Catheter access for hemodialysis defines higher mortality in late-presenting dialysis patients.
BACKGROUND
This study explores the relationship between mortality and late presentation for dialysis, focusing on the role of catheter access for hemodialysis (HD).


METHODS
We analyzed data from a cohort of 286 patients commencing dialysis in 2000-2001. Survival and factors associated with death were analyzed by univariate and multivariate analysis. Dialysis access was considered in three groups: HD-AVF, HD-Catheter, and peritoneal dialysis (PD). Late referral (LR) was defined as first review by a nephrologist less than 90 days before dialysis.


RESULTS
One-year mortality was low at 10.1%. HD-Catheter patients were older (p < 0.001), more hypoalbuminemic (p < 0.001), more anemic (p = 0.005), and more likely to be LR (p < 0.001). HD-Catheter patients did not have significantly higher comorbidity (p = 0.128). HD-Catheter was strongly associated with late presentation (75% LR vs. 28% early referral, p < 0.001). Factors associated with death by univariate analysis included age (p < 0.0001), comorbidity (p < 0.0001), HD-Catheter (p < 0.0001), LR (p = 0.0001), hypoalbuminemia (p = 0.0011), and diabetes (p = 0.02). When corrected for these factors, HD-Catheter was associated with death (HR 2.226, 95% CI 1.314-3.772, p = 0.003) but LR was not (p = 0.38).


CONCLUSIONS
A predominant feature of LR that predicts mortality is the use of catheter access for HD. This may be modifiable in those LR patients who do not present as uremic emergencies.
Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK.
Ajay
A
Raithatha
William
W
McKane
Debi
D
Kendray
Cariad
C
Evans
D000328:Adult; D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000453:epidemiology; D001166:Arteriovenous Shunt, Surgical; D015897:Comorbidity; D057210:Delayed Diagnosis; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000379:methods