Objective To evaluate the associations of the tip position of right femoral tunneled cuffed hemodialysis catheters with primary catheter patency and catheter-related complications. Methods This single-center retrospective cohort study included maintenance hemodialysis patients who underwent right femoral tunneled cuffed catheter (TCC) placement at the Hospital of Chengdu University of Traditional Chinese Medicine between August 2019 and August 2024. Catheter tip position was determined by postprocedural venography or fluoroscopy and classified as the inferior vena cava (IVC) group (catheter tip positioned within the lumen of the IVC) or the non-IVC group (atheter tip located in the iliac vein or more distal veins). Propensity score matching at a 1∶1 ratio was performed using age, sex, and dialysis vintage as covariates; catheter length distribution was compared after matching. Follow-up data were obtained from outpatient and inpatient records, dialysis-center records, imaging data, and telephone follow-up. The primary outcome (primary catheter patency) and secondary outcomes (catheter dysfunction and catheter-related complications) were compared between the two groups. Results A total of 66 patients were included. After matching, 26 patients were included in each group. In the non-IVC group, 18 patients (69.2%) used 23-cm catheters and 8 (30.8%) used 28-cm catheters; in the IVC group, 10 patients (38.5%) used 23-cm catheters and 16 (61.5%) used 28-cm catheters, and the difference was statistically significant (χ2=4.950, P=0.026). Primary patency did not differ significantly at 1 month (96.2% vs. 100.0%, P=1.000), whereas the IVC group had higher primary patency at 3, 6, and 12 months than the non-IVC group (88.5% vs. 61.5%, P=0.025; 80.8% vs. 50.0%, P=0.020; 57.7% vs. 23.1%, P=0.011). Kaplan-Meier analysis showed a significant difference in dysfunction-free catheter survival between groups (log-rank P=0.013). Catheter-related thrombosis, central venous stenosis, and catheter-related infection did not differ significantly between groups (P>0.05). Multivariable Cox regression showed that height ≥169 cm was a risk factor for catheter dysfunction [hazard ratio (HR)=6.06, 95% confidence interval (CI) (2.02, 18.16), P=0.001], whereas catheter tip placement in the IVC was protective [HR=0.30, 95%CI (0.12, 0.72), P=0.008]. Conclusion In patients receiving right femoral TCCs, tip placement in the IVC may improve primary catheter patency and reduce catheter dysfunction; further prospective multicenter studies with larger samples are needed.
Objective To retrospectively analyze the clinical characteristics of heat stroke (HS) and HS-acute kidney injury (AKI), analyze the risk factors leading to death in patients, and provide new ideas for the prevention and treatment of HS. Methods Patients with HS who visited 13 hospitals in Sichuan subtropical monsoon climate and HS high-incidence areas between July 2019 and September 2023 were retrospectively selected. According to whether in-hospital death or AKI occurred, the patients were divided into survival group and death group, AKI group and non-AKI group. According to serum creatinine level, patients in the AKI group were divided into AKI stage 1 group, AKI stage 2 group and AKI stage 3 group. The main clinical manifestations and important clinical data of the patients were analyzed, and the risk factors affecting the death of patients were analyzed by multivariate logistic regression. Results A total of 195 patients with HS and 115 patients with HS-AKI were included. The results of multivariate logistic regression analysis showed that AKI, abnormal coagulation function, nervous system injury, neutrophil/lymphocyte ratio, and D-dimer were independent risk factors for death (P＜0.05). The results of clinical characteristics analysis of HS-AKI showed that the mortality rate of patients with AKI stage 2 and AKI stage 3 was higher (P＜0.05). Conclusions AKI, abnormal coagulation function, nervous system injury, neutrophil/lymphocyte ratio, and D-dimer are independent risk factors for death in HS. Therefore, active treatment of patients with HS combined with AKI, abnormal coagulation function, and nervous system injury in the future will help reduce the risk of death in patients.
