Outcomes of non-tunneled non-cuffed hemodialysis catheters in patients on chronic hemodialysis in a resource limited sub-Saharan Africa setting

The aim of the present study was to investigate the adverse outcomes of non-tunneled hemodialysis catheters and determinants in chronic hemodialysis patients receiving care at the Yaoundé General Hospital hemodialysis center, Cameroon. This was a prospective study of 11 months duration (February-December 2008) involving 81 non-tunneled non-cuffed catheters (63 femoral, 18 internal jugular) placed in 72 adults (47 men, 65.3%) on chronic hemodialysis. Baseline clinical and laboratory parameters associated with catheter-related complications during follow-up were investigated. The difference between variables was assessed using the χ(2) test and equivalents. Sixty-five (80.2%) catheters were inserted for emergency dialysis, 11 (13.6%) for a failed native arteriovenous fistula and five (6.2%) for a failed prior catheter. The mean time-to-catheter removal was 35 ± 28 days. Catheter-related complications accounted for a third of catheter removals. The main catheter-related complications were infections (17/27, 62.9%) and bleeding (6/27, 22.2%), which were associated with unemployment (P = 0.0002) and longer duration of catheter (P = 0.004). The catheter-related infections were sepsis (11.8%), exit-site (29.4%) and both (58.8%); leading to death in 11/17 (64.7%) cases. Fever (94.1%), pain (88.2%) and pus (70.6%) were the main infectious signs with Staphylococcus aureus involved in 70.6%. Unemployment was significantly frequent in patients with infectious complications (76.5% vs. 26.6%, P = 0.0004). Non-tunneled hemodialysis catheters are mainly used for emergency dialysis through the femoral vein in this setting. Catheter-related infections due to Staphylococci are the leading complications associated with unemployment and longer utilization. Efforts are needed to improve early transfer of patients to nephrologists for better preparation for renal replacement therapy.