The impact of an “acute dialysis start” on the mortality attributed to the use of central venous catheters: a retrospective cohort study

BMC Nephrology

Bryce A Kiberd¹  Steven D Soroka¹  Karthik K Tennankore² 

[1] Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada;Department of Medicine, Division of Nephrology, University of Toronto, University Health Network/Toronto General Hospital, 21 Carlton Street, Unit 1405, Toronto, ON, Canada

关键词: Chronic;    Acute;    Peritoneal;    Fistula;    Access;    Incident;    Catheter;    Dialysis;    Mortality;    Vascular;   

Others  :  1083141
DOI  :  10.1186/1471-2369-13-72

 received in 2012-04-26, accepted in 2012-07-11,  发布年份 2012

【 摘 要 】

Background

Central venous catheters (CVCs) are associated with early mortality in dialysis patients. However, some patients progress to end stage renal disease after an acute illness, prior to reaching an estimated glomerular filtration rate (eGFR) at which one would expect to establish alternative access (fistula/peritoneal dialysis catheter). The purpose of this study was to determine if exclusion of this “acute start” patient group alters the association between CVCs and mortality.

Methods

We conducted a retrospective cohort study of 406 incident dialysis patients from 1 Jan 2006 to 31 Dec 2009. Patients were classified as acute starts if 1) the eGFR was >25 ml/min/1.73 m², ≤3 months prior to dialysis initiation and declined after an acute event (n = 45), or 2) in those without prior eGFR measurements, there was no supporting evidence of chronic kidney disease on history or imaging (n = 12). Remaining patients were classified as chronic start (n = 349).

Results

98 % and 52 % of acute and chronic starts initiated dialysis with a CVC. There were 148 deaths. The adjusted mortality hazard ratio (HR) for acute vs. chronic start patients was 1.84, (95 % CI [1.19-2.85]). The adjusted mortality HR for patients dialyzing with a CVC compared to alternative access was 1.19 (95 % CI [0.80-1.77]). After excluding acute start patients, the adjusted HR fell to 1.03 (95 % CI [0.67-1.57]).

Conclusions

A significant proportion of early dialysis mortality occurs after an acute start. Exclusion of this population attenuates the mortality risk associated with CVCs.

