Examining the Association between Hemodialysis Access Type and Mortality: The Role of Access Complications

Clinical Journal of the American Society of Nephrology : CJASN
Pietro RavaniBrenda W Gillespie

Abstract

People receiving hemodialysis to treat kidney failure need a vascular access (a fistula, a graft, or a central venous catheter) to connect to the blood purification machine. Higher rates of access complications are considered the mechanism responsible for the excess mortality observed among catheter or graft users versus fistula users. We tested this hypothesis using mediation analysis. We studied incident patients who started hemodialysis therapy from North America, Europe, and Australasia (the Dialysis Outcomes and Practice Patterns Study; 1996-2011). We evaluated the association between access type and time to noninfectious (e.g., thrombosis) and infectious complications of the access (mediator model) and the relationship between access type and time-dependent access complications with 6-month mortality from the creation of the first permanent access (outcome model). In mediation analysis, we formally tested whether access complications explain the association between access type and mortality. Of the 6119 adults that we studied (mean age =64 [SD=15] years old; 58% men; 47% patients with diabetes), 50% had a permanent catheter for vascular access, 37% had a fistula, and 13% had a graft. During the 6-month study follow-up, 20...Continue Reading

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Citations

Feb 7, 2018·Current Opinion in Nephrology and Hypertension·Adam PapiniRobert R Quinn
May 20, 2017·Clinical Journal of the American Society of Nephrology : CJASN·Timmy Lee, Michael Allon
Sep 9, 2018·Clinical Journal of the American Society of Nephrology : CJASN·Robert S BrownRoger B Davis
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