Identification of Predictors of Tunneled Central Venous Catheter Dysfunction in Hemodialysis: A Multicenter Retrospective Cohort With Repeated-Measure Sessions.

BACKGROUND: Tunneled central venous catheter dysfunction is a frequent and clinically relevant complication in hemodialysis, with a direct impact on treatment efficacy and vascular access survival. Identifying modifiable risk factors is essential for optimizing prevention strategies and guide clinical decision-making. This study aimed to identify predictors of tunneled central venous catheter dysfunction through a retrospective multicenter cohort of hemodialysis sessions with repeated measures cross-sectional, while other cross-sectional approaches-such as the one presented here-focus on data collected during each HD session to detect early warning signs of dysfunction, following KDOQI 2019 guidelines for vascular access dysfunction definition. The secondary objective was to explore associations. METHODS: A multicenter retrospective cohort study with repeated measures was conducted using all hemodialysis sessions performed in 2021 in 18 public hospitals. The unit of analysis was the index session, and the primary outcome was catheter dysfunction in the subsequent session, defined as blood flow < 300 mL/min with associated arterial or venous pressure changes. A mixed-effects logistic regression with a random intercept for each patient was fitted to account for the repeated hemodialysis sessions. RESULTS: Significant associations were found between catheter dysfunction and lower blood flow rates, elevated venous pressures, line inversion, and catheter placement in the left internal jugular vein. Protective factors included urokinase locking and post-dilution hemodiafiltration. Higher risk was also linked to interstitial nephropathies and unknown etiologies, whereas prior vascular access reduced the risk of dysfunction. CONCLUSION: Tunneled central venous catheter dysfunction is a preventable complication when clinical, technical, and hemodynamic parameters are systematically monitored to identify risk factors and guide catheter management. Continuous session-based monitoring enables early detection and timely intervention. This comprehensive strategy, when combined with pharmacologic management, helps preserve vascular access and enhances treatment outcomes in hemodialysis patients.