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An analysis of central venous catheter-based hemodialysis starts


Scott E Liebman, Eric Y Chang

    Clinical Nephrology
    |May 28, 2019
    PubMed

    Insights

    Most patients start hemodialysis (HD) with central venous catheters (CVCs), increasing risks. Urgent need in new patients and access issues in those known to nephrology were primary drivers for CVC use.

    Area of Science:

    • Nephrology
    • Vascular Access
    • Renal Replacement Therapy

    Background:

    • Central venous catheters (CVCs) are frequently used for initiating hemodialysis (HD) in the United States.
    • CVC use is associated with increased patient morbidity and mortality compared to permanent access.
    • Understanding the specific reasons for CVC initiation is crucial for improving patient outcomes.

    Purpose of the Study:

    • To determine the most common proximate causes for initiating hemodialysis via CVC.
    • To quantify the relative frequency of each identified cause for CVC-based HD starts.

    Main Methods:

    • Retrospective chart review of 136 consecutive patients initiating HD with a CVC.
    • Analysis of patient records to identify the primary reason for CVC use at dialysis initiation.

    Main Results:

    • The most frequent reason for CVC initiation was urgent need in patients previously unknown to nephrology (31%).
    • For patients known to nephrology, common reasons included rapid kidney disease progression/acute on CKD (26.4%), non-functioning or immature arteriovenous (AV) access (18.7%, 11%), and lack of AV access due to patient factors (16.5% refusal, 9.9% poor follow-up).

    Conclusions:

    • Urgent presentation and issues with permanent vascular access (AV fistula/graft) are key drivers for CVC use in hemodialysis.
    • Targeted strategies are needed to address these factors and promote the use of permanent access for dialysis initiation.

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