Comparison of feasibility and effectiveness of tunneled dialysis catheter placement with or without DSA guidance: a propensity score-matched cohort study

• Published in: Renal failure 2024-12, Vol.46 (2), p.2376935
• Main Authors: Shang, Yiwei, Pan, Shujun, Jin, Chen, Zheng, Danna, Xu, Xiujun, Zhu, Bin, Zhao, Li, Jin, Juan, He, Qiang, Shen, Xiaogang
• Format: Article
• Language: English
• Subjects: Adult; Aged; angiography; Angiography, Digital Subtraction; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - instrumentation; Catheterization, Central Venous - methods; Catheters; Catheters, Indwelling; digital subtraction angiography; Feasibility Studies; Female; Hemodialysis and Peritoneal Dialysis; Humans; Male; Middle Aged; Propensity Score; renal dialysis; Renal Dialysis - instrumentation; Renal Dialysis - methods; Retrospective Studies; ultrasonography; Ultrasonography, Interventional
• ISSN: 0886-022X; 1525-6049; 1525-6049
• DOI: 10.1080/0886022X.2024.2376935

In some resource-limited regions, the placement of tunneled dialysis catheters (TDC) is often preferred under ultrasound guidance rather than fluoroscopy. This study compared ultrasound-and digital subtraction angiography-guided (DSA)-guided TDC in renal replacement therapy. This retrospective cohort study included all TDC placements performed at our hospital between January 2020 and October 2022. We utilized 1:1 propensity score matching (PSM) to balance the demographic and clinical characteristics of the DSA-guided and ultrasound-guided groups. Dialysis prescriptions and actual dialysis completion were assessed using intraclass correlation coefficients (ICC). Multivariable logistic regression analyses determined the risk factors for early termination of dialysis. The differences in adverse events, catheter function, and catheter tip position were evaluated between the two groups. The study included 261 patients (142 in the DSA-guided group and 119 in the ultrasound-guided group). After PSM, 91 patients were included in each group, with no significant baseline differences (  > .1). Both groups achieved adequate catheter blood flow and ultrafiltration volumes without deviations from dialysis prescriptions (ICC ≥ 0.75). The DSA-guided group had fewer early dialysis terminations than the ultrasound-guided group (3.3 12.0%,  = .026). The position of the catheter tip in the right atrium was more consistent in the DSA-guided group (100 74.2%,