Initial Hemodialysis with a Temporary Catheter Is Associated with Complications of a Later Permanent Vascular Access

Zhu, Mingli; Zhang, Weimin; Zhou, Wenyan; Zhou, Yijun; Fang, Yan; Wang, Yongmei; Hai-fen, Zhang; Yan, Yucheng; Ni, Zhaohui; Qian, Jiaqi

doi:10.1159/000360269

Cited by 8 publications

(9 citation statements)

References 34 publications

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“…A 2.77-fold risk of access-related complications including thrombosis and access failure using non-tCVC was reported at the beginning of HD [12]. However, the tCVC as long-term vascular access has been not included in previous research.…”

Section: Discussionmentioning

confidence: 99%

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Catheter Failure and Mortality in Hemodialysis Patients with Tunneled Cuffed Venous Catheters in a Single Center

Shi¹,

Cui²,

Ma³

et al. 2017

Blood Purif

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Background: As of now, only a few studies have focused on the failure of tunneled cuffed venous catheter (tCVC) and mortality of hemodialysis (HD) patients using tCVC as long-term vascular access, whose vascular condition for arteriovenous fistula was not very satisfactory. In this study, we aimed to provide information about the first tCVC failure and survival rates of patients in this population. Methods: Fifty-nine patients who used tCVC from January 1, 2009 to December 31, 2014 in our HD center were analyzed in this retrospective study and followed up either until their death or until December 31, 2015. The first tCVC and patient survival rates were analyzed. Results: The incidence of catheter-related infections was 0.3 per 1,000 patient-days. The median survival duration of first tCVC was 45.0 (95% CI 29.3-69.7) months and the median survival time of all patients was 56.3 (95% CI 34.1-78.5) months by Kaplan-Meier analysis. Advanced age (hazard ratio [HR] 1.055, p < 0.05) and diabetic mellitus (HR 4.147, p < 0.05) at the initiation of HD were significant risk factors of first tCVC failure, while male (HR 2.712, p < 0.05) and cardiovascular diseases (CVDs; HR 4.139, p < 0.05) were significant risk factors for patient mortality as deduced by Cox proportional hazards methods. Conclusions: The study highlighted that first tCVC survival rates and patient survival rates were high in HD patients who were using tCVCs as long-term vascular access, with low incidence of catheter-related infections. In the study it was found that advanced age and diabetic mellitus at the initiation of HD influenced first tCVC failure, whereas male and CVDs seemed to be risk factors for patient mortality.

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Section: Discussionmentioning

confidence: 99%

“…Using a tCVC or non-tCVC at the initiation of HD was an independent risk factor for higher mortality than AVF [11]. Using non-tCVC in HD initiation would result in the occurrence of a side effect on a later permanent vascular access [12]. …”

Section: Introductionmentioning

confidence: 99%

Catheter Failure and Mortality in Hemodialysis Patients with Tunneled Cuffed Venous Catheters in a Single Center

Shi¹,

Cui²,

Ma³

et al. 2017

Blood Purif

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“…Surprisingly, we found that age was inversely associated with nonfunctional AV access after adjustment for the other covariates. Previous reports have showed less frequent AV fistula creation [ 7 ], poorer AV fistula maturation [ 30 ], and more long-term complications of vascular access [ 15 ] in the elderly. We believe that the relation seen between nonfunctional AV access and age in our study may partly reflect selection for AV access creation in elderly patients.…”

Section: Resultsmentioning

confidence: 99%

“…Most epidemiological studies have assessed factors associated with AV access use versus catheter without distinguishing between patients who had AV access created before dialysis and those who did not. Women, older patients, and those with cardiovascular diseases are more likely to start hemodialysis with a catheter [ 7 , 15 , 16 ]. Poor Fewer visits to a nephrologist and the lack of erythropoiesis-stimulating agent (ESA) in the predialysis period have also been associated with catheter use at hemodialysis initiation [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of nonfunctional arteriovenous access at hemodialysis initiation and timing of access creation: A registry-based study

