title: Initial vascular access type in patients with a failed renal transplant.
abstract: OBJECTIVE
  Permanent hemodialysis vascular access is crucial for RRT in ESRD patients and patients with failed renal transplants, because central venous catheters are associated with greater risk of infection and mortality than arteriovenous fistulae or arteriovenous grafts. The objective of this study was to determine the types of vascular access used by patients initiating hemodialysis after a failed renal transplant.
  
  
  METHODS
  Data from the US Renal Data System database on 16,728 patients with a failed renal transplant and 509,643 patients with native kidney failure who initiated dialysis between January 1, 2006, and September 30, 2011 were examined.
  
  
  RESULTS
  At initiation of dialysis, of patients with a failed transplant, 27.7% (n=4636) used an arteriovenous fistula, 6.9% (n=1146) used an arteriovenous graft, and 65.4% (n=10,946) used a central venous catheter. Conversely, 80.8% (n=411,997) of patients with native kidney failure initiated dialysis with a central venous catheter (P<0.001). Among patients with a failed transplant, predictors of central venous catheter use included women (adjusted odds ratio, 1.75; 95% confidence interval, 1.63 to 1.87), lack of referral to a nephrologist (odds ratio, 2.00; 95% confidence interval, 1.72 to 2.33), diabetes (odds ratio, 1.14; 95% confidence interval, 1.06 to 1.22), peripheral vascular disease (odds ratio, 1.31; 95% confidence interval, 1.16 to 1.48), and being institutionalized (odds ratio, 1.53; 95% confidence interval, 1.23 to 1.89). Factors associated with lower odds of central venous catheter use included older age (odds ratio, 0.85 per 10 years; 95% confidence interval, 0.83 to 0.87), public insurance (odds ratio, 0.74; 95% confidence interval, 0.68 to 0.80), and current employment (odds ratio, 0.87; 95% confidence interval, 0.80 to 0.95).
  
  
  CONCLUSIONS
  Central venous catheters are used in nearly two thirds of failed renal transplant patients. These patients are usually followed closely by transplant physicians before developing ESRD after a failed transplant, but the relatively low prevalence of arteriovenous fistulae/arteriovenous grafts in this group at initiation of dialysis needs to be investigated more thoroughly.
authors.affiliation: Divisions of Nephrology and mr.chan@hosp.wisc.edu.
authors.forename: Micah R
authors.initials: MR
authors.lastname: Chan
authors.affiliation: Divisions of Nephrology and.
authors.forename: Bharvi
authors.initials: B
authors.lastname: Oza-Gajera
authors.affiliation: Divisions of Nephrology and.
authors.forename: Kevin
authors.initials: K
authors.lastname: Chapla
authors.affiliation: Divisions of Nephrology and Transplant Surgery and.
authors.forename: Arjang X
authors.initials: AX
authors.lastname: Djamali
authors.affiliation: Divisions of Nephrology and.
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Muth
authors.affiliation: Divisions of Nephrology and.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Turk
authors.affiliation: Divisions of Nephrology and.
authors.forename: Maureen
authors.initials: M
authors.lastname: Wakeen
authors.affiliation: Divisions of Nephrology and.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Yevzlin
authors.affiliation: Divisions of Nephrology and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000592:standards / Q000706:statistics & numerical data; D019917:Blood Vessel Prosthesis Implantation / Q000592:standards / Q000706:statistics & numerical data; D002405:Catheterization, Central Venous / Q000592:standards / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014481:United States; D055815:Young Adult
keywords: arteriovenous fistula; arteriovenous graft; hemodialysis access; vascular access