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Nonprogrammed Vascular Access Is Associated With Greater Mortality in Patients Who Return to Hemodialysis With a

Gustavo Laham1, Gervasio Soler Pujol, Antonio Vilches

  • 11 Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Ciudad de Buenos Aires, Argentina.

Transplantation
|March 30, 2017
PubMed

Insights

For patients returning to hemodialysis after kidney transplant failure, using a catheter for vascular access (VA) significantly increases mortality risk compared to an arteriovenous fistula or graft. This highlights the importance of appropriate VA selection for improved outcomes.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Transplantation

Background:

  • Vascular access (VA) type impacts hemodialysis (HD) patient prognosis.
  • The role of VA in patients returning to HD after renal transplant failure is unclear.

Purpose of the Study:

  • To determine associations between VA type and mortality in patients restarting HD post-transplant failure.

Main Methods:

  • Retrospective observational cohort study of 138 patients (1995-2014).
  • Recorded VA type (programmed VA: fistula/graft; nonprogrammed VA: catheter) at HD initiation.
  • Analyzed effect of VA type on mortality using Cox regression.

Main Results:

  • 61.6% used programmed VA, 38.4% used nonprogrammed VA (catheters).
  • Catheter use was associated with significantly greater mortality (log rank P <0.0001).
  • Multivariate analysis showed catheter initiation independently predicted higher mortality (HR 5.90).

Conclusions:

  • Nonprogrammed VA (catheters) predicts all-cause mortality in patients with transplant failure reentering HD.
  • Optimizing vascular access is crucial for this vulnerable patient population.
Abstract

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