# Translumbar and Transhepatic Catheters for Hemodialysis in Chronic Kidney Disease: A Systematic Review and Meta-Analysis

## TL;DR

This study compares complications from two types of hemodialysis catheters in patients with chronic kidney disease, finding translumbar catheters have fewer issues.

## Contribution

A systematic review and meta-analysis comparing complication rates of translumbar and transhepatic hemodialysis catheters in CKD patients.

## Key findings

- Transhepatic catheters had significantly higher rates of irreversible infections and dysfunction compared to translumbar catheters.
- Transhepatic access showed more total infections, thrombosis, and catheter displacement than translumbar access.
- Translumbar catheters are associated with fewer complications but transhepatic remains a viable option in certain cases.

## Abstract

Patients with chronic kidney disease (CKD) often reach a point where their options for hemodialysis access are exhausted, when transhepatic and translumbar access becomes an option. The aim of this study is to compare the prevalence of complications associated with both types of catheters through a systematic review and meta-analysis.

Literature-based systematic review and meta-analysis were accomplished in 2021/2022. Studies were obtained from 11 registries, including Medline/PubMed, Embase, and Scopus.

Included studies involved patients with CKD in access exhaustion who underwent translumbar or transhepatic catheter placement.

Eligible designs included clinical trials, quasi-experimental studies, observational studies, and case series; case reports were excluded.

Two independent researchers used a tailored sheet to extract data from the studies.

A fixed-effect model for proportions was used to assess complications across 18 observational studies involving 649 catheters.

Compared to the translumbar group, the transhepatic group showed significantly higher proportions per 100 catheter-days of irreversible infections (0.085 [95% CI, 0.051-0.118] vs 0.015 [95% CI, 0.007-0.023]; P < 0.001) and irreversible dysfunction (0.259 [95% CI, 0.205-0.313] vs 0.071 [95% CI, 0.054-0.089]; P < 0.001). Total infections (P < 0.001), thrombosis (P < 0.001), and catheter displacement (P < 0.001) were also significantly more frequent in the transhepatic group.

The main challenge was the variability in study designs and the lack of randomized clinical trials, which was expected given the nature of the intervention.

Translumbar access in CKD is associated with fewer complications; however, transhepatic access remains a viable option as a bridge to definitive access or transplantation.