Influence of vascular access type on outcome measures in patients on maintenance hemodialysis.
BACKGROUND
Previous studies postulate that end-stage renal disease (ESRD) patients dialyzed with central venous catheters (CVC) have poorer outcomes compared to patients using arteriovenous fistulae (AVF) or arteriovenous grafts (AVG). Clinical practice guidelines should obviate these differences if access was not important. This study compared clinical measures of adequacy, anemia, and nutrition/inflammation in prevalent hemodialysis patients in 2003 by access type.


METHODS
Data from The Renal Network Data System were analyzed by univariate analysis of variance to compare Kt/V, URR, albumin, hemoglobin (Hb) and recombinant human erythropoietin (EPO) dose by access type, while adjusting for pertinent factors.


RESULTS
12,501 patients were included. The access type distribution was AVF 36%, AVG 41%, and CVC 23%. CVC patients had lower mean URR, Kt/V, albumin concentration (p < 0.001) than other accesses. Serum Hbs were similar (p = 0.416), however EPO dose (U/kg/week) was higher in those dialyzed with CVC compared to AVF/AVG (p < 0.001).


CONCLUSIONS
Despite practice guidelines, patients dialyzed via CVC have poorer outcome measures compared to other accesses. This suggests that AVF should be used and/or appropriate adjustments need to be made for those dialyzed with CVC to achieve equal outcomes. Further studies defining barriers need to be conducted.
Chand
Deepa H
DH
Department of Pediatric Nephrology and Hypertension, Akron Children's Hospital, Akron, Ohio 44308, USA. dchand@chmca.org
Teo
Boon Wee
BW
Fatica
Richard A
RA
Brier
Michael
M
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D001166:Arteriovenous Shunt, Surgical; D002405:Catheterization, Central Venous; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D006401:Hematologic Agents / Q000008:administration & dosage; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000379:methods*; D012709:Serum Albumin / Q000032:analysis; D016896:Treatment Outcome; D014508:Urea / Q000378:metabolism
D006401:Hematologic Agents; D006454:Hemoglobins; D011994:Recombinant Proteins; D012709:Serum Albumin; D004921:Erythropoietin; D014508:Urea