Complications of tunneled cuffed hemodialysis catheters in patients with human immunodeficiency virus infection.

PURPOSE: Although increased infectious and thrombotic complications have been reported in patients with human immunodeficiency virus (HIV), little is known regarding hemodialysis catheter-related complications in HIV patients. In this report, we reviewed our experience and complication rates for tunneled cuffed catheters (TCCs) in HIV patients requiring hemodialysis.

METHODS: A total of 85 patients with HIV infection underwent TCC placement for hemodialysis between 1996 and 2009. Hospital records were reviewed to determine causes and risk factors for TCC-related complications in HIV patients. For comparison, we studied 85 age- and sex-matched low-risk HIV case controls who received TCC for hemodialysis during the same period.

RESULTS: A total of 119 and 102 TCCs were inserted in the HIV and control group, respectively. Total numbers of catheter days in the HIV and control groups were 17,321 and 15,620 days, respectively. The primary unassisted TCC patency rates at 6 months in the HIV and control groups were 74% ± 11% and 86% ± 8%, respectively (NS). There was an increased TCC bacteremia rate in HIV patients compared with control subjects (5.38 vs. 2.66 per 1,000 TCC days, p=0.03). There was also a higher TCC tunnel infection rate in HIV patients compared with control cohorts (3.72 vs. 1.87 per 1,000 TCC days, p=0.04). Factors associated with increased catheter infection rate in HIV patients were 1) low CD4+ lymphocyte counts (<200/mm3), 2) low albumin level (<2.5 g/dl), and 3) history of illicit intravenous drug use.

CONCLUSION: TCCs are associated with an increased risk of infection in HIV patients requiring hemodialysis. Moreover, HIV infection is associated with an increased risk of mortality among hemodialysis patients. Hypoalbuminemia, history of intravenous drug use, and low CD4+ lymphocyte counts are associated with increased risk of catheter infection in HIV patients requiring hemodialysis.