title: Association of hemodialysis central venous catheter use with ipsilateral arteriovenous vascular access survival.
abstract: BACKGROUND
  Central venous catheters frequently are used for hemodialysis vascular access while patients await placement and maturation of an arteriovenous fistula or graft. Catheters may cause central vein stenosis, which can adversely affect vascular access outcomes. We compared vascular access outcomes in patients with a history of ipsilateral and contralateral dialysis catheters.
  
  
  METHODS
  Retrospective analysis of a prospective computerized vascular access database.
  
  
  METHODS
  Patients at a large medical center who initiated hemodialysis therapy with a catheter and subsequently received a fistula (n = 233) or graft (n = 89).
  
  
  METHODS
  History of central venous catheter placement ipsilateral versus contralateral to the arteriovenous fistula or graft.
  
  
  METHODS
  Primary access failure (access never suitable for dialysis) and cumulative access survival (time from successful cannulation until permanent access failure).
  
  
  RESULTS
  For patients receiving a fistula, the primary failure rate was similar for those with ipsilateral and contralateral catheters (50% vs 53%; HR, 0.94; 95% CI, 0.71-1.26; P = 0.7), and time to fistula maturation was similar (101 ± 41 vs 107 ± 39 days; P = 0.5). However, cumulative fistula survival was inferior in patients with ipsilateral catheters (HR, 2.48; 95% CI, 1.33-7.33; P = 0.009). For patients receiving a graft, the primary failure rate was similar for those with ipsilateral and contralateral catheters (35% vs 38%; HR, 0.92; 95% CI, 0.49-1.73; P = 0.8), but cumulative graft survival tended to be shorter with ipsilateral catheters (HR, 2.04; 95% CI, 0.92-5.38; P = 0.07).
  
  
  CONCLUSIONS
  Retrospective analysis, single medical center.
  
  
  CONCLUSIONS
  The primary failure rate of fistulas and grafts is not affected by the presence of an ipsilateral catheter. However, cumulative access survival is inferior in patients with prior ipsilateral catheters. Avoidance of ipsilateral catheters may improve long-term vascular access survival.
authors: Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors: Roman
authors: R
authors: Shingarev
authors: Jill
authors: J
authors: Barker-Finkel
authors: Michael
authors: M
authors: Allon
mesh_terms: D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000453:epidemiology / Q000401:mortality; D001166:Arteriovenous Shunt, Surgical / Q000401:mortality* / Q000706:statistics & numerical data*; D062905:Central Venous Catheters / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation* / Q000401:mortality* / Q000639:trends; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome