Factors influencing the prevalence of central venous catheter use in a Canadian haemodialysis centre.
BACKGROUND
The arteriovenous (AV) fistula is the optimal vascular access for chronic haemodialysis (HD) patients. The Dialysis Outcomes and Practice Patterns Study (DOPPS II) reported a high use of central venous (CV) catheters for HD in Canadian centres. We studied factors influencing the choice of access in a prevalent HD population at a Canadian centre.


METHODS
This was a cross-sectional study of all HD patients at the Ottawa Hospital (Ottawa, Canada). Demographic information, the type of HD vascular access used and the factors influencing access choice were obtained from medical records. Nephrologists at the Ottawa Hospital were surveyed to identify attitudes that might influence the choice of HD access.


RESULTS
In the survey of nephrologists (n = 17), there was 100% agreement that the AV fistula is the optimal HD access. In 599 prevalent chronic HD patients, AV fistulae were used in 58.0% (n = 347), CV catheters in 39.7% (n = 238) and only 2.3% had AV grafts (n = 14). By multivariate logistic regression, female gender, peripheral vascular disease and shorter duration of HD were independent predictors of CV catheter use. Of the patients with CV catheters, 68.9% had vascular factors or medical contraindications that precluded AV fistula creation. System/resource limitations influenced choice of access in only 19.3% of patients with CV catheters, although these factors were more important in patients within the first 6 months of HD initiation.


CONCLUSIONS
The relatively high prevalence of CV catheter use at our HD centre is due mainly to patient-specific factors (e.g. unsuitable vessels or medical co-morbidities), rather than resource limitations or physician attitudes. Target setting for AV fistula use requires consideration of these factors as well as the effect of HD duration.
Graham
Janet
J
Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Hiremath
Swapnil
S
Magner
Peter O
PO
Knoll
Greg A
GA
Burns
Kevin D
KD
D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data; D002170:Canada; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D000075202:Contraindications; D003430:Cross-Sectional Studies; D003625:Data Collection; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012737:Sex Factors; D014652:Vascular Diseases