Nephrology · 1 h ago
Mortality Gap Between Catheter and AV Access Use Narrowed in US Hemodialysis Patients
A US observational study of 536,836 adults initiating hemodialysis found that 18-month mortality declined from 2013 to 2022 among patients using either central venous catheters (CVCs) or arteriovenous (AV) access. The adjusted absolute mortality difference associated with continued CVC use narrowed, but remained higher than with AV access.
- 18-month mortality declined in both access groups.
- Absolute excess mortality with CVC use narrowed nearly 30%.
- Relative risk remained elevated with continued CVC use.
Guidelines favor AV access over CVCs for hemodialysis, in part because of lower infection risk, although many patients start dialysis with a CVC. Researchers used US Renal Data System records to study community-dwelling, functionally independent adults aged 18–85 years who began hemodialysis with a CVC from 2013 through 2022. The observational analysis included 536,836 patients and compared continued CVC use with transition to AV access, estimating adjusted 18-month mortality risks. Patients with a maturing AV access at initiation were excluded.
From 2013 to 2022, adjusted 18-month mortality risk fell from 26.8% to 21.3% with CVC use and from 20.9% to 17.1% with AV access. The absolute difference narrowed from 5.9 to 4.2 deaths per 100 patients, a reduction of nearly 30%. The relative risk declined less, from 1.28 to 1.25. Bloodstream infection-related mortality also declined, with a greater reduction in the between-group difference.
The findings show a narrowing absolute mortality gap, not elimination of the excess risk associated with continued CVC use. As an observational analysis, it cannot establish that access type caused the trends; results also apply to the selected population studied and may not generalize to all patients starting hemodialysis.
In practice
For adults resembling this study population who start hemodialysis with a CVC, continued CVC use was associated with higher 18-month mortality than transition to AV access throughout 2013–2022. The adjusted absolute difference narrowed over time, from 5.9 to 4.2 deaths per 100 patients, but the relative risk remained elevated. These observational trends do not show that access type caused the differences and do not establish that access planning or selection should change; applicability is limited to the selected community-dwelling, functionally independent adults studied.
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Journal of the American Society of Nephrology: Trends in Mortality of Patients with Central Venous Catheters versus Arteriovenous Accesses for Hemodialysis ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.