title: Haemodialysis catheters increase mortality as compared to arteriovenous accesses especially in elderly patients.
abstract: BACKGROUND
  Catheter use has been associated with an increased mortality risk in haemodialysis patients. However, differences in the all-cause and cause-specific mortality risk between catheter use and arteriovenous access use in young and elderly haemodialysis patients have not yet been investigated.
  
  
  METHODS
  In this prospective cohort study of 1109 incident haemodialysis patients from 38 centres in the Netherlands, hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated for 2-year all-cause, infection-related and cardiovascular mortality in patients with a catheter as compared to patients with an arteriovenous access stratified for age (< 65 years and ≥ 65 years).
  
  
  RESULTS
  Of the 1109 patients, 919 had an arteriovenous access and 190 had a catheter. The mortality rate was 76 per 1000 person-years in young patients with an arteriovenous access, 129 per 1000 person-years in young patients with a catheter, 222 per 1000 person-years in elderly patients with an arteriovenous access and 427 per 1000 person-years in elderly patients with a catheter. The adjusted HR was 3.15 (95% CI: 2.09-4.75) for elderly patients with a catheter as compared to young patients with an arteriovenous access. The adjusted HRs in elderly patients with a catheter as compared to elderly patients with an arteriovenous access were 1.54 (95% CI: 1.13-2.12) for all-cause mortality, 1.60 (95%: CI 0.62-4.19) for infection-related mortality and 1.67 (95% CI: 1.04-2.68) for cardiovascular mortality.
  
  
  CONCLUSIONS
  Especially, elderly haemodialysis patients with a catheter have an increased all-cause, infection-related and cardiovascular mortality risk as compared to patients with an arteriovenous access.
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Gürbey
authors.initials: G
authors.lastname: Ocak
authors.forename: Nynke
authors.initials: N
authors.lastname: Halbesma
authors.forename: Saskia
authors.initials: S
authors.lastname: le Cessie
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Hoogeveen
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dijk
authors.forename: Jeroen
authors.initials: J
authors.lastname: Kooman
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Krediet
authors.forename: Elisabeth W
authors.initials: EW
authors.lastname: Boeschoten
authors.forename: Marion
authors.initials: M
authors.lastname: Verduijn
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D002408:Catheters, Indwelling / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D009426:Netherlands; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D015996:Survival Rate