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Friday, July 31, 2020

Comparison of Clinical Performance of VectorFlow and Palindrome Symmetric-Tip Dialysis Catheters: A Multicenter, Randomized Trial


Clinical question:
How does the clinical performance and dialysis adequacy compare between two symmetric-tip tunneled hemodialysis catheters - the Arrow–Clark VectorFlow catheter (Teleflex, Wayne, Pennsylvania) and the Palindrome catheter (Medtronic, Dublin, Ireland)?

Take-away point:
The 90-day primary patency rates of Palindrome and VectorFlow catheters were not significantly different, and both achieved sustained high effective blood flow (QB) through 90 day follow-up. However, dialysis adequacy based on Kt/V [(dialyzer urea clearance * total treatment time) / total volume of urea distribution] was consistently better with the VectorFlow catheter versus the Palindrome.

Reference:
Nadolski GJ, Redmond J, Shin B, et al. Comparison of Clinical Performance of VectorFlow and Palindrome Symmetric-Tip Dialysis Catheters: A Multicenter, Randomized Trial. J Vasc Interv Radiol. 2020;31(7):1148-1155. doi:10.1016/j.jvir.2020.02.001

Click here for abstract

Study design:
Prospective, randomized, multi-center, open-label trial

Funding source:
T.W.I.C. receives personal fees from Teleflex (Wayne, Pennsylvania), Becton Dickinson (Franklin Lakes, New Jersey), Merit Medical (South Jordan, Utah), and B. Braun (Melsungen, Germany) and has a patent licensed to Teleflex. None of the other authors have identified a conflict of interest.

Setting:
Multiple Academic Centers








Summary:

A prospective, randomized, multi-center, open-label comparison of two tunneled hemodialysis catheters: Arrow-Clark VectorFlow and Palindrome. Follow-up included various variables up to 90-days.

Primary unassisted catheter patency at 90 days, urea reduction ratio, effective blood flow rate, and infection rates were not significantly different between groups.

The outcome measure that differed between the catheters was improved dialysis adequacy as measured by Kt/V ([dialyzer urea clearance x total treatment time] / total volume of urea distribution) for the VectorFlow catheter versus the Palindrome catheter (1.5 vs 1.3; P = 0.0003).


Commentary:


The authors present a comparison of two tunneled hemodialysis catheters from different manufacturers, with the main difference between the two catheters being Kt/V.

Of note, the National Kidney Foundation KDOQI clinical practice guidelines recommend a target Kt/V of 1.4 per HD session for 3 x weekly hemodialysis, with a minimum of 1.2. [Ref: National Kidney Foundation. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis 2015; 66: 884–930]. These guidelines are based mostly off of observational studies and expert opinion. Results of major randomized trials designed to look at hemodialysis dose and mortality (e.g. HEMO, DOPPS) did not show any benefit at higher doses of Kt/V.

Post Authors:
Farnaz Dadrass
MD Candidate class of 2021
Rush University Medical Center
@DadrassFarnaz

David M. Tabriz, MD
Assistant Professor
Rush University Medical Center
@DrDaveTabriz

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