title: Effect of temporary catheter and late referral on hospitalization and mortality during the first year of hemodialysis treatment.
abstract: Late referral (LR) to dialysis therapy has been associated with poor outcomes in people with end-stage renal disease. This had been ascribed to the frequent use of temporary vascular catheters (TVCs) in LR patients. The effects of LR and TVC on the outcomes of an incident hemodialysis population (n = 101) were investigated. There was a higher incidence of vascular access infection, longer period of hospitalization, and lower survival in TVC and LR groups, compared with arteriovenous fistula and early referral (ER) groups, respectively. Late referral patients had higher number of hospitalizations than ER patients. In univariate analysis, LR (hazard ratio [HR] 10.8, P = 0.02) and albumin (HR 0.23, P < 0.0001) were associated with mortality. Late referral and body mass index were associated with the increased risk of hospitalization in univariate analysis. In multivariate analysis, LR was the only risk factor associated with hospitalization (HR 3.51, P = 0.002). In conclusion, LR was associated with increased risk of mortality and increased risk of hospitalization independently of the presence of a TVC.
authors.affiliation: Division of Nephrology, Department of Medicine, Federal University of São Paulo-UNIFESP, São Paulo, SP, Brazil. elsapetry@yahoo.com.br
authors.forename: Elsa A P
authors.initials: EA
authors.lastname: Gonçalves
authors.forename: Maria Claudia C
authors.initials: MC
authors.lastname: Andreoli
authors.forename: Renato
authors.initials: R
authors.lastname: Watanabe
authors.forename: Maria Cecilia S
authors.initials: MC
authors.lastname: Freitas
authors.forename: Alessandra C
authors.initials: AC
authors.lastname: Pedrosa
authors.forename: Silvia R
authors.initials: SR
authors.lastname: Manfredi
authors.forename: Sérgio A
authors.initials: SA
authors.lastname: Draibe
authors.forename: Miguel
authors.initials: M
authors.lastname: Cendoroglo
authors.forename: Maria Eugenia F
authors.initials: ME
authors.lastname: Canziani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D012017:Referral and Consultation; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors
chemical_list: D006454:Hemoglobins; D003404:Creatinine