Chest Radiography and Echocardiography Predictors of Early Hemodialysis Catheter Dysfunction

Purpose: To determine whether radiographic heart morphology and echocardiography findings were associated with early central venous catheter (CVC) failure in hemodialysis patients. Materials & Methods: All hemodialysis catheter insertions between 1996-2007 were captured in a combined nephrology radiology database. Factors were identified that may be associated with early catheter failure. Factors examined included: echocardiography findings, radiographic evidence of flattened heart border, boot-shaped heart and left ventricular hypertrophy as well as patient comorbidities and peri-procedural characteristics. Results: Of the 132 CVC failures in 132 patients, 67 (50.8%) occurred within 30 days of insertion. Early CVC failure was more likely to occur in patients who had insertions from the left side (, p = 0.020) and with catheter tip position outside the cavoatrial junction (, p = 0.040). CVC failure rates also differed by year of placement (, p < 0.01), if the patient had evidence of left ventricular hypertrophy (, p = 0.030), left systolic dysfunction (, p = 0.030), and hypokinetic right wall mechanics (, p < 0.01). Conclusion: Radiographic findings of left ventricular hypertrophy and echocardiography findings of left systolic dysfunction were found to be associated with early failure.