Vascular access-related infection in nocturnal home hemodialysis.
Frequent hemodialysis is associated with increased vascular access adverse events. We hypothesized that bacteremia would be more frequent in patients with central venous catheter (CVC) than arteriovenous fistula or arteriovenous graft (AVF/AVG) in nocturnal home hemodialysis (NHHD). We reviewed blood culture reports and concurrent clinical data for a cohort of one hundred eighty-seven NHHD patients between January 1, 2006 and June 30, 2012. The primary outcome was time to first bacteremia, technique failure, or death after commencing NHHD. Types of bacteremia and clinical consequences were analyzed. Analyses were adjusted for a priori defined confounders. One hundred eighty-seven patients were included with a total follow up of six hundred five patient years. Initial vascular access was AVF in seventy-eight (42%) patients, AVG in eleven (6%) patients, and CVC in ninety-eight (52%) patients. A total of 79.3% of patients with a CVC reached the composite endpoint of bacteremia, technique failure, or death in the study period; 44.5% of patients with an AVF or AVG reached this composite endpoint. Adjusted time to first bacteremia, technique failure, or death was significantly shorter in patients with initial CVC access (hazard ratio 2.42, 95% confidence interval 1.50-3.90, p < 0.001). Risk factors for bacteremia were comorbid status quantified by the Charlson Comorbidity Index (p < 0.001) and diabetes (p < 0.001). Coagulase negative staphylococcus was the commonest organism cultured accounting for 51.4% bacteremias. The second commonest organism was staphylococcus aureus (20.3% bacteremias). Patients undergoing NHHD with a CVC have a shorter duration to first infection, technique failure, or death than those with permanent vascular access.
Division of Nephrology, Hospital for Sick Children, Toronto, Canada.
Wesley N
WN
Hayes
Karthik
K
Tennankore
Marisa
M
Battistella
Christopher T
CT
Chan
D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016470:Bacteremia / Q000209:etiology; D055499:Catheter-Related Infections / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology*; D015331:Cohort Studies; D005260:Female; D006437:Hemodialysis, Home / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007676:Kidney Failure, Chronic / Q000382:microbiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
Arteriovenous fistula; bacteremia; central venous catheter; nocturnal home hemodialysis; vascular access