Abstract: 【Abstract】Objective To assess the clinical efficacy of a tunneled cuffed catheter in femoral vein as a transitional blood access pathway for hemodialysis in elderly dialysis patients with diabetes. Methods This was a retrospective and cohort study. A total of 99 elderly dialysis patients with diabetes undergoing the establishment of a transitional blood access pathway for hemodialysis in the First Affiliated Hospital of Xiamen University during the period from January 2017 to January 2020 were enrolled in this study. Thirty-eight of the 99 patients used the tunneled cuffed catheter in femoral vein as the semi-permanent blood access pathway (femoral vein group), and 61 patients used various temporary central venous catheters via femoral vein or internal jugular vein (temporary catheter group). Autologous arteriovenous fistula (AVF) surgery was performed within 2 weeks after the catheterization in all patients in the two groups. Dialysis adequacy, catheter patency rate, catheter- related complications, duration of catheter indwelling, and medical expenses before the use of AVF were recorded and compared between the two groups. Results ①The post- dialysis Kt/v values were 1.39±0.05 and 1.25±0.04 (t=21.750, P=0.001) in the femoral vein group and the temporary catheter group respectively, suggesting that the femoral vein group had better dialysis adequacy than the temporary catheter
group. ②The catheter patency rates were 94.7% and 80.3% (χ2=4.004, P=0.045) in the femoral vein group and the temporary catheter group respectively, suggesting that the femoral vein group had higher catheter patency rate than the temporary catheter group. ③The rates of catheter complications were 2.6% and 16.4% (χ2=4.690, P=0.037) in the femoral vein group and the temporary catheter group respectively, significantly lower in the femoral vein group than in the temporary catheter group. In femoral vein group, one case had catheterrelated infection and required hospitalization to remove the catheter; in contrast in temporary catheter group, 5 cases had catheter-related infection and 4 cases had catheter occlusion and thrombosis, they required hospitalization to remove the catheters. ④The periods of catheter indwelling were 74.0±8.2 days and 51.7±9.9 days (t=11.630, P=0.001) in the femoral vein group and the temporary catheter group respectively, significantly longer in the femoral vein group than in the temporary catheter group. ⑤The medical expenses before the use of AVF for blood access was similar between the two groups (15636.3 ± 2148.7 vs. 14634.1 ± 4208.1 yuan, t=-2.027, P=0.177). However, the hospitalization days were shorter in the femoral vein group than in the temporary catheter group (8.3±2.7 vs. 10.4±5.1 day, t=1.360, P=0.045). Conclusion Tunneled cuffed catheter in femoral vein as a temporary transitional vascular access pathway was advisable for elderly dialysis patients with diabetes, especially for those with poor vascular conditions and slow maturation of the autologous AVF. This method had the advantages of longer catheter indwelling time, better dialysis adequacy, higher catheter patency rate, lower rate of catheter-related complications and shorter hospitalization period than the method of central venous temporary catheter, without extra medical expenses. Therefore, tunneled cuffed catheter in femoral vein is a better method to replace the central venous temporary catheter used as the transitional vascular access for hemodialysis.

Key words: Femoral vein, Catheter, Renal dialysis, Diabetic nephropathy, Elderly