Catheter access for hemodialysis defines higher mortality in late-presenting dialysis patients

Raithatha, Ajay; McKane, William; Kendray, Debi; Evans, Cariad

doi:10.3109/0886022x.2010.517347

Cited by 19 publications

(14 citation statements)

References 28 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may be the result of a widespread adoption of clinical practice guidelines that provide eGFR cutoff values below which dialysis therapy should be considered 8–12 , coupled to the belief that early dialysis initiation might prevent the progressive decline in nutritional status 7 , and might possibly allow for better vascular access planning and avoidance of dialysis catheters 44–46 . Unfortunately, there is no definitive evidence to support this approach.…”

Section: Discussionmentioning

confidence: 99%

GFR at Initiation of Dialysis and Mortality in CKD: A Meta-analysis

Susantitaphong

Altamimi

Ashkar

et al. 2012

American Journal of Kidney Diseases

102

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

GFR at Initiation of Dialysis and Mortality in CKD: A Meta-analysis

Susantitaphong

Altamimi

Ashkar

et al. 2012

American Journal of Kidney Diseases

102

View full text Add to dashboard Cite

“…Also, Raithatha et al [16] recently showed that the use of HD-catheter is one of the key features of late referral that determines poor prognosis. In the present study, ~80% of both HD-AVF and PD patients were referred to the nephologist early and experienced similarly high survival rates in the first year of dialysis, compared to HD-TCC patients.…”

Section: Discussionmentioning

confidence: 99%

“…Although technique survival with PD is shorter than that with HD, in part due to access-related infections, the frequency of PD catheter-related complications has decreased in recent years, with a low rate of bacteremia/sepsis [13,14]. However, there are few studies comparing the outcomes of incident PD patients with those of HD patients using different vascular access types at dialysis initiation in the literature, to our knowledge [15,16]. In the study presented here, we hypothesize that vascular access type at the time of dialysis initiation accounts for the higher early mortality rate observed in patients who start HD with a catheter, compared to those who initiate HD with a functioning fistula or PD.…”

Section: Introductionmentioning

confidence: 99%

Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study

et al. 2012

View full text Add to dashboard Cite

BackgroundAlthough several studies have demonstrated early survival advantages with peritoneal dialysis (PD) over hemodialysis (HD), the reason for the excess mortality observed among incident HD patients remains to be established, to our knowledge. This study explores the relationship between mortality and dialysis modality, focusing on the role of HD vascular access type at the time of dialysis initiation.MethodsA retrospective cohort study was performed among local adult chronic kidney disease patients who consecutively initiated PD and HD with a tunneled cuffed venous catheter (HD-TCC) or a functional arteriovenous fistula (HD-AVF) in our institution in the year 2008. A total of 152 patients were included in the final analysis (HD-AVF, n = 59; HD-TCC, n = 51; PD, n = 42). All cause and dialysis access-related morbidity/mortality were evaluated at one year. Univariate and multivariate analysis were used to compare the survival of PD patients with those who initiated HD with an AVF or with a TCC.ResultsCompared with PD patients, both HD-AVF and HD-TCC patients were more likely to be older (p<0.001) and to have a higher frequency of diabetes mellitus (p = 0.017) and cardiovascular disease (p = 0.020). Overall, HD-TCC patients were more likely to have clinical visits (p = 0.069), emergency room visits (p<0.001) and hospital admissions (p<0.001). At the end of follow-up, HD-TCC patients had a higher rate of dialysis access-related complications (1.53 vs. 0.93 vs. 0.64, per patient-year; p<0.001) and hospitalizations (0.47 vs. 0.07 vs. 0.14, per patient-year; p = 0.034) than HD-AVF and PD patients, respectively. The survival rates at one year were 96.6%, 74.5% and 97.6% for HD-AVF, HD-TCC and PD groups, respectively (p<0.001). In multivariate analysis, HD-TCC use at the time of dialysis initiation was the important factor associated with death (HR 16.128, 95%CI [1.431-181.778], p = 0.024).ConclusionOur results suggest that HD vascular access type at the time of renal replacement therapy initiation is an important modifier of the relationship between dialysis modality and survival among incident dialysis patients.

show abstract

“…Early and consistent access to nephrology care has been shown to improve clinical outcomes and reduce economic costs [16][17][18][19][20]. Though not studied in this cohort, early referral with high visit adherence has the potential to increase fistula/graft placement, reduce permcath insertion, and raise the number of patients getting their first dialysis treatment in the outpatient setting.…”

Section: Discussionmentioning

confidence: 99%

Telenephrology: Providing Healthcare to Remotely Located Patients with Chronic Kidney Disease

et al. 2018

View full text Add to dashboard Cite

Background: Chronic kidney disease (CKD) patients who live far (>30 miles) from their nephrologist experience lower rates of clinic visit adherence, limited access to treatment, and higher rates of hospitalization and mortality than patients who live in close proximity to their nephrologist. Strategies to minimize disparities between urban and remotely located CKD patients are needed. The purpose of this study was to determine whether adherence to clinic visits and clinical outcomes in the remote management of CKD via telenephrology is comparable to in-person conventional care. Methods: Renal clinic adherence and composite outcomes of death, end-stage renal disease (ESRD), or doubling of serum creatinine (Cr) were measured in geographically remote Hudson Valley VA Medical Center (HVVAMC) CKD patients enrolled in telenephrology (n = 112) and CKD patients enrolled in the Bronx VAMC renal clinic (n = 116). Results: Prior to implementing the telenephrology service, 53.1% of scheduled visits of rural HVVAMC patients to the Bronx VAMC renal clinic were either cancelled or were “no-shows.” This was reduced by nearly half (28.5%) after instituting telenephrology (p < 0.001). Moreover, the frequency of attending appointments was greater in the telenephrology (71.9%) vs. in-person Bronx VA cohort (61.0%). The incidence of the composite outcome of death, ESRD, or doubling of Cr was similar between both groups (p = 0.96) over 2 years of follow-up. Conclusions: Remote CKD care delivered through telenephrology improves renal clinic visit adherence while delivering comparable renal outcomes. Application of this technology is a promising method to provide access to care to rural CKD patients and to minimize the disparity between urban/rural patients.

show abstract

Catheter access for hemodialysis defines higher mortality in late-presenting dialysis patients

Abstract: A predominant feature of LR that predicts mortality is the use of catheter access for HD. This may be modifiable in those LR patients who do not present as uremic emergencies.

Cited by 19 publications

References 28 publications

GFR at Initiation of Dialysis and Mortality in CKD: A Meta-analysis

GFR at Initiation of Dialysis and Mortality in CKD: A Meta-analysis

Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study

Telenephrology: Providing Healthcare to Remotely Located Patients with Chronic Kidney Disease

Contact Info

Product

Resources

About