Effect of temporary catheter and late referral on hospitalization and mortality during the first year of hemodialysis treatment.
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.
Gonçalves
Elsa A P
EA
Division of Nephrology, Department of Medicine, Federal University of São Paulo-UNIFESP, São Paulo, SP, Brazil. elsapetry@yahoo.com.br
Andreoli
Maria Claudia C
MC
Watanabe
Renato
R
Freitas
Maria Cecilia S
MC
Pedrosa
Alessandra C
AC
Manfredi
Silvia R
SR
Draibe
Sérgio A
SA
Cendoroglo
Miguel
M
Canziani
Maria Eugenia F
ME
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
D006454:Hemoglobins; D003404:Creatinine