Effect of Change in Vascular Access on Patient Mortality in Hemodialysis Patients
Background: Hemodialysis patients using a catheter have a greater mortality risk than those using an arteriovenous (AV) access (fistula or graft). However, catheter-dependent patients also differ from those with an AV access in several clinical features, and these differences may themselves contribu...
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| Veröffentlicht in: | American journal of kidney diseases 2006-03, Vol.47 (3), p.469-477 |
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| creator | Allon, Michael Daugirdas, John Depner, Thomas A. Greene, Tom Ornt, Daniel Schwab, Steve J. |
| description | Background:
Hemodialysis patients using a catheter have a greater mortality risk than those using an arteriovenous (AV) access (fistula or graft). However, catheter-dependent patients also differ from those with an AV access in several clinical features, and these differences may themselves contribute to their excess mortality.
Methods:
The current study evaluates whether a change in vascular access affects risk for mortality in patients enrolled in the Hemodialysis Study. Time-dependent Cox regression was used to relate mortality risk to current type of access and change in access type during the preceding 1 year.
Results:
Compared with patients who dialyzed using an AV access at both the beginning and end of the preceding 1-year interval, relative risks for mortality were 3.43 (95% confidence interval [CI], 2.42 to 4.86) in patients who dialyzed with a catheter at both times; 2.38 (95% CI, 1.76 to 3.23) in patients switching from an AV access to a catheter, and 1.37 (95% CI, 0.81 to 2.32) in patients switching from a catheter to an AV access. Change from AV access to a catheter was associated with an antecedent decrease in serum albumin level (odds ratio, 1.25; 95% CI, 1.09 to 1.45 per 0.5 g/dL;
P = 0.002), weight loss (odds ratio, 1.14; 95% CI, 1.06 to 1.22 per 2 kg;
P < 0.001), and decreases in equilibrated normalized protein catabolic rate (odds ratio, 2.22; 95% CI, 1.41 to 3.57 per 0.25 g/kg/d;
P < 0.001) and non–access-related hospitalization (odds ratio, 1.19; 95% CI, 1.06 to 1.32 per 1 additional hospitalization over 4 months;
P = 0.002). Change from a catheter to AV access was predicted by only the antecedent non–access-related hospitalization rate (odds ratio, 0.93; 95% CI, 0.87 to 0.97 per 1 additional hospitalization over 4 months;
P < 0.001).
Conclusion:
Change from a catheter to AV access is associated with a substantial decrease in mortality risk. |
| doi_str_mv | 10.1053/j.ajkd.2005.11.023 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67676616</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0272638605018639</els_id><sourcerecordid>67676616</sourcerecordid><originalsourceid>FETCH-LOGICAL-c450t-47553578adf7a020080443468b0ed6f459a5819cf5dfaab5c895e942539347473</originalsourceid><addsrcrecordid>eNp90E1LwzAYwPEgis6XL-BBetFba97bgJcx5gtMVFCv4VmaaGbXatIK-_ZmbOJNcsjl9zwkf4ROCS4IFuxyUcDioy4oxqIgpMCU7aAREZTlsmLVLhphWtJcskoeoMMYFxhjxaTcRwdEcoUllSP0NHXOmj7rXDZ5h_bNZr7NXiGaoYGQjY2xMWZdmz1C723bZ_dd6KHx_Wrtbu2yqz00q-jjr4jHaM9BE-3J9j5CL9fT58ltPnu4uZuMZ7nhAvc5L4VgoqygdiXg9IcKc864rObY1tJxoUBURBknagcwF6ZSwipOBVOMl7xkR-his_czdF-Djb1e-mhs00BruyFqWaYjiUyQbqAJXYzBOv0Z_BLCShOs1yH1Qq9D6nVITYhOIdPQ2Xb7MF_a-m9kWy6B8y1IsaBxAVrj458rhaKEquSuNs6mFt_eBh1N6mRs7UMKr-vO__eOH6mxj4g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>67676616</pqid></control><display><type>article</type><title>Effect of Change in Vascular Access on Patient Mortality in Hemodialysis Patients</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Allon, Michael ; Daugirdas, John ; Depner, Thomas A. ; Greene, Tom ; Ornt, Daniel ; Schwab, Steve J.</creator><creatorcontrib>Allon, Michael ; Daugirdas, John ; Depner, Thomas A. ; Greene, Tom ; Ornt, Daniel ; Schwab, Steve J. ; HEMO Study Group</creatorcontrib><description>Background:
Hemodialysis patients using a catheter have a greater mortality risk than those using an arteriovenous (AV) access (fistula or graft). However, catheter-dependent patients also differ from those with an AV access in several clinical features, and these differences may themselves contribute to their excess mortality.
