3 years ago

Nonprogrammed Vascular Access Is Associated With Greater Mortality in Patients Who Return to Hemodialysis With a Failing Renal Graft

Pujol, Gervasio Soler, Laham, Gustavo, Diaz, Carlos, Cusumano, Ana, Vilches, Antonio
imageBackground: In incident hemodialysis (HD) patients, the use of catheters is associated with a worse prognosis when compared with those with an arteriovenous fistula, but the role of vascular access (VA) type in the morbidity and mortality of patients returning to HD with a failing renal allograft is unknown. We aimed to determine the associations between the type of VA and mortality in this population. Methods: This was a retrospective observational cohort study of 138 patients who initiated dialysis after kidney transplant failure between 1995 and 2014. We recorded access type, laboratory values at entry, stratified patients per risk, and determined the effect on mortality of programmed VA (PVA), (arteriovenous fistula or PTFE graft) and nonprogrammed VA (UPVA) (tunneled or nontunneled catheters) at the initiation of HD. Results: Eighty-five (61.6%) and 53 (38.4%) patients initiated therapy with PVA and UPVA, respectively. Overall mortality was 14.6% at 1 year. Patients using catheters had greater mortality than those with a PVA (log rank P <0.0001). At 24 months, 7 patients died in PVA group versus 22 in UPVA group. Multivariate Cox analysis showed that initiation of HD with a catheter (hazard ratio, 5.90; 95%, confidence interval, 2.83-12.31) was independently associated with greater mortality after adjusting for confounders. Conclusions: Nonprogrammed VA with a catheter predicted all-cause mortality among patients with transplant failure reentering HD.
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