Vascular Access and Survival in a Large Catheter-Dominant Dialysis Program

Damien Ashby, Neill Duncan, Albert Power, Sophie Kathirgamanathan

Research output: Contribution to conferenceConference Posterpeer-review

Abstract

Background: Compared to other forms of access, arteriovenous fi stulae are associated with improved survival in haemodialysis patients, and are widely believed to be superior, but the evidence base is entirely observational, and therefore subject to bias. Centre level data avoids some of this bias, so the outcome in centres with unusual practice patterns can be informative.
Methods: The largest UK dialysis centre(currently 1390 haemodialysis patients) is also an extreme outlier in terms of access practice with 80% of prevalent patients dialysing on tunneled catheters. This retrospective study examined survival after 90 days, in a cohort of patients who started dialysis during a 3 year period, with respect to vascular access.
Results: Between 01.12.2005 and 01.12.2008, 746 incident haemodialysis patients (aged 18–91, 60.1% male, 47.2% caucasian) were included. The dominant form of access was a pair of single-lumen tunneled catheters, used in 85.4% of patients at 90 days. Over a meanobservation period of 1178 days 34.7% of patients died, with fi stula access associated with longer survival (median 2721 versus 2298 days, p=0.019). In a Cox regression
model, the independent predictors of survival were age, ethnicity, comorbidity and renal diagnosis, with fi stula access only weakly associated with outcome (HR 0.717, p=0.116). In the catheter group, one year(after 90 day) survival was 91.5%, after adjustment to age 60.This compares favourably with the UK age adjusted average of 89.0% for the whole 2008 incident cohort (all access types).
Conclusions: The advantage of fistula access is diminished in this catheter-dominant program, where outcome in catheter patients is at least equivalent to the national average. This could be because catheter outcomes are improved incentres where they are more frequently used, or because a substantial fraction of the fistula “advantage” is actually a result of selection bias.
Original languageEnglish
Pages868A-868A
Number of pages1
Publication statusPublished - 2014
EventAmerican Society of Nephrology, Kidney Week 2014 - Philadelphia, United States
Duration: 11 Nov 201416 Nov 2014

Conference

ConferenceAmerican Society of Nephrology, Kidney Week 2014
CountryUnited States
CityPhiladelphia
Period11/11/1416/11/14

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