Introduction: Central venous catheter (CVC) as vascular access in hemodialysis (HD) associates with adverse outcomes. Early CVC to fistula or graft conversion improves these outcomes. While socioeconomic disparities between the USA and Mexico exist, little is known about CVC prevalence and conversion rates in uninsured Mexican HD patients. We examined vascular access practice patterns and their effects on survival and hospitalization rates among uninsured Mexican HD patients, in comparison with HD patients who initiated treatment in the USA. Methods: In this retrospective study of incident HD patients at Hospital Civil (HC; Guadalajara, MX) and the Renal Research Institute (RRI; USA), we categorized patients by the vascular access at the first month of HD and after the following 6 months. Factors associated with continued CVC use were identified by a logistic regression model. We developed multivariate Cox proportional hazards models to investigate the effects of access and conversion on mortality and hospitalization over an 18-month follow-up period. Results: In 1,632 patients from RRI, the CVC prevalence at month 1 was 64% and 97% among 174 HC patients. The conversion rate was 31.7% in RRI and 10.6% in HC. CVC to non-central venous catheter (NON-CVC) conversion reduced the risk of hospitalization in both HC (aHR 0.38 [95% CI: 0.21–0.68], p = 0.001) and RRI (aHR 0.84 [95% CI: 0.73–0.93], p = 0.001). NON-CVC patients had a lower mortality risk in both populations. Discussion/Conclusion: CVC prevalence and conversion rates of CVC to NON-CVC differed between the US and Mexican patients. An association exists between vascular access type and hospitalization and mortality risk. Prospective studies are needed to evaluate if accelerated and systematic catheter use reduction would improve outcomes in these populations.

1.
Garcia-Garcia
G
,
Garcia-Bejarano
H
,
Breien-Coronado
H
,
Perez-Cortes
G
,
Pazarin-Villaseñor
L
,
De la Torre-Campos
L
,
End-stage renal disease in Mexico
. In:
Garcia-Garcia
G
,
Agodoa
L
,
Norris
K
, editors. Chronic kidney disease in disadvantaged populations.
New York
:
Elsevier
;
2017
. p.
77
82
.
2.
Méndez-Durán
A
,
Ignorosa-Luna
MH
,
Pérez-Aguilar
G
,
Rivera-Rodríguez
FJ
,
González-Izquierdo
JJ
,
Dávila-Torres
J
.
Current status of alternative therapies renal function at the Instituto Mexicano del Seguro Social
.
Rev Med Inst Mex Seguro Soc
.
2016
;
54
(
5
):
588
93
.
3.
Metcalfe
W
,
Khan
IH
,
Prescott
GJ
,
Simpson
K
,
Macleod
AM
.
Hospitalization in the first year of renal replacement therapy for end-stage renal disease
.
QJM
.
2003
;
96
(
12
):
899
909
. .
4.
Rayner
HC
,
Pisoni
RL
,
Bommer
J
,
Canaud
B
,
Hecking
E
,
Locatelli
F
,
Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
.
Nephrol Dial Transplant
.
2004
;
19
(
1
):
108
20
. .
5.
O'Connor
AS
,
Wish
JB
,
Sehgal
AR
.
The morbidity and cost implications of hemodialysis clinical performance measures
.
Hemodial Int
.
2005
;
9
(
4
):
349
61
. .
6.
Dixon
BS
,
Novak
L
,
Fangman
J
.
Hemodialysis vascular access survival: upper-arm native arteriovenous fistula
.
Am J Kidney Dis
.
2002
;
39
(
1
):
92
101
. .
7.
Astor
BC
,
Eustace
JA
,
Powe
NR
,
Klag
MJ
,
Fink
NE
,
Coresh
J
,
Type of vascular access and survival among incident hemodialysis patients: the choices for healthy outcomes in caring for ESRD (CHOICE) Study
.
J Am Soc Nephrol
.
2005
;
16
(
5
):
1449
55
. .
8.
Dhingra
RK
,
Young
EW
,
Hulbert-Shearon
TE
,
Leavey
SF
,
Port
FK
.
Type of vascular access and mortality in US hemodialysis patients
.
Kidney Int
.
2001
;
60
(
4
):
1443
51
. .
9.
Pastan
S
,
Soucie
JM
,
McClellan
WM
.
Vascular access and increased risk of death among hemodialysis patients
.
Kidney Int
.
2002
;
62
(
2
):
620
6
. .
10.
Pisoni
RL
,
Arrington
CJ
,
Albert
JM
,
Ethier
J
,
Kimata
N
,
Krishnan
M
,
Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis
.
Am J Kidney Dis
.
2009
;
53
(
3
):
475
91
. .
11.
Polkinghorne
KR
,
McDonald
SP
,
Atkins
RC
,
Kerr
PG
.
Vascular access and all-cause mortality: a propensity score analysis
.
J Am Soc Nephrol
.
2004
;
15
(
2
):
477
86
. .
