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Influence of vascular access type on outcome measures in patients on maintenance hemodialysis

Deepa H Chand1, Boon Wee Teo, Richard A Fatica

  • 1Department of Pediatric Nephrology and Hypertension, Akron Children's Hospital, Akron, Ohio 44308, USA. dchand@chmca.org

Nephron. Clinical Practice
|January 24, 2008
PubMed

Insights

Patients on hemodialysis using central venous catheters (CVC) show poorer outcomes than those with arteriovenous fistulae (AVF) or grafts (AVG). This highlights the need to prioritize AVF or adjust CVC care for better results in end-stage renal disease (ESRD) patients.

Area of Science:

  • Nephrology
  • Vascular Access
  • Renal Replacement Therapy

Background:

  • End-stage renal disease (ESRD) patients often require hemodialysis.
  • Vascular access type (arteriovenous fistula (AVF), arteriovenous graft (AVG), or central venous catheter (CVC)) significantly impacts patient outcomes.
  • Previous studies suggest poorer outcomes for patients using CVC compared to AVF or AVG.

Purpose of the Study:

  • To compare clinical measures of dialysis adequacy, anemia management, and nutritional/inflammatory status among prevalent hemodialysis patients based on vascular access type.
  • To determine if current clinical practice guidelines adequately address potential outcome disparities related to vascular access.

Main Methods:

  • Analysis of data from The Renal Network Data System for 12,501 prevalent hemodialysis patients in 2003.
  • Univariate analysis of variance used to compare Kt/V, Urea Reduction Ratio (URR), albumin, hemoglobin (Hb), and recombinant human erythropoietin (EPO) dose across access types (AVF, AVG, CVC).
  • Statistical adjustments made for pertinent confounding factors.

Main Results:

  • Central venous catheter (CVC) use was observed in 23% of patients, contrasted with 36% for AVF and 41% for AVG.
  • Patients dialyzed via CVC demonstrated significantly lower mean URR, Kt/V, and albumin concentrations (p < 0.001) compared to AVF and AVG users.
  • While serum hemoglobin levels were similar across groups (p = 0.416), CVC patients required higher doses of EPO (p < 0.001).

Conclusions:

  • Despite established practice guidelines, hemodialysis patients utilizing CVC exhibit inferior clinical outcomes compared to those with AVF or AVG.
  • Findings underscore the importance of prioritizing AVF use or implementing appropriate adjustments for CVC patients to achieve comparable outcomes.
  • Further research is recommended to identify and address the barriers contributing to these disparities in CVC patient care.
Abstract

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