Association of Proteinuria with Central Venous Catheter Use at Initial Hemodialysis

Area of Science:

• Nephrology
• Vascular Access
• Dialysis Management

Background:

• Central venous catheters (CVCs) are associated with increased mortality and complications in hemodialysis patients.
• Despite decreased prevalent use, incident CVC use at the start of hemodialysis remains high.
• Identifying predictors for initial dialysis access is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the association between proteinuria and the use of CVCs at the initiation of hemodialysis.
• To determine if proteinuria can serve as a predictor for selecting initial dialysis vascular access.

Main Methods:

• Retrospective cohort study of 918 hemodialysis recipients.
• Data collected from Kaiser Permanente Northwest between January 1, 2004, and January 1, 2014.
• Multivariable logistic regression analysis was employed to assess the association between proteinuria and CVC use, adjusting for multiple clinical factors.

Main Results:

• 64% of patients initiated hemodialysis with a CVC, while 36% had an arteriovenous fistula.
• Proteinuria was significantly associated with CVC use at initial dialysis (p < 0.001).
• Only patients with midgrade proteinuria (0.5-3.5 g) demonstrated significantly lower odds of starting with a CVC (OR = 0.39).

Conclusions:

• Proteinuria is associated with CVC use at initial hemodialysis, but the relationship is not consistently graded.
• Midgrade proteinuria, but not other levels, was linked to reduced odds of CVC initiation.
• Proteinuria's predictive value for CVC use may lack pragmatic clinical utility, with lower proteinuria levels potentially indicating higher CVC risk.