12.
Quinn
RR
,
Oliver
MJ
,
Devoe
D
,
Poinen
K
,
Kabani
R
,
Kamar
F
,
The effect of predialysis fistula attempt on risk of all-cause and access-related death
.
J Am Soc Nephrol
.
2017
;
28
(
2
):
613
20
. .
13.
Brown
RS
,
Patibandla
BK
,
Goldfarb-Rumyantzev
AS
.
The survival benefit of “fistula first, catheter last” in hemodialysis is primarily due to patient factors
.
J Am Soc Nephrol
.
2017
;
28
(
2
):
645
52
. .
14.
Tirado-Gómez
LL
,
Durán-Arenas
JL
,
Rojas-Russell
ME
,
Venado-Estrada
A
,
Pacheco-Domínguez
RL
,
López-Cervantes
M
.
An evaluation of the characteristics, processes and outcomes of hemodialysis units in Mexico
.
Salud Publica Mex
.
2011
;
53
(
Suppl 4
):
491
8
. .
15.
Parra-Avila
I
,
Morales-Buenrostro
L
.
Epidemiología de la enfermedad renal en México
.
Mexico City
:
Academia Nacional de Medicina de México (ANMM)
;
2019
. Available from: http://www.anmm.org.mx/publicaciones/CAnivANM150/ACCESOS-VASCULARES.pdf.
16.
Lynch
JR
,
Wasse
H
,
Armistead
NC
,
McClellan
WM
.
Achieving the goal of the fistula first breakthrough initiative for prevalent maintenance hemodialysis patients
.
Am J Kidney Dis
.
2011
;
57
(
1
):
78
89
. .
17.
III. NKF-K/DOQI clinical practice guidelines for vascular access: update 2000
.
Am J Kidney Dis
.
2001
;
37
(
1 Suppl 1
):
S137
81
.
18.
Fistula first national access improvement initiative. Fistula first update 2011 United States of America: Fistula first; 2011.
19.
Spergel
LM
.
Has the fistula first breakthrough initiative caused an increase in catheter prevalence?
Semin Dial
.
2008
;
21
(
6
):
550
2
. .
20.
Lin
E
,
Mell
MW
,
Winkelmayer
WC
,
Erickson
KF
.
Health insurance in the first 3 months of hemodialysis and early vascular access
.
Clin J Am Soc Nephrol
.
2018
;
13
(
12
):
1866
75
. .
21.
Garcia-Garcia
G
,
Chavez-Iñiguez
JS
.
The tragedy of having ESRD in Mexico
.
Kidney Int Rep
.
2018
;
3
(
5
):
1027
9
. .
22.
Garcia-Garcia
G
,
Briseño-Rentería
G
,
Luquín-Arellan
VH
,
Gao
Z
,
Gill
J
,
Tonelli
M
.
Survival among patients with kidney failure in Jalisco, Mexico
.
J Am Soc Nephrol
.
2007
;
18
(
6
):
1922
7
. .
23.
Lee
T
,
Barker
J
,
Allon
M
.
Tunneled catheters in hemodialysis patients: reasons and subsequent outcomes
.
Am J Kidney Dis
.
2005
;
46
(
3
):
501
8
. .
24.
Asif
A
,
Cherla
G
,
Merrill
D
,
Cipleu
CD
,
Briones
P
,
Pennell
P
.
Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula
.
Kidney Int
.
2005
;
67
(
6
):
2399
406
. .
25.
Astor
BC
,
Eustace
JA
,
Powe
NR
,
Klag
MJ
,
Sadler
JH
,
Fink
NE
,
Timing of nephrologist referral and arteriovenous access use: the CHOICE Study
.
Am J Kidney Dis
.
2001
;
38
(
3
):
494
501
. .
26.
MacRae
JM
,
Ahmed
A
,
Johnson
N
,
Levin
A
,
Kiaii
M
.
Central vein stenosis: a common problem in patients on hemodialysis
.
ASAIO J
.
2005
;
51
(
1
):
77
81
. .
27.
Lacson
E
,
Wang
W
,
Lazarus
JM
,
Hakim
RM
.
Change in vascular access and hospitalization risk in long-term hemodialysis patients
.
Clin J Am Soc Nephrol
.
2010
;
5
(
11
):
1996
2003
. .
28.
Ng
LJ
,
Chen
F
,
Pisoni
RL
,
Krishnan
M
,
Mapes
D
,
Keen
M
,
Hospitalization risks related to vascular access type among incident US hemodialysis patients
.
Nephrol Dial Transplant
.
2011
;
26
(
11
):
3659
66
. .
29.
Bradbury
BD
,
Chen
F
,
Furniss
A
,
Pisoni
RL
,
Keen
M
,
Mapes
D
,
Conversion of vascular access type among incident hemodialysis patients: description and association with mortality
.
Am J Kidney Dis
.
2009
;
53
(
5
):
804
14
. .
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.