC Nephrol, 2017, 18(1): 69.
17. Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med, 2012, 40(8): 2479-2485.

West China Medical Journal

Vascular access and complications in renal replacement therapy: a Meta-analysis

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