Abstract
BackgroundNon-tunneled (temporary) hemodialysis catheters (NTHCs) are the least-optimal initial vascular access for incident maintenance hemodialysis patients yet little is known about factors associated with NTHC use in this context. We sought to determine factors associated with NTHC use and examine regional and facility-level variation in NTHC use for incident maintenance hemodialysis patients.MethodsWe analyzed registry data collected between January 2001 and December 2010 from 61 dialysis facilities within 12 geographic regions in Canada. Multi-level models and intra-class correlation coefficients were used to evaluate variation in NTHC use as initial hemodialysis access across facilities and geographic regions. Facility and patient characteristics associated with the lowest and highest quartiles of NTHC use were compared.ResultsDuring the study period, 21,052 patients initiated maintenance hemodialysis using a central venous catheter (CVC). This included 10,183 patients (48.3 %) in whom the initial CVC was a NTHC, as opposed to a tunneled CVC. Crude variation in NTHC use across facilities ranged from 3.7 to 99.4 % and across geographic regions from 32.4 to 85.1 %. In an adjusted multi-level logistic regression model, the proportion of total variation in NTHC use explained by facility-level and regional variation was 40.0 % and 34.1 %, respectively. Similar results were observed for the subgroup of patients who received greater than 12 months of pre-dialysis nephrology care. Patient-level factors associated with increased NTHC use were male gender, history of angina, pulmonary edema, COPD, hypertension, increasing distance from dialysis facility, higher serum phosphate, lower serum albumin and later calendar year.ConclusionsThere is wide variation in NTHC use as initial vascular access for incident maintenance hemodialysis patients across facilities and geographic regions in Canada. Identifying modifiable factors that explain this variation could facilitate a reduction of NTHC use in favor of more optimal initial vascular access.
Highlights
Non-tunneled hemodialysis catheters (NTHCs) are the least-optimal initial vascular access for incident maintenance hemodialysis patients yet little is known about factors associated with Non-tunneled (temporary) hemodialysis catheters (NTHCs) use in this context
Similar to what has been well described for tunneled catheters [3], likely related to consequent central venous stenosis [1], there is some evidence to suggest that initial use of a NTHC is associated with later vascular access complications such as arteriovenous fistula (AVF) thrombosis [5]
Despite efforts aimed at improving access to and provision of pre-dialysis nephrology care to minimize the use of central venous catheters (CVCs) [6], CVCs remain the initial vascular access for up to 80 % of chronic hemodialysis patients in Canada [7]
Summary
Non-tunneled (temporary) hemodialysis catheters (NTHCs) are the least-optimal initial vascular access for incident maintenance hemodialysis patients yet little is known about factors associated with NTHC use in this context. Non-tunneled (temporary) hemodialysis catheters (NTHCs) are the preferred initial vascular access for patients with acute kidney injury (AKI) [1]. For patients initiating chronic hemodialysis, NTHCs are the least optimal initial vascular access [2,3,4]. Despite efforts aimed at improving access to and provision of pre-dialysis nephrology care to minimize the use of central venous catheters (CVCs) (tunneled CVCs and NTHCs) [6], CVCs remain the initial vascular access for up to 80 % of chronic hemodialysis patients in Canada [7]. Little is known about the use of NTHCs as previous studies have not distinguished between tunneled CVCs and NTHCs [8,9,10]
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