1. Comparable rates of catheter-related bloodstream infections between non-tunneled and tunneled hemodialysis catheters : a retrospective single-center studyMatej Zrimšek, Jakob Gubenšek, 2026, original scientific article Abstract: Background: A hemodialysis catheter may serve as a short- or medium-term vascular access solution. Current guidelines suggest restricting non-tunneled catheter use to 2 weeks, partially based on studies using straight non-tunneled jugular catheters, which have now been widely replaced with pre-curved catheters. We compared the rate of catheter-related blood stream infections (CRBSIs) and possible CRBSIs (PCRBSIs) of pre-curved non-tunneled and tunneled catheters in our hemodialysis center. Methods: This was a retrospective study including patients dialyzed on an outpatient basis between 1 January 2018 and 1 July 2024, with a follow-up until 1 March 2025. The primary aim was to compare the rates of CRBSIs. Results: In 301 patients, 625 non-tunneled single lumen catheter pairs and 53 double lumen tunneled catheters were used. There were 53 CRBSIs in non-tunneled and 10 in tunneled catheters, with identical incidence rate (0.48/1000 catheter-days in both groups). Analyzing CRBSIs and PCRBSIs together also showed similar infection rates [0.66 vs 0.58, incidence rate ratio (IRR) with 95% confidence interval 1.14 (0.6–2.1), P = .68]. Two subanalyses were made: CRBSI IRR in 27 patients with both types of catheters during study period was 1.37 (0.55–3.41, P = .49) and 2.01 (0.52–7.72, P = .47) in 36 patients after their first CRBSI. Time to CRBSI was also comparable in all analyses. Conclusions: Our study found no significant difference in the incidence of CRBSIs. We conclude that prolonged use of non-tunneled pre-curved catheters, which are easily managed, is a viable option for patients awaiting construction of arteriovenous fistula, insertion of a peritoneal catheter or kidney transplantation in a reasonable time. Promising results on long-term use from this study need to be confirmed in prospective studies.
Keywords: catheter-related blood stream infection, chronic hemodialysis, hemodialysis catheter, pre-curved jugular non-tunneled catheters, tunneled hemodialysis catheters
Published in DiRROS: 20.01.2026; Views: 116; Downloads: 85
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2. Interleukin-6 extraction ratios during prolonged CytoSorb hemoadsorption depend on procedural blood flowJakob Gubenšek, Barbara Vajdič Trampuž, Matej Zrimšek, Vanja Peršič, 2025, original scientific article Abstract: Background: Hemoadsorption with CytoSorb is a novel treatment for cytokine release syndrome, but there are few published data on the rate of cytokine removal with prolonged use. Here, we report a prospective observational study of IL-6 extraction ratios with prolonged CytoSorb use. Methods: A secondary analysis was conducted on a prospective observational cohort study involving patients treated with CytoSorb. Blood samples for IL-6 were taken before treatment, after 30 min, and every 6 h of treatment at three sites: (1) before the adsorber, (2) between the adsorber and dialyzer, and (3) after the dialyzer. The extraction ratios of the adsorber were then calculated. Results: We included 21 dialysis circuits performed in 15 critically ill patients, mainly those with cytokine storm because of septic shock. The median extraction ratio of IL-6 after 30 min was 26% (interquartile range, IQR 18-37%). The ratio decreased to 10% (6-21%) after 6 h and remained between 9-16% for up to 24 h (with a low number of circuits used beyond 12 h). Extraction ratios were similar in circuits with high (>1,000 ng/L) and low baseline IL-6 levels. On the contrary, in circuits with high blood flow (≥200 mL/min, i.e., intermittent hemodialysis), the extraction ratio was very low (median 6%) at 6 h and negligible thereafter, whereas the circuits with lower blood flow (<200 mL/min) maintained an extraction ratio of 20% for up to 12 h. Conclusion: We observed a significant reduction in the IL-6 extraction ratio within 6 h in circuits with high blood flow, whereas circuits with lower blood flow maintained an adequate extraction ratio for up to 12 h. Recent consensus recommendations on an 8-12 h exchange interval should mainly be applied to continuous dialysis methods, whereas in intermittent hemodialysis, the exchanges should be more frequent.
