A prospective study of vascular access infections at seven outpatient hemodialysis centers

Tokars, Jerome I.; Light, Paul D.; Anderson, John E.; Miller, Elizabeth M.; Parrish, Joan; Armistead, Nancy; Jarvis, William R.; Gehr, Todd W.B.

doi:10.1053/ajkd.2001.24527

Cited by 94 publications

(83 citation statements)

References 17 publications

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“…The HEMO Study confirms previous reports showing an increased risk of serious infectious events among diabetic patients, older patients, individuals with serious co-morbidity, patients with hypoalbuminemia, and those using catheters for access (1,(3)(4)(5)(6)(7). Hypoalbuminemia, a particularly striking risk factor for infectious events in the present study, is frequently a marker of inflammatory conditions in hemodialysis patients (19 -21), which may predispose those patients to a higher risk of death or hospitalization.…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Impact of Dialysis Dose and Membrane on Infection-Related Hospitalization and Death

Allon¹,

Depner

Radeva

et al. 2003

Journal of the American Society of Nephrology

195

136

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Abstract. Infection is the second most common cause of death among hemodialysis patients. A predefined secondary aim of the HEMO study was to determine if dialysis dose or flux reduced infection-related deaths or hospitalizations. The effects of dialysis dose, dialysis membrane, and other clinical parameters on infection-related deaths and first infection-related hospitalizations were analyzed using Cox regression analysis. Among the 1846 randomized patients (mean age, 58 yr; 56% female; 63% black; 45% with diabetes), there were 871 deaths, of which 201 (23%) were due to infection. There were 1698 infection-related hospitalizations, yielding a 35% annual rate. . The first infection-related hospitalization was related to the vascular access in 21% of the cases, and non-access-related in 79%. Catheters were present in 32% of all study patients admitted with access-related infection, even though catheters represented only 7.6% of vascular accesses in the study. In conclusion, infection accounted for almost one fourth of deaths. Infection-related deaths were not reduced by higher dose or by high flux dialyzers. In this prospective study, most infection-related hospitalizations were not attributed to vascular access. However, the frequency of accessrelated, infection-related hospitalizations was disproportionately higher among patients with catheters compared with grafts or fistulas.Infection is the second most common cause of death (after cardiovascular disease) among hemodialysis patients (1,2) and is a frequent cause of hospitalization (3). Mortality due to sepsis occurs about 250-fold more commonly among hemodialysis patients than among the general population (4). There is limited literature analyzing the type and frequency of serious infections among hemodialysis patients. Most reported studies are retrospective and have identified diabetes, older age, comorbidity, hypoalbuminemia, and the use of a temporary dialysis catheter as the major, independent risk factors for serious infections (1,3-7).Observational studies have suggested that a higher dialysis dose and use of a high-flux membrane may each decrease the likelihood of infectious events (1,8), but these potential benefits have not been evaluated in randomized studies. The HEMO Study was a large, prospective, multicenter study in which chronic hemodialysis patients were randomized to receive either standard-dose or high-dose dialysis and to use high-flux or low-flux dialyzers, and clinical outcomes tracked prospectively (9). A predefined secondary aim of the study was to determine whether dialysis dose (clearance of small molecules) or membrane flux (clearance of larger molecules) affected infectionrelated deaths or hospitalizations.The present report (1) evaluates the frequency and specific etiologies of infection-related deaths and hospitalizations in this defined patient population (2), assesses whether a higher Kt/V or high-flux dialyzer decreased the likelihood of serious infections, and (3) determines what other baseline clinical factors affect infect...

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Section: Discussionsupporting

confidence: 90%

“…There is limited literature analyzing the type and frequency of serious infections among hemodialysis patients. Most reported studies are retrospective and have identified diabetes, older age, comorbidity, hypoalbuminemia, and the use of a temporary dialysis catheter as the major, independent risk factors for serious infections (1,(3)(4)(5)(6)(7).…”

mentioning

confidence: 99%

Impact of Dialysis Dose and Membrane on Infection-Related Hospitalization and Death

Allon¹,

Depner

Radeva

et al. 2003

Journal of the American Society of Nephrology

195

136

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“…This, in combination with the increasing number of patients entering RRT programmes with poor arterial vessels due to diabetes and widespread vascular disease, has resulted in fewer patients having successful AVFs. The alternatives are either synthetic grafts, which carry an increased risk of sepsis and have a shorter lifespan 19,20 or 'permanent' tunnelled cannulae, also complicated by sepsis, 19,21 reduced longevity, poor blood flows and the risk of subclavian vein stenosis, which causes obstruction and venous hypertension.…”

Section: Current Vascular Access (Clinical Questionnaire)mentioning

confidence: 99%

An evaluation of the costs, effectiveness and quality of renal replacement therapy provision in renal satellite units in England and Wales

Roderick

Nicholson²,

Armitage³

et al. 2005

Health Technol Assess

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“…Reported risk factors for this adverse event include immunodeficiency, low serum albumin level, female gender, adult polycystic kidney disease, diabetes mellitus, inadequate dialysis and the use of catheters or synthetic graft. [53] It is estimated that 30 to 50% of bacteraemia in haemodialysis patients is caused by vascular access infection. [53] There are reports that infection rates range from 0.5 to 3.5% for autogenous AVF, 5-8% for prosthetic graft accesses and 2-5.5 episodes of bacteremia per 1000 patient days for central venous catheters.…”

Section: Infection Of Vascular Accessmentioning

confidence: 99%

“…[53] It is estimated that 30 to 50% of bacteraemia in haemodialysis patients is caused by vascular access infection. [53] There are reports that infection rates range from 0.5 to 3.5% for autogenous AVF, 5-8% for prosthetic graft accesses and 2-5.5 episodes of bacteremia per 1000 patient days for central venous catheters. [54,55] …”

Section: Infection Of Vascular Accessmentioning

confidence: 99%

Current Management of Vascular Infections

Ktenidis¹,

Giannopoulos²

2012

Vascular Surgery - Principles and Practice

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A prospective study of vascular access infections at seven outpatient hemodialysis centers

Cited by 94 publications

References 17 publications

Impact of Dialysis Dose and Membrane on Infection-Related Hospitalization and Death

Impact of Dialysis Dose and Membrane on Infection-Related Hospitalization and Death

An evaluation of the costs, effectiveness and quality of renal replacement therapy provision in renal satellite units in England and Wales

Current Management of Vascular Infections

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