Catheter-Related Complications among Children Treated with Hemodialysis: A Prospective Observational Study
Shailza Mahajan, Lesa Dawman, Karalanglin Tiewsoh, Thakurvir Singh, Aarchie Gupta, Manisha BiswalBackground
Central venous catheters (CVCs) are commonly used for hemodialysis (HD) access in children but are associated with significant complications. This study aimed to determine the incidence and risk factors for catheter-related complications in pediatric patients undergoing HD.
Materials and Methods
A prospective cohort study was conducted from July 2021 to December 2022 in children undergoing HD. Incidence rates per 1,000 catheter-days were calculated for catheter-related bloodstream infection (CRBSI), mechanical complications, thrombosis, and bleeding/hematoma.
Results
Ninety-seven children were enrolled (57.7% male; mean age 103.4 ± 34.9 months). The right internal jugular vein (IJV) was the most common insertion site (72.2%); non-tunneled catheters accounted for 93.8% of insertions. CRBSI was the most frequent complication (3.21/1,000 catheter-days), followed by bleeding/hematoma (1.99), mechanical dysfunction (1.84), and thrombosis (1.38). On multivariable Cox analysis, femoral access conferred significantly higher complication risk compared with right IJV (right femoral HR 1.98, 95% CI 1.03–3.80; left femoral HR 9.71, 95% CI 2.70–34.89, p <0.001). The markedly elevated HR for left femoral access should be interpreted cautiously, given the small subgroup size and wide confidence intervals. Prior HD exposure was independently protective (HR 0.49, 95% CI 0.27–0.91, p = 0.024). Serum albumin greater than 3 g/dL showed a non-significant trend toward improved catheter survival (HR 0.43, 95% CI 0.18–1.05, p = 0.065).
Conclusion
CRBSI is the leading complication in pediatric patients undergoing HD. Access-site selection, particularly avoidance of femoral placement, and optimization of modifiable risk factors are critical for improving catheter outcomes in this vulnerable population.