【 授权许可】

   
2012 Tennankore et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]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):1449-1455.
• [2]Moist LM, Trpeski L, Na Y, Lok CE: Increased hemodialysis catheter use in Canada and associated mortality risk: data from the Canadian Organ Replacement Registry 2001-2004. Clin J Am Soc Nephrol 2008, 3(6):1726-1732.
• [3]Pisoni RL, Arrington CJ, Albert JM, Ethier J, Kimata N, Krishnan M, Rayner HC, Saito A, Sands JJ, Saran R, et al.: Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis 2009, 53(3):475-491.
• [4]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):477-486.
• [5]Astor BC, Eustace JA, Powe NR, Klag MJ, Sadler JH, Fink NE, Coresh J: Timing of nephrologist referral and arteriovenous access use: the CHOICE Study. Am J Kidney Dis 2001, 38(3):494-501.
• [6]Perl J, Wald R, McFarlane P, Bargman JM, Vonesh E, Na Y, Jassal SV, Moist L: Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol 2011, 22(6):1113-1121.
• [7]Jindal K, Chan CT, Deziel C, Hirsch D, Soroka SD, Tonelli M, Culleton BF: Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. J Am Soc Nephrol 2006, 17(3 Suppl 1):1-27.
• [8]2006 Updates Clinical Practice Guidelines and Recommendations: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy, Vascular Access. http://www.kidney.org/professionals/kdoqi/guidelines webcite
• [9]Sidawy AN, Spergel LM, Besarab A, Allon M, Jennings WC, Padberg FT, Murad MH, Montori VM, O'Hare AM, Calligaro KD: The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg 2008, 48(5):2-25.
• [10]Figueiredo A, Goh BL, Jenkins S, Johnson DW, Mactier R, Ramalakshmi S, Shrestha B, Struijk D, Wilkie M: Clinical practice guidelines for peritoneal access. Perit Dial Int 2010, 30(4):424-429.
• [11]Ponce D, Balbi AL: Peritoneal dialysis in acute kidney injury: a viable alternative. Perit Dial Int 2011, 31(4):387-389.
• [12]Povlsen JV, Ivarsen P: How to start the late referred ESRD patient urgently on chronic APD. Nephrol Dial Transplant 2006, 21(Suppl 2):56-59.
• [13]Bhandari S, Turney JH: Survivors of acute renal failure who do not recover renal function. QJM 1996, 89(6):415-421.
• [14]Hsu CY, Chertow GM, McCulloch CE, Fan D, Ordonez JD, Go AS: Nonrecovery of kidney function and death after acute on chronic renal failure. Clin J Am Soc Nephrol 2009, 4(5):891-898.
• [15]Descamps C, Labeeuw M, Trolliet P, Cahen R, Ecochard R, Pouteil-Noble C, Villar E: Confounding factors for early death in incident end-stage renal disease patients: Role of emergency dialysis start. Hemodial Int 2011, 15(1):23-29.
• [16]Lee P, Johansen K, Hsu CY: End-stage renal disease preceded by rapid declines in kidney function: a case series. BMC Nephrol 2011, 12:5. BioMed Central Full Text
• [17]Emamian SA, Nielsen MB, Pedersen JF, Ytte L: Kidney dimensions at sonography: correlation with age, sex, and habitus in 665 adult volunteers. AJR American journal of roentgenology 1993, 160(1):83-86.
• [18]Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40(5):373-383.
• [19]Bradbury BD, Fissell RB, Albert JM, Anthony MS, Critchlow CW, Pisoni RL, Port FK, Gillespie BW: Predictors of early mortality among incident US hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin J Am Soc Nephrol 2007, 2(1):89-99.
• [20]Nitsch D, Burden R, Steenkamp R, Ansell D, Byrne C, Caskey F, Roderick P, Feest T: Patients with diabetic nephropathy on renal replacement therapy in England and Wales. QJM 2007, 100(9):551-560.
• [21]Noordzij M, Korevaar JC, Dekker FW, Boeschoten EW, Bos WJ, Krediet RT, Bossuyt PM, Geskus RB: Mineral metabolism and mortality in dialysis patients: a reassessment of the K/DOQI guideline. Blood Purif 2008, 26(3):231-237.
• [22]Plantinga LC, Fink NE, Levin NW, Jaar BG, Coresh J, Levey AS, Klag MJ, Powe NR: Early, intermediate, and long-term risk factors for mortality in incident dialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. Am J Kidney Dis 2007, 49(6):831-840.
• [23]Wright S, Klausner D, Baird B, Williams ME, Steinman T, Tang H, Ragasa R, Goldfarb-Rumyantzev AS: Timing of dialysis initiation and survival in ESRD. Clin J Am Soc Nephrol 2010, 5(10):1828-1835.
• [24]Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE: The impact of anemia on cardiomyopathy, morbidity, and and mortality in end-stage renal disease. Am J Kidney Dis 1996, 28(1):53-61.
