BACKGROUND AND OBJECTIVES: Conversion from central venous catheters to a graft or a fistula is associated with lower mortality risk in long-term hemodialysis (HD) patients; however, a similar association with hospitalization risk remains to be elucidated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a prospective observational study all maintenance in-center HD patients who were treated in Fresenius Medical Care, North America legacy facilities; were alive on January 1, 2007; and had baseline laboratory data from December 2006. Access conversion (particularly from a catheter to a fistula or a graft) during the 4-month period from January 1 through April 30, 2007, was linked using Cox models to hospitalization risk during the succeeding 1-year follow-up period (until April 30, 2008). RESULTS: The cohort (N = 79,545) on January 1, 2007 had 43% fistulas, 29% catheters, and 27% grafts. By April 30, 2007, 70,852 patients were still on HD, and among 19,792 catheters initially, only 10.3% (2045 patients) converted to either a graft or a fistula. With catheters as reference, patients who converted to grafts/fistulas had similar adjusted hazard ratios (0.69) as patients on fistulas (0.71), while patients with fistulas/grafts who converted to catheters did worse (1.22), all P < 0.0001. CONCLUSIONS: Catheters remain associated with the greatest hospitalization risk. Conversion from a catheter to either graft or fistula had significantly lower hospitalization risk relative to keeping the catheter. Prospective studies are needed to determine whether programs that reduce catheters will decrease hospitalization risk in HD patients.
BACKGROUND AND OBJECTIVES: Conversion from central venous catheters to a graft or a fistula is associated with lower mortality risk in long-term hemodialysis (HD) patients; however, a similar association with hospitalization risk remains to be elucidated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a prospective observational study all maintenance in-center HDpatients who were treated in Fresenius Medical Care, North America legacy facilities; were alive on January 1, 2007; and had baseline laboratory data from December 2006. Access conversion (particularly from a catheter to a fistula or a graft) during the 4-month period from January 1 through April 30, 2007, was linked using Cox models to hospitalization risk during the succeeding 1-year follow-up period (until April 30, 2008). RESULTS: The cohort (N = 79,545) on January 1, 2007 had 43% fistulas, 29% catheters, and 27% grafts. By April 30, 2007, 70,852 patients were still on HD, and among 19,792 catheters initially, only 10.3% (2045 patients) converted to either a graft or a fistula. With catheters as reference, patients who converted to grafts/fistulas had similar adjusted hazard ratios (0.69) as patients on fistulas (0.71), while patients with fistulas/grafts who converted to catheters did worse (1.22), all P < 0.0001. CONCLUSIONS: Catheters remain associated with the greatest hospitalization risk. Conversion from a catheter to either graft or fistula had significantly lower hospitalization risk relative to keeping the catheter. Prospective studies are needed to determine whether programs that reduce catheters will decrease hospitalization risk in HDpatients.
Authors: Charmaine E Lok; Michael Allon; Louise Moist; Matthew J Oliver; Hemal Shah; Deborah Zimmerman Journal: J Am Soc Nephrol Date: 2006-09-20 Impact factor: 10.121
Authors: Laura M Dember; Gerald J Beck; Michael Allon; James A Delmez; Bradley S Dixon; Arthur Greenberg; Jonathan Himmelfarb; Miguel A Vazquez; Jennifer J Gassman; Tom Greene; Milena K Radeva; Gregory L Braden; T Alp Ikizler; Michael V Rocco; Ingemar J Davidson; James S Kaufman; Catherine M Meyers; John W Kusek; Harold I Feldman Journal: JAMA Date: 2008-05-14 Impact factor: 56.272
Authors: Eduardo Lacson; J Michael Lazarus; Jonathan Himmelfarb; T Alp Ikizler; Raymond M Hakim Journal: Am J Kidney Dis Date: 2007-09 Impact factor: 8.860
Authors: Adriana Hung; Lara Pupim; Chang Yu; Ayumi Shintani; Edward Siew; Carlos Ayus; Raymond M Hakim; Talat Alp Ikizler Journal: Hemodial Int Date: 2008-04 Impact factor: 1.812
Authors: Douglas M Silverstein; Scott O Trerotola; Timothy Clark; Garth James; Wing Ng; Amy Dwyer; Marius C Florescu; Roman Shingarev; Stephen R Ash Journal: Clin J Am Soc Nephrol Date: 2018-10-11 Impact factor: 8.237
Authors: Matthew B Rivara; Melissa Soohoo; Elani Streja; Miklos Z Molnar; Connie M Rhee; Alfred K Cheung; Ronit Katz; Onyebuchi A Arah; Allen R Nissenson; Jonathan Himmelfarb; Kamyar Kalantar-Zadeh; Rajnish Mehrotra Journal: Clin J Am Soc Nephrol Date: 2016-01-04 Impact factor: 8.237
Authors: Jennifer E Flythe; Suzanne L Katsanos; Yichun Hu; Abhijit V Kshirsagar; Ronald J Falk; Carlton R Moore Journal: Clin J Am Soc Nephrol Date: 2016-05-05 Impact factor: 8.237
Authors: Hui Xue; Joachim H Ix; Weiling Wang; Steven M Brunelli; Michael Lazarus; Raymond Hakim; Eduardo Lacson Journal: Am J Kidney Dis Date: 2012-11-16 Impact factor: 8.860
Authors: Rita L McGill; Robin Ruthazer; Klemens B Meyer; Dana C Miskulin; Daniel E Weiner Journal: Clin J Am Soc Nephrol Date: 2016-06-23 Impact factor: 8.237