lacement catheters inserted by either strategy. Methods: Observational data from the REDUCCTION trial, which enrolled a nationwide cohort of 6400 adults who received an incident hemodialysis catheter (2016-2020) was used for this secondary analysis. Tunneled catheters were replaced by either catheter exchange through the existing tunnel tract or removal and replacement through a new tract. The effect of the replacement strategy on the time to catheter removal due to infection or dysfunction was estimated by emulating a hypothetical pragmatic randomized trial among a subset of 434 patients with mechanical tunneled catheter failure. Results: Out of 9974 tunneled hemodialysis catheters inserted during the trial, 380 had infectious and 945 had mechanical complications that required replacement. Almost all infected hemodialysis catheters (97%) were removed and separately replaced through a new tunnel tract, whereas nephrology services differed widely in their replacement practices for catheters with mechanical failure (median = 50% guidewire exchanged, interquartile range= 30%-67%). Service-level differences accounted for 29% of the residual variation after adjusting for patient factors. In the target trial emulation cohort of mechanical failure (N=434 patients), catheter exchange was not associated with lower complication-free survival at one, six, or 12 months (counterfactual survival difference at one month = 5.9%, 95% CI = -2%, 14%). Conclusion: Guidewire exchange for mechanical failure of catheter was not associated with lower catheter survival and may be preferable for patients. Copyright © 2024 by the American Society of Nephrology...

中文翻译：

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出现并发症的隧道式血液透析导管的更换策略：全国队列研究


通过任一策略插入留置导管。方法：来自 REDUCCTION 试验的观察数据用于二次分析，该试验招募了全国范围内 6400 名接受事件血液透析导管的成年人（2016-2020 年）。隧道导管的更换方式是通过现有隧道管道交换导管或通过新管道移除和更换。通过模拟一项假设的实用随机试验，评估了更换策略对因感染或功能障碍而拔除导管时间的影响，该试验由 434 名患有机械隧道导管故障的患者组成。结果：在试验期间插入的 9974 根隧道式血液透析导管中，380 根存在感染性，945 根存在机械并发症，需要更换。几乎所有受感染的血液透析导管 (97%) 均被拔除并通过新的隧道单独更换，而肾病科服务机构对于机械故障导管的更换做法差异很大（中位数 = 50% 更换导丝，四分位数范围 = 30%-67% ）。调整患者因素后，服务水平差异占剩余变异的 29%。在机械故障的目标试验模拟队列（N = 434 名患者）中，导管更换与 1、6 或 12 个月的无并发症生存率较低无关（1 个月的反事实生存率差异 = 5.9%，95% CI = -2%, 14%)。结论：因导管机械故障而更换导丝与导管存活率降低无关，并且可能对患者更有利。版权所有 © 2024 美国肾脏病学会...