Outcome and survival of temporary hemodialysis catheters: a prospective study from a single center in Iraq.

BACKGROUND: The use of temporary hemodialysis catheters (THC) has facilitated the delivery of hemodialysis to patients lacking functional vascular access. However, the use of these catheters is often associated with infections or mechanical complications. METHODS: A review of experiences at a tertiary referral center in Iraq with the use of 128 THC catheters in 103 patients was undertaken over one year, to identify indications for use and outcomes and issues limiting survival. RESULTS: The indications for insertion of THC included the following: as acute dialysis access for patients with chronic renal failure (CRF) in 42.1%, failed arteriovenous fistulae in 14%, acute renal failure in 18%, failed prior THC in 18.7%, absent vascular access in patients with transplant rejection in 6.2% and severe anasarca in one patient (0.78%). The site of insertion was the right internal jugular vein in 101 patients, the right subclavian vein in 23 patients, and the left internal jugular vein in four patients. During follow-up, 86 catheters were removed: 62 in patients with end-stage renal disease (ESRD), 23 in patients with acute renal failure and one patient with severe anasarca. The reasons for removal of THC in ESRD patients were elective removal (44%), catheter related sepsis (CRS) in 30%, mechanical complications (19%) and others (7%). The subclavian site was associated with infection in 20% of patients, while the internal jugular site was associated with infection in 22.7% of patients. For patients in whom THC removal was for infection, a post removal culture of the catheter tip showed Staphylococcus aureus in 57.8%, Klebsiella in 15.7%, Pseudomonas in 15.7% and Streptococcus hemolyticus in 10.5% of the cases. CONCLUSIONS: THC is advantageous for vascular access in patients with acute renal failure. Infections and blockage significantly reduce the survival of THC in patients with ESRD. Approaches to minimize these complications are likely to lead to improved clinical outcomes with THC use.

Tuberculosis after renal transplantation: a case report.

Renal transplant recipients are susceptible to a variety of infections with both common and opportunistic pathogens as a result of immunosuppressive therapy. We report herein a case of a 32-year-old female renal transplant recipient who developed pulmonary tuberculosis with supraglotic mass causing suffocation, 1.7 years after undergoing renal transplantation. She responded well to a combination of tracheostomy and antituberculous therapy. Although tuberculosis is a common infection in transplant recipients, its presentation as a supraglotic mass is unusual.