Kidney and Dialysis

Therapeutic plasma exchange is a procedure in which plasma is removed and replaced with another fluid to correct blood abnormalities. There is growing evidence of its benefit in certain clinical conditions, including thrombotic thrombocytopenic purpura, hematological diseases, and immune-mediated neurological disorders. Therapeutic plasma exchange prescription includes the choice of technique (centrifugation or membrane filtration) and the choice of vascular access, as well as the total plasma volume to be exchanged, the type of replacement fluid, the number and frequency of sessions, and the method of anticoagulation. These patients may be critically ill and undergo this technique in an intensive care unit, where the intensivist manages the procedure independently or in collaboration with other specialists. We aim to make an easy-to-follow general prescription of this procedure, by offering a practical revision that empowers physicians, such as non-autonomous intensivists, to autonomously prescribe and manage this procedure, reducing delays in initiating treatment and addressing complications.

Introduction: Temporary non-tunneled catheters are necessary in patients with chronic kidney disease requiring acute hemodialysis care, and complications associated with these catheters, such as infection and thrombosis, represent the most important sources of morbidity. There are no studies available that suggest the optimum duration of their use before catheter exchange or removal. This study aimed to explore the duration of temporary catheter insertion before the occurrence of catheter-related infection and mechanical complications in hemodialysis patients. Methods: Systematic searches were conducted according to the PRISMA 2020 guidelines on four databases up to 1 May 2025 (PROSPERO: CRD420251069657). The study outcome was the occurrence time to catheter-related infection and mechanical complications (thrombosis, obstruction, and kinking, causing dysfunction, failure, or insufficient blood flow) in days, pooled using a single-arm meta-analysis. Mean and 95% confidence interval (CI) were used as the summary statistics. Results: Nine studies involving 1448 participants undergoing hemodialysis using temporary catheters were included. Incidence of infection ranged from 0.7 to 13.58 per 1000 catheter-days. The most common bacterium identified was Staphylococcus aureus and Pseudomonas aeruginosa. The pooled mean time to catheter-related infection from 298 catheters was 15.98 days (95% CI 10.47–21.50; I² = 97.73%). We also found that the pooled mean time to mechanical complications from 507 catheters was 6.69 days (95% CI 2.49–10.90; I² = 98.03%). Conclusion: Among patients who developed complications, the mean time from temporary catheter insertion was approximately two weeks to the occurrence of catheter-related infection and one week to mechanical complications. Our finding was consistent with the recommendation of the KDOQI guideline, which suggests limiting catheter duration to typically less than two weeks.

Background: Preserving arm veins is important for arteriovenous fistula (AVF) creation in patients with advanced chronic kidney disease (CKD), as mature AVF is the preferred hemodialysis access. Midline catheters introduced into AVF candidate veins may cause thrombosis, hindering AVF formation. This study aims to determine ultrasonographic rates of midline-associated upper extremity deep venous thrombosis (UE-DVT) or superficial venous thrombosis (SVT) in patients with advanced CKD. Methods: We conducted a prospective study involving subjects with advanced CKD, who had a point-of-care ultrasound-guided midline placed in an arm vein. Within 35 days of midline insertion, participants underwent routine bilateral UE venous duplex ultrasound. The primary outcome was a composite occurrence of UE-DVT/SVT ipsilateral to the midline. Comparative analyses were performed based on patient demographics and device-specific variables. Results: 49 subjects with advanced CKD received midlines. The median midline catheter dwell time was <6 days for 15/49 patients (30.6%). The primary outcome occurred in 15/49 patients (30.6%), mostly asymptomatic thrombosis. No significant associations were found between outcomes and patient or device characteristics. Conclusions: Our study identified frequent use of midlines with short dwell times in subjects with advanced CKD which calls into question proper device selection. In this cohort, midline-associated arm clots were frequent.