et al. 2017

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Determinants of nonfunctional arteriovenous (AV) access, including timing of AV access creation, have not been sufficiently described. We studied 29 945 patients who had predialysis AV access placement and were included in the French REIN registry from 2005 through 2013. AV access was considered nonfunctional when dialysis began with a catheter. We estimated crude and adjusted odds ratio (OR) with 95% confidence intervals (CI) of nonfunctional versus functional AV access associated with case-mix, facility characteristics, and timing of AV access creation. Analyses were stratified by dialysis start condition (planned or as an emergency) and comorbidity profile. Overall, 18% patients had nonfunctional AV access at hemodialysis initiation. In the group with planned dialysis start, female gender (OR 1.43, 95% CI 1.32–1.56), diabetes (OR 1.28, 95% CI 1.15–1.44), and a higher number of cardiovascular comorbidities (OR 1.27, 95% CI 1.09–1.49, and 1.31, 1.05–1.64, for 3 and >3 cardiovascular comorbidities versus none, respectively) were independent predictors of nonfunctional AV access. A higher percentage of AV access creation at the region level was associated with a lower rate of nonfunctional AV access (OR 0.98, 95% CI 0.98–0.99 per 1% increase). The odds of nonfunctional AV access decreased as time from creation to hemodialysis initiation increased up to 3 months in nondiabetic patients with fewer than 2 cardiovascular comorbidities and 6 months in patients with diabetes or 2 or more such comorbidities. In conclusion, both patient characteristics and clinical practices may play a role in successful AV access use at hemodialysis initiation. Adjusting the timing of AV access creation to patients’ comorbidity profiles may improve functional AV access rates.

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“…Given the high complication rates associated with the use of CVCs [ 5 , 6 ], healthcare providers and organizations have encouraged and incentivized the use of non-catheter access via AVFs, or AVGs where an AVF is not feasible [ 4 ]. Once successfully created, an AVF or AVG may not remain patent.…”

Section: Introductionmentioning

confidence: 99%

Successful restoration of arteriovenous dialysis access patency after late intervention

El-Damanawi

Kershaw

Campbell

et al. 2014

Clinical Kidney Journal

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BackgroundArteriovenous dialysis access may be lost due to stenosis and thrombosis. Patency may be restored by thrombectomy or thrombolysis, but this is often not undertaken when the presentation is delayed. The success rate of delayed intervention is largely unknown.MethodsIn this single-centre study, we identified all instances of arteriovenous vascular access (VA) failure treated with angioplasty, thrombectomy or thrombolysis between August 2010 and July 2013. Patency rates immediately after intervention, and after 3 months, were assessed using multilevel mixed effects logistic regression.ResultsSixty failures occurred in 41 accesses (38 patients). The access age at failure was 495 (316–888) days. Intervention was carried out after >48 h in 19 failures (32%). Immediate patency was achieved in 46 failures, of which 32 remained patent after 3 months. Delaying intervention increased the likelihood of achieving immediate patency (OR 0.55, 95% CI 0.31–1.0, P = 0.05). Having lost arteriovenous accesses previously increased the risk of immediate failure (OR 4.0, 95% CI 1.07–14.95, P = 0.04). There was no association between failure-to-intervention-time and 3-month patency rates (P = 0.23). Effect estimates did not differ between arteriovenous fistulae and synthetic arteriovenous grafts.ConclusionDelayed intervention for failed arteriovenous VA may result in superior early patency rates and yields equivalent 3-month patency rates.

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Initial Hemodialysis with a Temporary Catheter Is Associated with Complications of a Later Permanent Vascular Access

Cited by 8 publications

References 34 publications

Catheter Failure and Mortality in Hemodialysis Patients with Tunneled Cuffed Venous Catheters in a Single Center

Catheter Failure and Mortality in Hemodialysis Patients with Tunneled Cuffed Venous Catheters in a Single Center

Predictors of nonfunctional arteriovenous access at hemodialysis initiation and timing of access creation: A registry-based study

Successful restoration of arteriovenous dialysis access patency after late intervention

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