Keywords: CytoSorb, cytokines, hemoadsorption, interleukin 6 (IL6), reduction ratio, removal rate
Published in DiRROS: 13.01.2026; Views: 136; Downloads: 74
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3. A pilot study on the replacement of fibrinogen with fibrinogen concentrates during therapeutic plasma exchange with mild to moderate bleeding risk : a comparison with fresh frozen plasma and albumin replacementMatej Zrimšek, Jakob Gubenšek, Andreja Marn-Pernat, 2024, original scientific article Abstract: Background: Therapeutic plasma exchange (TPE) removes coagulation factors and leads to depletion coagulopathy. The aim of the study was to compare hemostasis between TPE procedures without coagulation factor replacement (electrolyte group), the partial replacement of fibrinogen with fibrinogen concentrates (fibrinogen group) and partial coagulation factors replacement with fresh frozen plasma (partial FFP group). Methods: A total of 73 TPE procedures in patients with fibrinogen levels 1–2 g/L were divided into three study groups depending on clinically estimated bleeding risk. Standard coagulation and ROTEM® tests were performed before and after TPE. Results: Fibrinogen levels before TPE (p = 0.88) and after TPE (p = 0.33) were comparable between the fibrinogen and partial FFP groups. INR and ROTEM® parameters reflected moderately worse hemostasis after TPE with fibrinogen-only replacement compared to partial FFP replacement, which could result in increased bleeding risk. In the electrolyte group, most laboratory tests confirmed the most deranged hemostasis after TPE, as compared to fibrinogen or partial FFP replacement. A mild allergic reaction to FFP infusion was noted during one TPE. No clinically significant bleeding occurred in any of the study groups. Conclusions: Fibrinogen concentrate supplementation and partial FFP replacement can both maintain fibrinogen levels > 1 g/L after TPE, but modest differences in classical coagulation tests and bedside ROTEM® tests favor FFP replacement (NCT03801135).
Keywords: therapeutic plasma exchange, coagulation, fibrinogen concentrate, fresh frozen plasma, bleeding risk
Published in DiRROS: 01.12.2025; Views: 518; Downloads: 117
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4. Complications on the feeding artery after an arterio-venous fistula closure in patients after kidney transplantation : a national cohort studyMatej Zrimšek, Barbara Vajdič Trampuž, Matija Jelenc, Juš Kšela, Jakob Gubenšek, 2025, original scientific article Abstract: Background: Arteriovenous fistulas (AVFs) in kidney transplant recipients are sometimes closed, either as a policy or due to complications. We collected data on the incidence of complications after AVF closure in a national cohort of transplanted patients. Methods: Patients who received a kidney transplant between 2000 and 2015 and had a functional AVF that was later ligated or extirpated were included. Medical records were searched for arterial complications on the arm with the closed AVF. Furthermore, all patients who were still alive in January 2023 were invited for a follow-up arterial ultrasound exam. Results: Sixty patients were included; mean follow-up was 9.3 ± 3.8 years. There were five (8% cumulative incidence) patients with symptomatic arterial thrombosis and three (5% incidence) with a symptomatic feeding artery aneurysm. Prospective ultrasound exams were performed in 50 patients; the mean diameter of the brachial artery was almost doubled on the arm with the closed AVF (8.1 ± 3.2 versus 4.7 ± 0.7 mm; P < .001). Additional asymptomatic complications were found in nine patients (18% incidence): seven cases (14% incidence) of arterial thrombosis, some extending up to the axillary artery, and three (6% incidence) brachial artery aneurysms. All patients in whom the thrombosis spread to the brachial artery had large brachial arteries (>10 mm) or an aneurysm. Conclusion: We observed a high cumulative incidence of arterial thrombosis (20%) and brachial artery aneurysms (10%), sometimes developing several years after AVF closure. These complications should be taken into account when contemplating closure of a well-developed AVF and an AVF-preserving approach with flow reduction surgery might be preferred in some cases.
Keywords: kidney transplantation, arterial thrombosis, arteriovenous fistula, complications, true brachial artery aneurysm, ultrasound exam
Published in DiRROS: 01.12.2025; Views: 774; Downloads: 118
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