Initial vascular access type in patients with a failed renal transplant

Area of Science:

• Nephrology
• Vascular Surgery
• Public Health

Background:

• Permanent hemodialysis vascular access is critical for patients with end-stage renal disease (ESRD) and failed renal transplants.
• Central venous catheters (CVCs) carry higher infection and mortality risks compared to arteriovenous fistulae (AVFs) or arteriovenous grafts (AVGs).

Purpose of the Study:

• To determine the types of vascular access utilized by patients initiating hemodialysis following a renal transplant failure.

Main Methods:

• Analysis of data from the US Renal Data System (USRDS) database.
• Inclusion of 16,728 patients with failed renal transplants and 509,643 patients with native kidney failure initiating dialysis between January 1, 2006, and September 30, 2011.

Main Results:

• At dialysis initiation, 65.4% of failed transplant patients used CVCs, versus 27.7% using AVFs and 6.9% using AVGs.
• In contrast, 80.8% of patients with native kidney failure initiated dialysis with CVCs.
• Predictors for CVC use in failed transplant patients included female gender, lack of nephrologist referral, diabetes, peripheral vascular disease, and institutionalization. Older age, public insurance, and employment were associated with lower CVC use.

Conclusions:

• Central venous catheters are prevalent in nearly two-thirds of patients with failed renal transplants initiating hemodialysis.
• The low prevalence of AVFs/AVGs in this group warrants further investigation, despite close monitoring by transplant physicians.
• Improving vascular access selection in this patient population is crucial for reducing associated risks.