A randomized controlled trial of catheters with different tips and lengths for patients requiring continuous renal replacement therapy in intensive care unit
Authors' conclusion
Step-tip catheters may be preferable for CRRT, particularly for patients in the lower BMI tercile. Longer femoral vein catheterization demonstrated enhanced benefits in CRRT, especially among obese patients.
Study context
- Population
- Critically ill patients receiving continuous renal replacement therapy (CRRT) in ICU
- Participants
- 351 patients
- Comparison
- 20 cm side-hole vs 20 cm step-tip vs 25 cm step-tip catheters
- An = 116
- Bn = 117reference
- Cn = 118
- Primary endpoint
- Incidence of catheter dysfunction and catheter survival time
Methodological detailsopen-label, three-arm
- Open-label
- Three-arm
Primary result
As reported in the abstract
Catheter dysfunction; catheter survival time
| Group | Value | Catheter survival time (IQR 2.5-9.3) | Catheter survival time (IQR 3.0-10.0) | Catheter survival time (IQR 3.9-12.0) |
|---|---|---|---|---|
| A | 35.7% | 5.5 days | ||
| B | 17.7% | 5.0 days | ||
| C | 15.6% | 6.4 days |
Value
A35.7%
B17.7%
C15.6%
Catheter survival time (IQR 2.5-9.3)
A5.5 days
B— not stated in the abstract
C— not stated in the abstract
Catheter survival time (IQR 3.0-10.0)
A— not stated in the abstract
B5.0 days
C— not stated in the abstract
Catheter survival time (IQR 3.9-12.0)
A— not stated in the abstract
B— not stated in the abstract
C6.4 days
- A vs B: P = 0.001 — catheter dysfunction significantly higher in A
- C vs B: P = 0.744 — catheter dysfunction: no difference
- A vs B: P = 0.626 — catheter survival time comparable
- C vs B: P = 0.019 — catheter survival time significantly longer in C
Secondary outcomes
BMI as risk factor for catheter dysfunction (Cox regression)
| HR (95% CI) | P value | ||
|---|---|---|---|
| BMIIndependent risk factor | 1.052 (1.003–1.103) | P = 0.036 | |
| 0.512Hazard ratio (log scale) |
| Outcome | C |
|---|---|
| Filter lifespan | 36.5 (IQR 16.9–68.1) h |
- Filter lifespan — Trend to longer filter lifespan in C
- P = 0.001
Catheter dysfunction by BMI tertile (subgroup)
- Similar results only in lower BMI (BMI < 24.2); chi-square 13.65
- P = 0.001
- Not consistent across BMI tertiles
Other secondary outcomes
- Not significantly different among groups
Safety
- Catheter-related thrombosis — C
- 10.40 (95% CI 5.93–17.83) per 1000 catheter-days
- Catheter-related thrombosis — Trend to lower incidence in C
- P = 0.019
Original publication
A randomized controlled trial of catheters with different tips and lengths for patients requiring continuous renal replacement therapy in intensive care unit. Crit Care. Published 11 April 2025. doi:10.
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