Overutilization of central venous catheters in incident hemodialysis patients: Reasons and potential resolution strategies

Oliver Lenz, Sanghamitra Sadhu, Alessia Fornoni, Arif Asif

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Even after adjusting for comorbidities, the outcomes in hemodialysis (HD) patients using a central venous catheter (CVC) as dialysis access are worse than in those with a permanent vascular access. In spite of this, nationwide data suggest that only about 25% of incident HD patients initiate dialysis with an arteriovenous fistula. We conducted a retrospective study to identify reasons and resolution strategies for CVC use in patients who initiated HD at an academic medical center with a well-established chronic kidney disease (CKD) clinic and a dedicated vascular surgeon. Estimated glomerular filtration rate (eGFR) loss over time to record progression of patients to HD was also examined. The charts of 170 consecutive patients were reviewed. Ninety-two percent were found to initiate HD using a CVC. Three factors explained 93% of all CVC in our cohort: absence of adequate predialysis care (45%), acute illness with failure to recover from an episode of acute renal failure (31%), and patient's failure to adhere to scheduled clinic or surgical appointments (17%). In addition, analyses of eGFR suggest that the velocity of GFR loss rather than a defined degree of renal function might be a better trigger for vascular access referral. We conclude that early referral, a close follow up of CKD patients who initiate dialysis due to acute illness, and patient education may have a positive impact to counteract overutilization of CVCs for dialysis. The rate in eGFR decline might also be used to calculate the referral time adequate for fistula creation.

Original languageEnglish
Pages (from-to)543-550
Number of pages8
JournalSeminars in Dialysis
Volume19
Issue number6
DOIs
StatePublished - Nov 1 2006

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Central Venous Catheters
Renal Dialysis
Dialysis
Glomerular Filtration Rate
Blood Vessels
Referral and Consultation
Chronic Renal Insufficiency
Arteriovenous Fistula
Patient Education
Acute Kidney Injury
Fistula
Comorbidity
Appointments and Schedules
Retrospective Studies
Kidney

ASJC Scopus subject areas

  • Nephrology

Cite this

Overutilization of central venous catheters in incident hemodialysis patients : Reasons and potential resolution strategies. / Lenz, Oliver; Sadhu, Sanghamitra; Fornoni, Alessia; Asif, Arif.

In: Seminars in Dialysis, Vol. 19, No. 6, 01.11.2006, p. 543-550.

Research output: Contribution to journalArticle

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