Methods:
The current study evaluates whether a change in vascular access affects risk for mortality in patients enrolled in the Hemodialysis Study. Time-dependent Cox regression was used to relate mortality risk to current type of access and change in access type during the preceding 1 year.
Results:
Compared with patients who dialyzed using an AV access at both the beginning and end of the preceding 1-year interval, relative risks for mortality were 3.43 (95% confidence interval [CI], 2.42 to 4.86) in patients who dialyzed with a catheter at both times; 2.38 (95% CI, 1.76 to 3.23) in patients switching from an AV access to a catheter, and 1.37 (95% CI, 0.81 to 2.32) in patients switching from a catheter to an AV access. Change from AV access to a catheter was associated with an antecedent decrease in serum albumin level (odds ratio, 1.25; 95% CI, 1.09 to 1.45 per 0.5 g/dL;
P = 0.002), weight loss (odds ratio, 1.14; 95% CI, 1.06 to 1.22 per 2 kg;
P < 0.001), and decreases in equilibrated normalized protein catabolic rate (odds ratio, 2.22; 95% CI, 1.41 to 3.57 per 0.25 g/kg/d;
P < 0.001) and non–access-related hospitalization (odds ratio, 1.19; 95% CI, 1.06 to 1.32 per 1 additional hospitalization over 4 months;
P = 0.002). Change from a catheter to AV access was predicted by only the antecedent non–access-related hospitalization rate (odds ratio, 0.93; 95% CI, 0.87 to 0.97 per 1 additional hospitalization over 4 months;
P < 0.001).
Conclusion:
Change from a catheter to AV access is associated with a substantial decrease in mortality risk.</description><identifier>ISSN: 0272-6386</identifier><identifier>EISSN: 1523-6838</identifier><identifier>DOI: 10.1053/j.ajkd.2005.11.023</identifier><identifier>PMID: 16490626</identifier><language>eng</language><publisher>Orlando, FL: Elsevier Inc</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Arteriovenous Shunt, Surgical ; Biological and medical sciences ; catheter ; Catheters, Indwelling ; Emergency and intensive care: renal failure. Dialysis management ; Female ; fistula ; graft ; Humans ; Intensive care medicine ; Male ; Medical sciences ; Middle Aged ; mortality ; Nephrology. Urinary tract diseases ; Prospective Studies ; Renal Dialysis - methods ; Renal Dialysis - mortality ; Vascular access</subject><ispartof>American journal of kidney diseases, 2006-03, Vol.47 (3), p.469-477</ispartof><rights>2006 National Kidney Foundation, Inc.</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c450t-47553578adf7a020080443468b0ed6f459a5819cf5dfaab5c895e942539347473</citedby><cites>FETCH-LOGICAL-c450t-47553578adf7a020080443468b0ed6f459a5819cf5dfaab5c895e942539347473</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0272638605018639$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17592129$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16490626$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Allon, Michael</creatorcontrib><creatorcontrib>Daugirdas, John</creatorcontrib><creatorcontrib>Depner, Thomas A.</creatorcontrib><creatorcontrib>Greene, Tom</creatorcontrib><creatorcontrib>Ornt, Daniel</creatorcontrib><creatorcontrib>Schwab, Steve J.</creatorcontrib><creatorcontrib>HEMO Study Group</creatorcontrib><title>Effect of Change in Vascular Access on Patient Mortality in Hemodialysis Patients</title><title>American journal of kidney diseases</title><addtitle>Am J Kidney Dis</addtitle><description>Background:
Hemodialysis patients using a catheter have a greater mortality risk than those using an arteriovenous (AV) access (fistula or graft). However, catheter-dependent patients also differ from those with an AV access in several clinical features, and these differences may themselves contribute to their excess mortality.
