National surveillance of dialysis-associated diseases in the United States, 2000.

In December 2000, all U.S. dialysis centers were surveyed regarding selected patient care practices and dialysis-associated diseases. The results were compared with similar surveys conducted in previous years. During 1997-2000, the percentage of patients vaccinated against hepatitis B virus infection increased from 47% to 58% and the percentage of staff vaccinated increased from 87% to 88%. In 2000, an estimated 64% of patients were vaccinated for influenza and 27% for pneumococcal pneumonia. In 2000, routine testing for antibody to hepatitis C virus (anti-HCV) was performed on staff at 40% of centers and on patients at 58% of centers; anti-HCV was found in 1.7% of staff and 8.4% of patients. During 1995-2000, the percentage of patients who received dialysis through central catheters increased from 13% to 24%; this trend is worrisome because infections and antimicrobial use are higher in patients receiving dialysis through catheters. However, during the same period the percentage of patients receiving dialysis through fistulas increased from 22% to 28%. In 2000, 25% of catheters were used for new patients awaiting an implanted access, 28% for established patients with a failed access awaiting a new implanted access, 41% as an access of last resort, and 6% for other reasons, including patient preference. The percentage of centers reporting one or more patients infected or colonized with vancomycin-resistant enterococcus (VRE) increased from 11.5% in 1995 to 32.7% in 2000.