Characteristics and 3-year mortality and infection rates among incident hemodialysis patients with a permanent catheter undergoing a first vascular access conversion

Abstract

Although vascular access conversions to arteriovenous fistula (AVF)/arteriovenous graft (AVG) in incident and maintenance hemodialysis (HD) patients are reported to be associated with lower mortality and infection risk, it is unclear whether these effects are limited to the first year. The aims of this historical cohort study were to investigate patient characteristics of vascular access conversion and the impact of vascular access conversion on 1- and 3-year mortality and infection rates in incident HD patients with a permanent catheter to initiate HD. Our study included 868 incident patients who underwent HD for at least 3 months and who, between January 1, 2004 and December 31, 2006, received a permanent catheter within 3 days of starting HD. The effects of vascular access conversion on rates of infection and mortality during the subsequent 3 years were assessed using claims data from the National Health Insurance Program in Taiwan. Factors associated with lower 1- and 3-year mortality and infection rates were a first vascular access converted to AVF or AVG, female gender, age <65 years, and the presence of a lower Romano-Charlson comorbidity index score (P < 0.05). Patients who received an AVF/AVG at hospitals which perform a high number of vascular access procedures annually had lower 3-year infection rates. The lower mortality and infection rates also extended throughout the 3-year period in incident patients starting HD with a permanent catheter to receiving vascular access conversion to AVF (Hazard ratio [HR] 0.47, 95 % CI 0.32-0.67, P < 0.0001) and AVG (HR 0.51, 95 % CI 0.27-0.99, P < 0.05).