• [25]Smart NA, Titus TT: Outcomes of early versus late nephrology referral in chronic kidney disease: a systematic review. Am J Med 2011, 124(11):1073-1080.
• [26]Hemmelgarn BR, Manns BJ, Quan H, Ghali WA: Adapting the Charlson Comorbidity Index for use in patients with ESRD. Am J Kidney Dis 2003, 42(1):125-132.
• [27]Wu VC, Huang TM, Lai CF, Shiao CC, Lin YF, Chu TS, Wu PC, Chao CT, Wang JY, Kao TW, et al.: Acute-on-chronic kidney injury at hospital discharge is associated with long-term dialysis and mortality. Kidney Int 2011, 80(11):1222-1230.
• [28]Lafrance JP, Miller DR: Acute kidney injury associates with increased long-term mortality. J Am Soc Nephrol 2010, 21(2):345-352.
• [29]Shafi T, Jaar BG, Plantinga LC, Fink NE, Sadler JH, Parekh RS, Powe NR, Coresh J: Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study. Am J Kidney Dis 2010, 56(2):348-358.
• [30]Bargman JM, Thorpe KE, Churchill DN: Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol 2001, 12(10):2158-2162.
• [31]Lacson E, Wang W, Lazarus JM, Hakim RM: Change in vascular access and mortality in maintenance hemodialysis patients. Am J Kidney Dis 2009, 54(5):912-921.
• [32]Chan KE, Maddux FW, Tolkoff-Rubin N, Karumanchi SA, Thadhani R, Hakim RM: Early outcomes among those initiating chronic dialysis in the United States. Clin J Am Soc Nephrol 2011, 6(11):2642-2649.
• [33]Udayaraj UP, Haynes R, Winearls CG: Late presentation of patients with end-stage renal disease for renal replacement therapy–is it always avoidable? Nephrol Dial Transplant 2011, 26(11):3646-3651.
• [34]Schinstock CA, Albright RC, Williams AW, Dillon JJ, Bergstralh EJ, Jenson BM, McCarthy JT, Nath KA: Outcomes of arteriovenous fistula creation after the fistula first initiative. Clin J Am Soc Nephrol 2011, 6(8):1996-2002.
• [35]Biuckians A, Scott EC, Meier GH, Panneton JM, Glickman MH: The natural history of autologous fistulas as first-time dialysis access in the KDOQI era. J Vasc Surg 2008, 47(2):415-421.
• [36]Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN: A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 2007, 45(2):420-426.
• [37]Vachharajani TJ, Moossavi S, Jordan JR, Vachharajani V, Freedman BI, Burkart JM: Re-evaluating the Fistula First Initiative in Octogenarians on Hemodialysis. Clin J Am Soc Nephrol 2011, 6(7):1663-1667.
• [38]Richardson AI, Leake A, Schmieder GC, Biuckians A, Stokes GK, Panneton JM, Glickman MH: Should fistulas really be first in the elderly patient? J Vasc Access 2009, 10(3):199-202.
• [39]Mendelssohn DC, Curtis B, Yeates K, Langlois S, MacRae JM, Semeniuk LM, Camacho F, McFarlane P: Suboptimal initiation of dialysis with and without early referral to a nephrologist. Nephrol Dial Transplant 2011, 26(9):2959-2965.
• [40]Mendelssohn DC, Malmberg C, Hamandi B: An integrated review of "unplanned" dialysis initiation: reframing the terminology to "suboptimal" initiation. BMC Nephrol 2009, 10:22. BioMed Central Full Text
• [41]O'Hare AM, Batten A, Burrows NR, Pavkov ME, Taylor L, Gupta I, Todd-Stenberg J, Maynard C, Rodriguez RA, Murtagh FE, et al.: Trajectories of kidney function decline in the 2 years before initiation of long-term dialysis. Am J Kidney Dis 2012, 59(4):513-522.
• [42]Sens F, Schott-Pethelaz AM, Labeeuw M, Colin C, Villar E: Survival advantage of hemodialysis relative to peritoneal dialysis in patients with end-stage renal disease and congestive heart failure. Kidney Int 2011, 80(9):970-977.
• [43]Couchoud C, Moranne O, Frimat L, Labeeuw M, Allot V, Stengel B: Associations between comorbidities, treatment choice and outcome in the elderly with end-stage renal disease. Nephrol Dial Transplant 2007, 22(11):3246-3254.
• [44]Hoen B, Paul-Dauphin A, Hestin D, Kessler M: EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol 1998, 9(5):869-876.
• [45]Manns B, Tonelli M, Yilmaz S, Lee H, Laupland K, Klarenbach S, Radkevich V, Murphy B: Establishment and maintenance of vascular access in incident hemodialysis patients: a prospective cost analysis. J Am Soc Nephrol 2005, 16(1):201-209.
• [46]Wasse H, Kutner N, Zhang R, Huang Y: Association of initial hemodialysis vascular access with patient-reported health status and quality of life. Clin J Am Soc Nephrol 2007, 2(4):708-714.
• [47]Ng LJ, Chen F, Pisoni RL, Krishnan M, Mapes D, Keen M, Bradbury BD: Hospitalization risks related to vascular access type among incident US hemodialysis patients. Nephrol Dial Transplant 2011, 26(11):3659-3666.