title: Temporal risk profile for infectious and noninfectious complications of hemodialysis access.
abstract: Vascular access complications are a major cause of morbidity in patients undergoing hemodialysis, and determining how the risks of different complications vary over the life of an access may benefit the design of prevention strategies. We used data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) to assess the temporal profiles of risks for infectious and noninfectious complications of fistulas, grafts, and tunneled catheters in incident hemodialysis patients. We used longitudinal data to model time from access placement or successful treatment of a previous complication to subsequent complication and considered multiple accesses per patient and repeated access complications using baseline and time-varying covariates to obtain adjusted estimates. Of the 7769 incident patients identified, 7140 received at least one permanent access. During a median follow-up of 14 months (interquartile range, 7-22 months), 10,452 noninfectious and 1131 infectious events (including 551 hospitalizations for sepsis) occurred in 112,085 patient-months. The hazards for both complication types declined over time in all access types: They were 5-10 times greater in the first 3-6 months than in later periods after access placement or a remedial access-related procedure. The hazards declined more quickly with fistulas than with grafts and catheters (P<0.001; Weibull regression). These data indicate that risks for noninfectious and infectious complications of the hemodialysis access decline over time with all access types and suggest that prevention strategies should target the first 6 months after access placement or a remedial access-related procedure.
authors.affiliation: Department of Medicine.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Gillespie
authors.forename: Robert Ross
authors.initials: RR
authors.lastname: Quinn
authors.forename: Jennifer
authors.initials: J
authors.lastname: MacRae
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.forename: David
authors.initials: D
authors.lastname: Mendelssohn
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
authors.forename: Matthew
authors.initials: M
authors.lastname: James
authors.forename: Neesh
authors.initials: N
authors.lastname: Pannu
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Robinson
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.forename: Ronald
authors.initials: R
authors.lastname: Pisoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D018570:Risk Assessment; D013997:Time Factors; D062666:Vascular Access Devices / Q000009:adverse effects*