Influence of intravenous drug abuse on vascular access placement and survival in HIV-seropositive patients

Joseph A. Eustace, Peter C. Gregory, Mahesh Krishnan, Wen Ni, Doreen M. Kuhn, Brad C. Astor, Paul J. Scheel

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The influence of intravenous drug abuse (IVDA) on hemodialysis access placement practices and access survival in HIV-infected patients is unknown. Methods: We conducted a retrospective study of 60, HIV seropositive, maintenance hemodialysis patients. Type of access and assisted access survival (measured from date of placement) were compared in those with (77%) and without (23%) a history of IVDA. Results: Mean age was 37.8 years, mean baseline serum albumin was 2.9 g/dl and median CD4 count was 222 cells/mm3. Fifteen patients, all IVDA, were dialyzed using only tunneled catheters (median number of catheters per person (range): 2.5 (1-11)). There were longer delays in creation of a permanent access (p = 0.08), but no difference in the type of permanent access placed in IVDA versus the non-IVDA group. Over 1,051 cumulative months of access follow-up, 134 tunneled catheters, 28 grafts and 19 fistulae were placed, with observed failure rates of 1 per 4.7 access-months, 1 per 19.7 access-months, 1 per 38.2 access-months, respectively. The adjusted relative hazard of access failure for grafts versus catheters was 0.41 (95% Cl: 0.23, 0.72; p = 0.002) and for fistulae versus catheters was 0.21 (95% Cl: 0.08, 0.52; p = 0.001). Thirty-two percent of accesses were removed due to infection, an infection removal rate for catheters of 1 per 7.8 access-months and for grafts of 1 per 62.5 access-months; all graft infections occurred in the IVDA group. No fistula was removed due to infection. Conclusion: Fistulae are the first line of choice for hemodialysis access in HIV-seropositive patients regardless of IVDA history; if not feasible, graft placement in non-IVDA or abstinent IVDA patients is recommended. In those with active IVDA, the optimal method of renal replacement therapy and type of hemodialysis access remain uncertain.

Original languageEnglish (US)
Pages (from-to)c38-c45
JournalNephron - Clinical Practice
Volume100
Issue number2
DOIs
StatePublished - Jun 1 2005

Keywords

  • Arteriovenous fistula
  • Arteriovenous graft
  • Catheters
  • Human immunovirus
  • Intravenous drug abuse

ASJC Scopus subject areas

  • Nephrology

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