CLINICAL PROFILE AND OUTCOME OF TUNNELED CUFFED CATHETER AS VASCULAR ACCESS IN PATIENTS ON MAINTENANCE HEMODIALYSIS: A SINGLE TERTIARY CENTER STUDY IN INDIA

An arteriovenous fistula (AVF) is the preferred vascular access for maintenance hemodialysis. However less than 20% of patients are initiated on maintaince hemodialysis through arteriovenous fistula.  This necessitates use of alternatives like tunneled cuffed catheters (TCCs). Data on TCC outcomes in India are scarce. This study aimed to evaluate the outcomes and complications associated with this vascular access in patients awaiting a functional AVF at a tertiary care center.

 This prospective observational study was conducted at the Department of Nephrology, All India Institute of Medical Sciences(AIIMS), Patna, from November, 2023 to September, 2025. We followed 65 patients with end-stage kidney disease who required a tunneled cuffed catheter (Permcath) continuing maintenance hemodialysis.  All patients were initially managed with a temporary non-tunneled catheter before conversion to a TCC. Following TCC insertion, patients were followed for a period of six months. We collected data on patient demographics, catheter insertion site, complications (including procedural events, catheter-related bloodstream infections, and thrombosis), and clinical outcomes such as transition to an arteriovenous fistula and mortality.

A total of 65 patients were included, of which 45 (69.2%) were male and 20 female (30.7%). The mean age was 41.5 ± 18.8 years. The mean time from temporary catheter placement to conversion to a TCC was 23.3 ± 13.7 days. The right internal jugular vein was the predominant insertion site, used in 90.7% of patients. All patients were advised for AV fistula creation. But only 39 patients had AV fistula created in study period. During the follow-up, only 16 patients (24.6%) had a functional AVF utilized for dialysis, with a mean maturation time of 40.8 ± 17.9 days. Catheter-related bloodstream infection (CRBSI) occurred in 12 patients (18.4%), necessitating catheter removal in half of these cases (n=6, 9.2%). Among these 12 patients, 6 had culture-positive CRBSI. Pseudomonas aeruginosa (n=4) and Klebsiella pneumoniae (n=2) were the most common bacterial isolates, with all strains sensitive to colistin. Other complications included one case of procedural hypotension/bradycardia, one non-functional catheter, and one catheter thrombosis. Overall, 28 TCCs (43%) were removed during study period. The causes for TCC removal were secondary to CRBSI (n=6), catheter thrombosis (n=1), functional AVF (n=16), renal transplant (n=4), and recovery of renal function (n=1). 7 deaths (10.7%) occurred during the study period due to causes unrelated to vascular access complication, specifically myocardial infarction (n=2) and acute heart failure (n=5).

The majority  of our patients (75.4%) remained catheter-dependent throughout the six-month follow-up, underscoring a significant systemic gap between dialysis initiation and the establishment of permanent access. This prolonged catheter use comes at a cost, with a notable CRBSI rate of 18.4%, a finding comparable to other studies.The clinical impact of these infections was substantial, necessitating catheter removal in half of the affected patients and highlighting the morbidity associated with TCC dependency. Despite these risks, TCCs effectively fulfilled their bridging role, with nearly a quarter of patients successfully transitioning to a functional AVF, receiving a kidney transplant, or recovering renal function