Vascular access type and risk of mortality in a national prospective cohort of haemodialysis patients.
BACKGROUND
Central venous catheters (CVC) are a potential source of bacteraemia and have been associated with increased mortality in haemodialysis patients. We aimed to investigate the relationships between haemodialysis vascular access, taking into account changes in vascular access type during patients' lives, and cause specific mortality risk in a national cohort of dialysis patients.


METHODS
Prospective cohort study including all patients receiving haemodialysis in Scotland at annual cross sectional surveys in 2009, 2010 and 2011. Data were collected through the Scottish Renal Registry and by a structured review of case records following death. Cox proportional hazards regression and multivariable logistic regression were used to model survival and risk of death from septicaemia respectively.


RESULTS
Of a cohort of 2666 patients, 873 (32%) died during follow-up. After case-mix adjustment, patients using only tunnelled CVC during follow-up had a higher risk of all cause mortality across all strata of prior renal replacement therapy exposure [adjusted hazard ratio (HR): 1.83-2.08]. Case-mix adjusted risks of cardiovascular death (adjusted HR: 2.20-2.95) and infection-related death (adjusted HR: 3.10-3.63) were also higher in this group. Patients using tunnelled CVCs during follow-up and prior to death had 6.9-fold higher odds of death from septicaemia compared with those using only arteriovenous fistulae or grafts.


CONCLUSIONS
Compared with an arteriovenous fistula or graft, sustained use of tunnelled CVCs for vascular access is associated with higher risks of all-cause, cardiovascular and infection-related mortality.
Scottish Renal Registry, Cirrus House, Marchburn Drive, Paisley PA32SJ, UK. benthebray@gmail.com
B D
BD
Bray
J
J
Boyd
C
C
Daly
K
K
Donaldson
A
A
Doyle
J G
JG
Fox
A
A
Innes
I
I
Khan
R K
RK
Peel
A
A
Severn
I
I
Shilliday
K
K
Simpson
G A
GA
Stewart
J
J
Traynor
W
W
Metcalfe
D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000401:mortality*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis / Q000401:mortality*; D051437:Renal Insufficiency / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom