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Increased hemodialysis catheter use in Canada and associated mortality risk: data from the Canadian Organ Replacement
Louise M Moist1, Lilyanna Trpeski, Yingbo Na
1Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada. louise.moist@lhsc.on.ca
Insights
Vascular access trends in Canada show increasing catheter use and decreasing fistulas, linked to a 6-fold higher mortality risk. Urgent strategies are needed to reduce catheter reliance for hemodialysis patients.
Area of Science:
- Nephrology
- Vascular Surgery
- Public Health
Background:
- Canadian vascular access guidelines prioritize fistulas.
- Hemodialysis access trends and outcomes require ongoing evaluation.
Purpose of the Study:
- To describe hemodialysis access trends in Canada from 2001 to 2004.
- To examine provincial variations in access use.
- To assess the association between vascular access type and mortality.
Main Methods:
- Observational study of adult hemodialysis patients in the Canadian Organ Replacement Registry.
- Analysis of incident and prevalent access trends, adjusted for patient characteristics.
- Cox proportional hazard regression to determine mortality risk.
Main Results:
- Incident catheter use rose (76.8% to 79.1%), while fistula use declined (21.6% to 18.6%).
- Prevalent catheter use increased (41.8% to 51.7%), with decreases in fistulas and grafts.
- Incident catheter use correlated with a 6-fold increased mortality risk compared to fistulas or grafts.
Conclusions:
- A shift towards increased catheter use for hemodialysis in Canada, unexplained by patient factors.
- Significant provincial variations in vascular access practices were observed.
- The heightened mortality risk associated with catheters necessitates interventions to promote fistula use.
Background And Objectives:
The 1999 Canadian vascular access guidelines recommend the fistula as the access of choice. The study describes the trends in hemodialysis access use, variation among provinces, and the association with mortality from 2001 to 2004.
Design, Setting, Participants And Measurements:
An observational study of adult patients registered in Canadian Organ Replacement Registry on hemodialysis. Access trends were examined among incident and prevalent hemodialysis patients adjusted for age, sex, body mass index, late referral, race, smoking status, province, etiology of end-stage renal disease, and comorbidities. Cox proportional hazard regression analysis was used to analyze risk for death for patients followed to December 31, 2005.
Results:
From 2001 to 2004, incident catheter use increased from 76.8% to 79.1%, fistulas decreased from 21.6% to 18.6%, and grafts remained between 2.1% to 2.6%. Prevalent catheter use increased from 41.8% to 51.7%, and fistulas and grafts decreased from 46.8% to 41.6% and 11.4% to 6.7%, respectively. There was significant variation in incident and prevalent fistulae use among the provinces. Adjustment for differences in patient characteristics did not change these trends. Incident catheter use was associated with a 6 times greater risk of death compared with fistula or graft use combined.
Conclusions:
In Canada there has been a decrease in fistulae and grafts with a subsequent increase in catheters that is not explained by changes in patient characteristics. Vascular access use varied by province, suggesting differences in practice patterns. Because incident catheter use was associated with increased mortality, urgent measures are needed to develop strategies to decrease catheter use.
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