Abstract
Background
Tunnelled central venous catheters are frequently used for chronic haemodialysis; however, whether the outcomes of catheter use have changed over time is uncertain.
Aims
We sought to determine trends in the rates of catheter failure among the incident haemodialysis population over the past 25 years.
Methods
A retrospective cohort study was performed using linked data between a statewide administrative hospital admissions dataset and a national dialysis registry, including all adults commencing chronic haemodialysis via a tunnelled central venous catheter in the state of Queensland between 1999 and 2023. The primary outcome was the time to the first catheter failure event, determined using probabilistic data linkage, the Kaplan–Meier method and multivariable Cox proportional hazards modelling.
Results
Of the 11 520 individuals who commenced chronic haemodialysis during the study period, approximately 41% commenced via a tunnelled catheter. The proportion of incident patients using a tunnelled catheter increased from 29% in 1999–2003 to 47% in 2019–2023. Tunnelled catheter survival improved over the study period, with 12-month catheter survival rates of 73% (95% confidence interval (CI): 65–81%) in 1999–2003 versus 86% (CI: 84–88%) in 2019–2023 (P < 0.01). On multivariate analysis, the risks of catheter failure at 12 months were significantly lower in 2014–2018 (hazard ratio (HR): 0.52 (95% CI: 0.33–0.80)) and 2019–2023 (HR: 0.44 (95% CI: 0.29–0.68)) than in 1999–2003. Catheter failure was associated with treatment at urban as opposed to non-urban centres (P < 0.01) and small as opposed to medium centres (P < 0.05).
Conclusions
The rates of tunnelled haemodialysis catheter failure have fallen significantly over the past 25 years. Improvements in catheter outcomes underscore the contemporary importance of an individualised approach to dialysis access.