Background: Previous studies postulate that end-stage renal disease (ESRD) patients dialyzed with central venous catheters (CVC) have poorer outcomes compared to patients using arteriovenous fistulae (AVF) or arteriovenous grafts (AVG). Clinical practice guidelines should obviate these differences if access was not important. This study compared clinical measures of adequacy, anemia, and nutrition/inflammation in prevalent hemodialysis patients in 2003 by access type. Methods: Data from The Renal Network Data System were analyzed by univariate analysis of variance to compare Kt/V, URR, albumin, hemoglobin (Hb) and recombinant human erythropoietin (EPO) dose by access type, while adjusting for pertinent factors. Results: 12,501 patients were included. The access type distribution was AVF 36%, AVG 41%, and CVC 23%. CVC patients had lower mean URR, Kt/V, albumin concentration (p < 0.001) than other accesses. Serum Hbs were similar (p = 0.416), however EPO dose (U/kg/week) was higher in those dialyzed with CVC compared to AVF/AVG (p < 0.001). Conclusions: Despite practice guidelines, patients dialyzed via CVC have poorer outcome measures compared to other accesses. This suggests that AVF should be used and/or appropriate adjustments need to be made for those dialyzed with CVC to achieve equal outcomes. Further studies defining barriers need to be conducted.

Keywords:
Vascular access, Hemodialysis, Arteriovenous fistula, Central venous catheter
1.
Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK: Type of vascular access and mortality in US hemodialysis patients. Kidney Int 2001;60:1443–1451.
2.
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;16:1449–1455.
3.
Pastan S, Soucie JM, McClellan WM: Vascular access and increased risk of death among hemodialysis patients. Kidney Int 2002;62:620–626.
4.
Greenwood RN, Ronco C, Gastaldon F, Brendolan A, Homel P, Usvyat L, et al: Erythropoeitin dose variation in different facilities in different countries and its relationship to drug resistance. Kidney Int 2003;(suppl):S78–S86.
5.
Roberts TL, Obrador GT, St Peter WL, Pereira BJ, Collins AJ: Relationship among catheter insertions, vascular access infections, and anemia management in hemodialysis patients. Kidney Int 2004;66:2429–2436.
6.
Goicoechea M, Caramelo C, Rodriguez P, Verde E, Gruss E, Albalate M, et al: Role of type of vascular access in erythropoietin and intravenous iron requirements in haemodialysis. Nephrol Dial Transplant 2001;16:2188–2193.
7.
Rocco MV, Dwyer JT, Larive B, Greene T, Cockram DB, Chumlea WC, et al: The effect of dialysis dose and membrane flux on nutritional parameters in hemodialysis patients: results of the HEMO Study. Kidney Int 2004;65:2321–2334.
8.
Leavey SF, Strawderman RL, Young EW, Saran R, Roys E, Agodoa LY, et al: Cross-sectional and longitudinal predictors of serum albumin in hemodialysis patients. Kidney Int 2000;58:2119–2128.
9.
Rayner HC, Besarab A, Brown WW, Disney A, Saito A, Pisoni RL: Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines. Am J Kidney Dis 2004;44:22–26.
10.
Collins AJ, Roberts TL, St Peter WL, Chen SC, Ebben J, Constantini E: United States Renal Data System assessment of the impact of the National Kidney Foundation-Dialysis Outcomes Quality Initiative guidelines. Am J Kidney Dis 2002;39:784–795.
11.
US Renal Data System, USRDS 2005 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2005.
12.
I. NKF-K/DOQI Clinical Practice Guidelines for Hemodialysis Adequacy: update 2000. Am J Kidney Dis 2001;37:S7–S64.
13.
NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: Update 2000. Am J Kidney Dis 2001;37:S137–S181.
14.
IV. NKF-K/DOQI Clinical Practice Guidelines for Anemia of Chronic Kidney Disease: update 2000. Am J Kidney Dis 2001;37:S182–S238.
15.
K/DOQI, National Kidney Foundation: Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2000;35:S1–S140.
16.
Daugirdas JT: Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol 1993;4:1205–1213.
17.
Daugirdas JT, Greene T, Depner TA, Gotch FA, Star RA: Relationship between apparent (single-pool) and true (double-pool) urea distribution volume. Kidney Int 1999;56:1928–1933.
18.
Cortez AJ, Paulson WD, Schwab SJ: Vascular access as a determinant of adequacy of dialysis. Semin Nephrol 2005;25:96–101.
19.
Kaysen GA: Serum albumin concentration in dialysis patients: why does it remain resistant to therapy? Kidney Int 2003;(suppl):S92–S98.
© 2008 S. Karger AG, Basel
2008
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