Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study
Open Access
- 23 August 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Nephrology
- Vol. 13 (1), 1-7
- https://doi.org/10.1186/1471-2369-13-88
Abstract
Background: Although several studies have demonstrated early survival advantages with peritoneal dialysis (PD) over hemodialysis (HD), the reason for the excess mortality observed among incident HD patients remains to be established, to our knowledge. This study explores the relationship between mortality and dialysis modality, focusing on the role of HD vascular access type at the time of dialysis initiation. Methods: A retrospective cohort study was performed among local adult chronic kidney disease patients who consecutively initiated PD and HD with a tunneled cuffed venous catheter (HD-TCC) or a functional arteriovenous fistula (HD-AVF) in our institution in the year 2008. A total of 152 patients were included in the final analysis (HD-AVF, n = 59; HD-TCC, n = 51; PD, n = 42). All cause and dialysis access-related morbidity/mortality were evaluated at one year. Univariate and multivariate analysis were used to compare the survival of PD patients with those who initiated HD with an AVF or with a TCC. Results: Compared with PD patients, both HD-AVF and HD-TCC patients were more likely to be older (pp = 0.017) and cardiovascular disease (p = 0.020). Overall, HD-TCC patients were more likely to have clinical visits (p = 0.069), emergency room visits (ppvs. 0.93 vs. 0.64, per patient-year; pvs. 0.07 vs. 0.14, per patient-year; p = 0.034) than HD-AVF and PD patients, respectively. The survival rates at one year were 96.6%, 74.5% and 97.6% for HD-AVF, HD-TCC and PD groups, respectively (pp = 0.024). Conclusion: Our results suggest that HD vascular access type at the time of renal replacement therapy initiation is an important modifier of the relationship between dialysis modality and survival among incident dialysis patients.Keywords
This publication has 28 references indexed in Scilit:
- Selection Bias Explains Apparent Differential Mortality between Dialysis ModalitiesJournal of the American Society of Nephrology, 2011
- Choosing peritoneal dialysis reduces the risk of invasive access interventionsNephrology Dialysis Transplantation, 2011
- Hemodialysis Vascular Access Modifies the Association between Dialysis Modality and SurvivalJournal of the American Society of Nephrology, 2011
- Educating end-stage renal disease patients on dialysis modality selection: clinical advice from the European Renal Best Practice (ERBP) Advisory BoardNephrology Dialysis Transplantation, 2010
- Propensity-Matched Mortality Comparison of Incident Hemodialysis and Peritoneal Dialysis PatientsJournal of the American Society of Nephrology, 2010
- An integrated review of "unplanned" dialysis initiation: reframing the terminology to "suboptimal" initiationBMC Nephrology, 2009
- Ethical and Legal Obligation to Avoid Long-Term Tunneled Catheter AccessClinical Journal of the American Society of Nephrology, 2009
- Increased Hemodialysis Catheter Use in Canada and Associated Mortality RiskClinical Journal of the American Society of Nephrology, 2008
- Initial survival advantage of peritoneal dialysis relative to haemodialysisNephrology Dialysis Transplantation, 2002
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987