Vascular access and increased risk of death among hemodialysis patients

Abstract

Venous catheters are associated with an increased risk of all-cause and infection-related mortality among hemodialysis patients.

Fistula First Initiative

“…Studies have previously demonstrated an association between AVF use and a patient survival benefit (48,51). However, attaining targets for AVF was not associated with reduced mortality in a large prospective study of incident dialysis patients (78).…”

“…Such admissions are associated with an increased risk for myocardial infarction, congestive heart failure, PVD, and stroke for the next 5 yr (46). The risk for a sepsis- attributable death in dialysis patients is 100 times that of the general population (47), with CVC associated with the greatest risk for infection-related and all-cause mortality (48). The consistent association of CVC use at any time and increased mortality (48 -51) is the most compelling argument to reduce CVC use.…”

Long-term outcome of chronic dialysis in children

“…If possible, in all children with CKD stages 3-5, the use of the non-dominant arm for venipuncture and lines should be avoided [20,21]. A study of adults has shown that HD with any type of venous catheter compared with a graft or fistula increases the risk of both all-cause-related mortality and infection-related mortality [22]. Even in small children, the use of fistulae or grafts is associated with access survival rates equivalent to those of adults and with better survival rates than with cuffed venous catheters [23].…”

Avaliação do acesso vascular para hemodiálise em crianças e adolescentes: um estudo de coorte retrospectivo de 10 anos

“…4 In spite of the Kidney Disease Outcomes Quality Initiative (K/DOQI) recommendation to prioritize AVF as initial vascular access, and the evidence pointing to increased morbidity and mortality of adult patients with central venous catheters (CVCs), 5 studies have shown that most pediatric patients still begin HD with a CVC, instead of an AVF or prosthetic graft. 6,7 Infection and thrombosis are the most frequent catheter-related complications.…”