Variability in reasons for hemodialysis catheter use by race, sex, and geography: findings from the ESRD Clinical Performance Measures Project.
BACKGROUND
Race, sex, and geographic differences in hemodialysis vascular access use have been reported, but differences in reasons for catheter use have not been assessed.


METHODS
Cross-sectional.


METHODS
Data obtained from the 2005 Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures Project for adult hemodialysis patients.


METHODS
Race, sex, and geographic region.


METHODS
Reasons for catheter use were categorized as short term and long term. Race, sex, and geographic associations with reasons were assessed by using bivariate analyses and multivariate logistic regression.


RESULTS
Of 8,479 hemodialysis patients, 3,302 (39%) used a fistula, 2,725 (32%) used a graft, and 2,299 (27%) used a catheter. We placed 857 patients with a catheter (37%) in the short-term-reason cohort and 1,404 (61%) in the long-term-reason cohort, and 38 (2%) lacked information to be placed. Reasons for catheter use were independently associated with race, sex, and geographic region. Whites were 43%, 49%, and 34% less likely than African Americans to use a catheter because of graft maturation, graft interruption, and all vascular access sites exhausted and 70% and 40% more likely because of fistula maturation and no fistula or graft surgically planned, respectively. Men were 50% less likely than women to use a catheter because of graft interruption and 80% more likely because of fistula maturation. Geographic end-stage renal disease network was associated with catheter use because of fistula maturation (P = 0.03), no fistula or graft surgically created (P < 0.001), and no fistula or graft surgically planned (P = 0.05).


CONCLUSIONS
The cross-sectional study design precludes our ability to assess trends over time in reasons for catheter use. Associations were assessed for a limited set of variables.


CONCLUSIONS
Race, sex, and geographic differences in reasons for hemodialysis catheter use exist. Understanding these differences may aid in developing strategies to decrease catheter initiation rates.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. shopson@sph.emory.edu
Sari
S
Hopson
Diane
D
Frankenfield
Michael
M
Rocco
William
W
McClellan
D001741:Black or African American; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010353:Patient Education as Topic; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D012737:Sex Factors; D019737:Transplants / Q000706:statistics & numerical data; D014481:United States; D044465:White People