The association between national dialysis catheter use and kidney transplantation activity

This study investigates the relationship between national catheter use among hemodialysis (HD) patients and kidney transplantation (KTX) activity, exploring the hypothesis that higher KTX activity may be associated with increased catheter usage. The rationale is based on the idea that shorter waiting times for transplants in high-activity countries could make central venous catheters (CVCs) more favorable as a temporary bridge to transplantation compared to arteriovenous fistulas or grafts which require longer maturation times.

Nine national dialysis and transplant registries (Argentina, Australia, Austria, New Zealand, Portugal, Scotland, Sweden, USA, Turkey) were included in this analysis. The included descriptive analysis of baseline information from included countries, followed by crude association analyses using correlation and regression analyses to explore the relationship between CVC usage and kidney transplants per million inhabitants, considering relevant confounders. Adjusted analyses were performed to account for these confounders, providing a more nuanced understanding of the relationship.

Data from nine different national registries was analyzed. CVC use and KTX activity had a weak to moderate positive correlation (r = 0.23, 95% CI: 0.07, 0.39). In all included countries CVC use increased over time. Adjusting for temporal patterns, country-specific factors, and the proportion of female HD patients, there was still strong evidence for a moderate increase of CVCs among prevalent HD patients with increasing KTX activity.

Higher national KTX activity is associated with a moderate increase in CVCs among prevalent HD patients.