Association of hemodialysis central venous catheter use with ipsilateral arteriovenous vascular access survival.

ABSTRACT

BACKGROUND: Central venous catheters frequently are used for hemodialysis vascular access while patients await placement and maturation of an arteriovenous fistula or graft. Catheters may cause central vein stenosis, which can adversely affect vascular access outcomes. We compared vascular access outcomes in patients with a history of ipsilateral and contralateral dialysis catheters. STUDY DESIGN: Retrospective analysis of a prospective computerized vascular access database. SETTING & PARTICIPANTS: Patients at a large medical center who initiated hemodialysis therapy with a catheter and subsequently received a fistula (n = 233) or graft (n = 89). PREDICTOR History of central venous catheter placement ipsilateral versus contralateral to the arteriovenous fistula or graft. OUTCOME & MEASUREMENTS Primary access failure (access never suitable for dialysis) and cumulative access survival (time from successful cannulation until permanent access failure). RESULTS: For patients receiving a fistula, the primary failure rate was similar for those with ipsilateral and contralateral catheters (50% vs 53%; HR, 0.94; 95% CI, 0.71-1.26; P = 0.7), and time to fistula maturation was similar (101 ± 41 vs 107 ± 39 days; P = 0.5). However, cumulative fistula survival was inferior in patients with ipsilateral catheters (HR, 2.48; 95% CI, 1.33-7.33; P = 0.009). For patients receiving a graft, the primary failure rate was similar for those with ipsilateral and contralateral catheters (35% vs 38%; HR, 0.92; 95% CI, 0.49-1.73; P = 0.8), but cumulative graft survival tended to be shorter with ipsilateral catheters (HR, 2.04; 95% CI, 0.92-5.38; P = 0.07). LIMITATIONS: Retrospective analysis, single medical center. CONCLUSIONS: The primary failure rate of fistulas and grafts is not affected by the presence of an ipsilateral catheter. However, cumulative access survival is inferior in patients with prior ipsilateral catheters. Avoidance of ipsilateral catheters may improve long-term vascular access survival.