Silent and dangerous: catheter-associated right atrial thrombus (CRAT) in children on chronic haemodialysis.
Background: Catheter-associated right atrial thrombus (CRAT) is a recognised complication of central venous catheter (CVC) use for haemodialysis (HD) patients. Methods: This was a single-centre retrospective longitudinal observational study of consecutive children aged 6 months–18 years over a 7-yea...
| Publicado en: | Pediatric Nephrology Vol. 36; no. 5; pp. 1245 - 1255 |
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| Autores principales: | , , , , , |
| Formato: | algorithm research tables/charts Journal Article |
| Publicado: |
Springer Nature
May2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=149550542&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 149550542 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0931041X EF1 jtl: Pediatric Nephrology issn: 0931041X maglogo: N pubinfo: dt: May2021 vid: 36 iid: 5 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 149550542 146726587 149550542 149550542 10.1007/s00467-020-04743-9 149550542 ppf: 1245 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Silent and dangerous: catheter-associated right atrial thrombus (CRAT) in children on chronic haemodialysis. aug: au: Garcia-Nicoletti, Martin Sinha, Manish D. Savis, Alexandra Adalat, Shazia Karunanithy, Narayan Calder, Francis affil: Department of Paediatric Nephrology, Evelina London Children's Hospital, SE1 7EH, London, UK sug: subj: Central Venous Catheters Adverse Effects Heart Atrium, Right Pathology Thrombosis Drug Therapy Hemodialysis Methods Renal Insufficiency Therapy Human Retrospective Design Prospective Studies Nonexperimental Studies Infant Adolescence Child, Preschool Child Descriptive Statistics Male Female Renal Replacement Therapy Peritoneal Dialysis Time Factors Treatment Duration Anticoagulants Therapeutic Use Equipment Failure Thrombosis Mortality Echocardiography Infant: 1-23 months Adolescent: 13-18 years Child, Preschool: 2-5 years Child: 6-12 years Male Female ab: Background: Catheter-associated right atrial thrombus (CRAT) is a recognised complication of central venous catheter (CVC) use for haemodialysis (HD) patients. Methods: This was a single-centre retrospective longitudinal observational study of consecutive children aged 6 months–18 years over a 7-year period receiving in-centre chronic HD. Echocardiograms as per routine cardiac surveillance were performed 6 months or earlier given clinical concerns. Results: Sixty-five children, 36 boys (55.4%), median (IQR) age 11.8 (5.3, 14.7) years, received HD for kidney failure with replacement therapy (KFRT). Initial modality was HD in 45 (69.2%), with CVC as initial access in 42 (93.3%) and AVF in 3 (6.7%); in the remaining 20 (30.8%) patients PD was the initial modality before switching to HD. Seven of 65 (10.8%) developed CRAT at median 2 (0.8, 8.4) months from CVC insertion, with one CRAT detected 3 days following insertion. One child had 2 episodes of CRAT and one additionally thrombosed their AVF. No patient had an underlying primary kidney disease associated with a pro-thrombotic state. Those with CRAT were younger, had more frequent CVC change and received dialysis for longer duration compared to those with no CRAT. Six episodes of CRAT (75%) received anticoagulation therapy. Infective complications were observed in 25% and catheter malfunction in 50%. Five CRAT episodes (62.5%) resulted in CVC loss. One patient died after a haemorrhagic complication of anticoagulation and sepsis, and another developed life-threatening superior vena cava obstruction syndrome. Overall mortality 14% (1/7). Conclusions: This is the first report of CRAT in a paediatric HD population. There was ~ 11% incidence of CRAT in patients receiving chronic HD detected by surveillance echocardiography. Although frequently asymptomatic, CRAT is associated with serious sequelae. Anticoagulation and surveillance with expert echocardiography remain mainstays of management. Graphical abstract pubtype: Academic Journal doctype: algorithm research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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