Comparison of the adequacy of dialysis and urea recirculation in patients with symmetrical tip and stepped tip catheters on chronic hemodialysis.

Abstract

Introduction: In Mexico, around 120,000 patients with chronic renal failure require HD replacement therapy. Angio access to HD can be temporary, semi-permanent, and permanent. Semi-permanent catheters have more remarkable survival, greater extracorporeal blood flow, and less recirculation. Different designs in the termination of the catheters (symmetrical tip and stepped tip) are associated with the recirculation percentage and the dialysis adequacy. The objective of this study was to compare the adequacy of hemodialysis in catheters with a symmetrical tip coated with heparin and silver against a stepped tip in patients on chronic hemodialysis with previous angioaccess.

Methods: Patients were randomized into two groups: group one, where the heparin-silver-coated catheter with a symmetrical tip was placed, and group two, patients with a stepped-tip catheter, considering the presence or absence of stenotic sequelae. During the follow-up, the dialysis dose was evaluated (through Kt/V, percentage reduction of urea, and blood recirculation). The results were assessed through X², t student, and U Mann Whitney with the statistical package SPSS version 21.

Results: A total of 38 patients were included from April to June 2017. So far, 28 patients have completed the follow-up period, 15 from group 1 and 13 from group 2. The reported KT/V was 1.14 for group 1 and 1.28 for group 2, as well as the urea reduction percentage of 61 and 63 for groups 1 and 2, respectively (P=0.25). The percentage of recirculation reported was 2.97 for group 1 and 1.96 for group 2 (P=0.34).

Conclusion: In the present study, there are no differences in the dialysis dose and the percentage of urea recirculation in catheters with symmetrical tips and stepped tips, so cost-benefit research is imperative.