Vascular access type and risk of mortality in a national prospective cohort of haemodialysis patients

Bray, Benjamin; Boyd, Jessica H.; Daly, Conal; Donaldson, Ken; Doyle, Arthur; Fox, John; Innes, Andrew; Khan, Izhar; Peel, Robert; Severn, Alison; Shilliday, Ilona; Simpson, Kenneth J.; Stewart, Gareth; Traynor, Jamie P.; Metcalfe, Wendy

doi:10.1093/qjmed/hcs143

Cited by 85 publications

(68 citation statements)

References 18 publications

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“…Approximate one third of tCVC usages are removed for other working access and one third for infection [7]. Using a tCVC as long-term vascular access possesses higher mortality than AVF or AVG [3,8]. Conversion of vascular access type was associated with mortality in incident dialysis patients [9,10].…”

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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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: 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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“…The high rates of systemic infection reported in haemodialysis patients are related to their impaired immune system, the high number of invasive procedures they are exposed to and the type of vascular access used [1].…”

Section: Introductionmentioning

confidence: 99%

UK Renal Registry 16th Annual Report: Chapter 15 Epidemiology of Reported Infections amongst Patients Receiving Dialysis for Established Renal Failure in England from May 2011 to April 2012: a Joint Report from Public Health England and the UK Renal Registry

Crowley¹,

Pitcher²,

Wilson³

et al. 2013

Nephron Clin Pract

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Introduction: Infection remains one of the leading causes of mortality in established renal failure patients receiving renal replacement therapy (RRT). Since 2007, centres providing RRT in England have been asked to provide additional data on patients with methicillin resistant Staphylococcus aureus (MRSA) bacteraemia. Since 2011, the option to provide data on methicillin sensitive Stapylococcus aureus (MSSA) and Escherichia coli bacteraemia, as well as Clostridium difficile infection has also been available. Methods: Data were submitted to Public Health England by laboratories via HCAI-DCS including whether the patients were receiving dialysis. Individual renal centres then confirmed the record either directly via the database or after being contacted. Data were collected for the period of the 1st May 2011 to the 30th April 2012. Results: There were 49 episodes of MRSA bacteraemia, an overall rate of 0.22 per 100 dialysis patients per year, representing a further year on year fall in MRSA rate. There were a higher number of MSSA episodes, 322 in total, with an overall rate of 1.15 per 100 dialysis patients per year. The number of episodes and overall rate of E. coli and C. difficile were 284 and 0.92 per 100 prevalent dialysis patients per year and 172 and 0.61 per 100 prevalent dialysis patients per year respectively. In each infection type the presence of a central venous catheter appeared to correlate with an elevated risk. Conclusions: Data are presented from one year of infections reported to PHE. The rate of MRSA bacteraemia episodes in England continues to fall. There was a higher rate of MSSA infections amongst renal dialysis patients. Findings from the first year of E. coli and C. difficile data collection are also reported. Future cycles will give us a further idea of the trend in incidences of these infections.Fax +41 61 306 12 34 E-Mail

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“…Statistical tests were 2-tailed, with P < .05 considered statistically significant. Analyses included frequencies (numbers of participants with an event and percentages) and χ 2 or Fisher exact tests. The 2-sample independent t test and Mann-Whitney U test were used to estimate differences in group means.…”

Section: Methodsmentioning

confidence: 99%

Is 2% chlorhexidine gluconate in 70% isopropyl alcohol more effective at preventing central venous catheter–related infections than routinely used chlorhexidine gluconate solutions: A pilot multicenter randomized trial (ISRCTN2657745)?

McCann

Fitzpatrick

Mellotte

et al. 2016

American Journal of Infection Control

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Vascular access type and risk of mortality in a national prospective cohort of haemodialysis patients

Abstract: Compared with an arteriovenous fistula or graft, sustained use of tunnelled CVCs for vascular access is associated with higher risks of all-cause, cardiovascular and infection-related mortality.

Cited by 85 publications

References 18 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

UK Renal Registry 16th Annual Report: Chapter 15 Epidemiology of Reported Infections amongst Patients Receiving Dialysis for Established Renal Failure in England from May 2011 to April 2012: a Joint Report from Public Health England and the UK Renal Registry

Is 2% chlorhexidine gluconate in 70% isopropyl alcohol more effective at preventing central venous catheter–related infections than routinely used chlorhexidine gluconate solutions: A pilot multicenter randomized trial (ISRCTN2657745)?

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