Methods:
The current study evaluates whether a change in vascular access affects risk for mortality in patients enrolled in the Hemodialysis Study. Time-dependent Cox regression was used to relate mortality risk to current type of access and change in access type during the preceding 1 year.
Results:
Compared with patients who dialyzed using an AV access at both the beginning and end of the preceding 1-year interval, relative risks for mortality were 3.43 (95% confidence interval [CI], 2.42 to 4.86) in patients who dialyzed with a catheter at both times; 2.38 (95% CI, 1.76 to 3.23) in patients switching from an AV access to a catheter, and 1.37 (95% CI, 0.81 to 2.32) in patients switching from a catheter to an AV access. Change from AV access to a catheter was associated with an antecedent decrease in serum albumin level (odds ratio, 1.25; 95% CI, 1.09 to 1.45 per 0.5 g/dL;
P = 0.002), weight loss (odds ratio, 1.14; 95% CI, 1.06 to 1.22 per 2 kg;
P < 0.001), and decreases in equilibrated normalized protein catabolic rate (odds ratio, 2.22; 95% CI, 1.41 to 3.57 per 0.25 g/kg/d;
P < 0.001) and non–access-related hospitalization (odds ratio, 1.19; 95% CI, 1.06 to 1.32 per 1 additional hospitalization over 4 months;
P = 0.002). Change from a catheter to AV access was predicted by only the antecedent non–access-related hospitalization rate (odds ratio, 0.93; 95% CI, 0.87 to 0.97 per 1 additional hospitalization over 4 months;
P < 0.001).
Conclusion:
Change from a catheter to AV access is associated with a substantial decrease in mortality risk.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Arteriovenous Shunt, Surgical</subject><subject>Biological and medical sciences</subject><subject>catheter</subject><subject>Catheters, Indwelling</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Female</subject><subject>fistula</subject><subject>graft</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>mortality</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Prospective Studies</subject><subject>Renal Dialysis - methods</subject><subject>Renal Dialysis - mortality</subject><subject>Vascular access</subject><issn>0272-6386</issn><issn>1523-6838</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90E1LwzAYwPEgis6XL-BBetFba97bgJcx5gtMVFCv4VmaaGbXatIK-_ZmbOJNcsjl9zwkf4ROCS4IFuxyUcDioy4oxqIgpMCU7aAREZTlsmLVLhphWtJcskoeoMMYFxhjxaTcRwdEcoUllSP0NHXOmj7rXDZ5h_bNZr7NXiGaoYGQjY2xMWZdmz1C723bZ_dd6KHx_Wrtbu2yqz00q-jjr4jHaM9BE-3J9j5CL9fT58ltPnu4uZuMZ7nhAvc5L4VgoqygdiXg9IcKc864rObY1tJxoUBURBknagcwF6ZSwipOBVOMl7xkR-his_czdF-Djb1e-mhs00BruyFqWaYjiUyQbqAJXYzBOv0Z_BLCShOs1yH1Qq9D6nVITYhOIdPQ2Xb7MF_a-m9kWy6B8y1IsaBxAVrj458rhaKEquSuNs6mFt_eBh1N6mRs7UMKr-vO__eOH6mxj4g</recordid><startdate>20060301</startdate><enddate>20060301</enddate><creator>Allon, Michael</creator><creator>Daugirdas, John</creator><creator>Depner, Thomas A.</creator><creator>Greene, Tom</creator><creator>Ornt, Daniel</creator><creator>Schwab, Steve J.</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20060301</creationdate><title>Effect of Change in Vascular Access on Patient Mortality in Hemodialysis Patients</title><author>Allon, Michael ; Daugirdas, John ; Depner, Thomas A. ; Greene, Tom ; Ornt, Daniel ; Schwab, Steve J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c450t-47553578adf7a020080443468b0ed6f459a5819cf5dfaab5c895e942539347473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Arteriovenous Shunt, Surgical</topic><topic>Biological and medical sciences</topic><topic>catheter</topic><topic>Catheters, Indwelling</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Female</topic><topic>fistula</topic><topic>graft</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>mortality</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Prospective Studies</topic><topic>Renal Dialysis - methods</topic><topic>Renal Dialysis - mortality</topic><topic>Vascular access</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Allon, Michael</creatorcontrib><creatorcontrib>Daugirdas, John</creatorcontrib><creatorcontrib>Depner, Thomas A.