Relationship among catheter insertions, vascular access infections, and anemia management in hemodialysis patients.
BACKGROUND
Arteriovenous fistulas are the recommended permanent vascular access (VA) for chronic hemodialysis. However, in the United States most patients begin chronic hemodialysis with a catheter. Recent data suggest that VA type contributes to recombinant human erythropoietin (rHuEPO) resistance. We examined catheter insertions, VA infections, and anemia management in Medicare, rHuEPO-treated, chronic hemodialysis patients.


METHODS
We compared hemoglobin values and rHuEPO and intravenous iron dosing with concurrent catheter insertions and VA infections in 186,348 period-prevalent patients in 2000. We studied anemia management after catheter insertions and VA infections in 67,410 incident patients from 1997 to 1999. Multiple linear regression models examined follow-up hemoglobin and rHuEPO dose per week (rHuEPO/wk) by numbers of catheter insertions and hospitalizations for VA infection.


RESULTS
In the prevalent cohort, increasing temporary and permanent catheter insertions and VA infections were associated with slightly lower hemoglobin, higher rHuEPO doses, and higher intravenous iron doses. In the incident cohort, compared to patients with no VA infections or no catheter insertions (temporary or permanent), respectively, patients with 2+ VA infections or 2+ catheter insertions had 0.12 g/dL and 0.06 g/dL lower mean hemoglobin (P = 0.0028 and P < 0.0001), and 25.7% and 12.2% higher mean rHuEPO/wk (P < 0.0001).


CONCLUSIONS
Higher rHuEPO doses may be required to maintain similar or slightly lower mean hemoglobin values among chronic hemodialysis patients with higher numbers of catheter insertions and VA infections, compared to patients without any.
Roberts
Tricia L
TL
Nephrology Analytical Services, Minneapolis Medical Research Foundation, Minneapolis, Minnesota 55404, USA.
Obrador
Gregorio T
GT
St Peter
Wendy L
WL
Pereira
Brian J G
BJ
Collins
Allan J
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy / Q000453:epidemiology*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006454:Hemoglobins; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011994:Recombinant Proteins; D006435:Renal Dialysis; D014546:Urinary Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data*
D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin