Krishna Poinen1, Robert R Quinn1, Alix Clarke1, Pietro Ravani1, Swapnil Hiremath2, Lisa M Miller3, Peter G Blake4, Matthew J Oliver5. 1. Cumming School of Medicine, Department of Community Health Sciences, and Department of Family Medicine, University of Calgary, Calgary, Canada. 2. Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Canada. 3. Division of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada. 4. Division of Nephrology, Department of Medicine, London Health Sciences Centre, London. 5. Division of Nephrology, Department of Medicine, London Health Sciences Centre, London; Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: matthew.oliver@sunnybrook.ca.
Abstract
RATIONALE & OBJECTIVE: Clinical practice guidelines discourage the use of central venous catheters (CVCs) for vascular access in dialysis. However, some patients have inadequate vessels for arteriovenous fistula creation or choose to use a dialysis catheter. The risks associated with CVC use and their relationship to patient age are poorly characterized. STUDY DESIGN: Observational retrospective cohort study. SETTING & PARTICIPANTS: Cohort of 1,041 patients older than 18 years from 5 Canadian dialysis programs who initiated outpatient maintenance hemodialysis therapy with a tunneled CVC between 2004 and 2012 and who had no creation of an arteriovenous fistula or arteriovenous graft. EXPOSURES: Age, sex, body size, initiating dialysis therapy in the hospital, and comorbid conditions. OUTCOMES: CVC-related procedures, hospitalization, and death. ANALYTICAL APPROACH: Complications were reported as a cumulative risk at 1 and 2 years. Cox proportional hazards regression for recurrent events was used to evaluate risk factors for study outcomes. RESULTS: At 1 year, risks for CVC-related bacteremia, malfunction, and central stenosis were 9%, 15%, and 2%, respectively. Risks for any CVC-related complication at 1 and 2 years were 30% and 38%, respectively. Death related to CVC complications occurred in 6 of 1,041 (0.5%) patients. Compared with patients younger than 60 years, patients aged 70 to 79 and those 80 years or older experienced lower rates of CVC complications: HRs of 0.67 (95% CI, 0.52-0.85; P = 0.001) and 0.69 (95% CI, 0.52-0.92; P = 0.01), respectively. LIMITATIONS: This Canadian dialysis population may not be representative of populations in other countries. CVC use was not compared with other types of hemodialysis vascular access. CONCLUSIONS: Approximately one-third of hemodialysis patients who used tunneled CVCs during 1 to 2 years experienced complications. Bacteremia occurred in ∼9% of patients at 1 year and were the most common cause of CVC-related hospitalizations. CVC-related death was infrequent. This information could be used to communicate the risk for CVC complications to patients treated with this type of hemodialysis vascular access.
RATIONALE & OBJECTIVE: Clinical practice guidelines discourage the use of central venous catheters (CVCs) for vascular access in dialysis. However, some patients have inadequate vessels for arteriovenous fistula creation or choose to use a dialysis catheter. The risks associated with CVC use and their relationship to patient age are poorly characterized. STUDY DESIGN: Observational retrospective cohort study. SETTING & PARTICIPANTS: Cohort of 1,041 patients older than 18 years from 5 Canadian dialysis programs who initiated outpatient maintenance hemodialysis therapy with a tunneled CVC between 2004 and 2012 and who had no creation of an arteriovenous fistula or arteriovenous graft. EXPOSURES: Age, sex, body size, initiating dialysis therapy in the hospital, and comorbid conditions. OUTCOMES: CVC-related procedures, hospitalization, and death. ANALYTICAL APPROACH: Complications were reported as a cumulative risk at 1 and 2 years. Cox proportional hazards regression for recurrent events was used to evaluate risk factors for study outcomes. RESULTS: At 1 year, risks for CVC-related bacteremia, malfunction, and central stenosis were 9%, 15%, and 2%, respectively. Risks for any CVC-related complication at 1 and 2 years were 30% and 38%, respectively. Death related to CVC complications occurred in 6 of 1,041 (0.5%) patients. Compared with patients younger than 60 years, patients aged 70 to 79 and those 80 years or older experienced lower rates of CVC complications: HRs of 0.67 (95% CI, 0.52-0.85; P = 0.001) and 0.69 (95% CI, 0.52-0.92; P = 0.01), respectively. LIMITATIONS: This Canadian dialysis population may not be representative of populations in other countries. CVC use was not compared with other types of hemodialysis vascular access. CONCLUSIONS: Approximately one-third of hemodialysis patients who used tunneled CVCs during 1 to 2 years experienced complications. Bacteremia occurred in ∼9% of patients at 1 year and were the most common cause of CVC-related hospitalizations. CVC-related death was infrequent. This information could be used to communicate the risk for CVC complications to patients treated with this type of hemodialysis vascular access.