</creatorcontrib><creatorcontrib>Greene, Tom</creatorcontrib><creatorcontrib>Ornt, Daniel</creatorcontrib><creatorcontrib>Schwab, Steve J.</creatorcontrib><creatorcontrib>HEMO Study Group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of kidney diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Allon, Michael</au><au>Daugirdas, John</au><au>Depner, Thomas A.</au><au>Greene, Tom</au><au>Ornt, Daniel</au><au>Schwab, Steve J.</au><aucorp>HEMO Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Change in Vascular Access on Patient Mortality in Hemodialysis Patients</atitle><jtitle>American journal of kidney diseases</jtitle><addtitle>Am J Kidney Dis</addtitle><date>2006-03-01</date><risdate>2006</risdate><volume>47</volume><issue>3</issue><spage>469</spage><epage>477</epage><pages>469-477</pages><issn>0272-6386</issn><eissn>1523-6838</eissn><abstract>Background:
Hemodialysis patients using a catheter have a greater mortality risk than those using an arteriovenous (AV) access (fistula or graft). However, catheter-dependent patients also differ from those with an AV access in several clinical features, and these differences may themselves contribute to their excess mortality.
Methods:
The current study evaluates whether a change in vascular access affects risk for mortality in patients enrolled in the Hemodialysis Study. Time-dependent Cox regression was used to relate mortality risk to current type of access and change in access type during the preceding 1 year.
Results:
Compared with patients who dialyzed using an AV access at both the beginning and end of the preceding 1-year interval, relative risks for mortality were 3.43 (95% confidence interval [CI], 2.42 to 4.86) in patients who dialyzed with a catheter at both times; 2.38 (95% CI, 1.76 to 3.23) in patients switching from an AV access to a catheter, and 1.37 (95% CI, 0.81 to 2.32) in patients switching from a catheter to an AV access. Change from AV access to a catheter was associated with an antecedent decrease in serum albumin level (odds ratio, 1.25; 95% CI, 1.09 to 1.45 per 0.5 g/dL;
P = 0.002), weight loss (odds ratio, 1.14; 95% CI, 1.06 to 1.22 per 2 kg;
P < 0.001), and decreases in equilibrated normalized protein catabolic rate (odds ratio, 2.22; 95% CI, 1.41 to 3.57 per 0.25 g/kg/d;
P < 0.001) and non–access-related hospitalization (odds ratio, 1.19; 95% CI, 1.06 to 1.32 per 1 additional hospitalization over 4 months;
P = 0.002). Change from a catheter to AV access was predicted by only the antecedent non–access-related hospitalization rate (odds ratio, 0.93; 95% CI, 0.87 to 0.97 per 1 additional hospitalization over 4 months;
P < 0.001).
Conclusion:
Change from a catheter to AV access is associated with a substantial decrease in mortality risk.</abstract><cop>Orlando, FL</cop><pub>Elsevier Inc</pub><pmid>16490626</pmid><doi>10.1053/j.ajkd.2005.11.023</doi><tpages>9</tpages></addata></record> |
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| ispartof | American journal of kidney diseases, 2006-03, Vol.47 (3), p.469-477 |
| issn | 0272-6386 1523-6838 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Arteriovenous Shunt, Surgical Biological and medical sciences catheter Catheters, Indwelling Emergency and intensive care: renal failure. Dialysis management Female fistula graft Humans Intensive care medicine Male Medical sciences Middle Aged mortality Nephrology. Urinary tract diseases Prospective Studies Renal Dialysis - methods Renal Dialysis - mortality Vascular access |
| title | Effect of Change in Vascular Access on Patient Mortality in Hemodialysis Patients |
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