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- Title
Hospitalization risks related to vascular access type among incident US hemodialysis patients.
- Authors
Ng, Leslie J.; Chen, Fangfei; Pisoni, Ronald L.; Krishnan, Mahesh; Mapes, Donna; Keen, Marcia; Bradbury, Brian D.
- Abstract
Background. The excess morbidity and mortality related to catheter utilization at and immediately following dialysis initiation may simply be a proxy for poor prognosis. We examined hospitalization burden related to vascular access (VA) type among incident patients who received some predialysis care.Methods. We identified a random sample of incident US Dialysis Outcomes and Practice Patterns Study hemodialysis patients (1996–2004) who reported predialysis nephrologist care. VA utilization was assessed at baseline and throughout the first 6 months on dialysis. Poisson regression was used to estimate the risk of all-cause and cause-specific hospitalizations during the first 6 months.Results. Among 2635 incident patients, 60% were dialyzing with a catheter, 22% with a graft and 18% with a fistula at baseline. Compared to fistulae, baseline catheter use was associated with an increased risk of all-cause hospitalization [adjusted relative risk (RR) = 1.30, 95% confidence interval (CI): 1.09–1.54] and graft use was not (RR = 1.07, 95% CI: 0.89–1.28). Allowing for VA changes over time, the risk of catheter versus fistula use was more pronounced (RR = 1.72, 95% CI: 1.42–2.08) and increased slightly for graft use (RR = 1.15, 95% CI: 0.94–1.41). Baseline catheter use was most strongly related to infection-related (RR = 1.47, 95% CI: 0.92–2.36) and VA-related hospitalizations (RR = 1.49, 95% CI: 1.06–2.11). These effects were further strengthened when VA use was allowed to vary over time (RR = 2.31, 95% CI: 1.48–3.61 and RR = 3.10, 95% CI: 1.95–4.91, respectively). A similar pattern was noted for VA-related hospitalizations with graft use.Discussion. Among potentially healthier incident patients, hospitalization risk, particularly infection and VA-related, was highest for patients dialyzing with a catheter at initiation and throughout follow-up, providing further support to clinical practice recommendations to minimize catheter placement.
- Subjects
UNITED States; HOSPITAL care; HEMODIALYSIS patients; HEALTH outcome assessment; NEPHROLOGISTS; FISTULA; MEDICAL statistics; MEDICAL care
- Publication
Nephrology Dialysis Transplantation, 2011, Vol 26, Issue 11, p3659
- ISSN
0931-0509
- Publication type
Article