Predictors of Delayed Transition From Central Venous Catheter Use to Permanent Vascular Access Among ESRD Patients

Haimanot Wasse, Rebecca A. Speckman, Diane L. Frankenfield, Michael V. Rocco, William M. McClellan

Research output: Contribution to journalArticle

Abstract

Background: Early arteriovenous fistula (AVF) creation is necessary to curb the use of central venous catheters (CVCs) and reduce their complications. We sought to examine patient characteristics that may influence persistent CVC use 90 days after dialysis therapy initiation among patients using a CVC. Methods: Data from the 1999 to 2003 Clinical Performance Measures Project was linked to the Centers for Medicare & Medicaid Services Medical Evidence (2728) form. Results: Most patients (59.4%) starting dialysis with a CVC failed to transition to permanent access within 90 days, whereas 25.4% received a graft and only 15.2% received an AVF. Older patients (>75 years) were more than 2-fold more likely to remain CVC dependent at 90 days (P = 0.0.001) compared with those younger than 50 years. In addition, race and sex were highly predictive of CVC dependence at 90 days; black females, white females, and black males were 75% (P <0.001), 61% (P <0.001), and 35% (P = 0.023) more likely than white males to maintain CVC use, whereas patients with ischemic heart disease and peripheral vascular disease were 35% (P = 0.023) and 39% (P = 0.007) more likely to remain CVC dependent at 90 days, respectively. Conclusion: Prolonged CVC dependence is more likely to occur among patients of older age, females, blacks, and those with cardiovascular comorbidity, suggesting inadequate or late access referral or greater primary access failure. Our findings suggest possible missed opportunities for early conversion of patients to permanent vascular access that may vary by race and sex.

Original languageEnglish (US)
Pages (from-to)276-283
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume49
Issue number2
DOIs
StatePublished - Feb 2007
Externally publishedYes

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Central Venous Catheters
Chronic Kidney Failure
Blood Vessels
Arteriovenous Fistula
Dialysis
Peripheral Vascular Diseases
Medicaid
Medicare
Myocardial Ischemia
Comorbidity
Referral and Consultation
Transplants

Keywords

  • Hemodialysis vascular access

ASJC Scopus subject areas

  • Nephrology

Cite this

Predictors of Delayed Transition From Central Venous Catheter Use to Permanent Vascular Access Among ESRD Patients. / Wasse, Haimanot; Speckman, Rebecca A.; Frankenfield, Diane L.; Rocco, Michael V.; McClellan, William M.

In: American Journal of Kidney Diseases, Vol. 49, No. 2, 02.2007, p. 276-283.

Research output: Contribution to journalArticle

Wasse, Haimanot ; Speckman, Rebecca A. ; Frankenfield, Diane L. ; Rocco, Michael V. ; McClellan, William M. / Predictors of Delayed Transition From Central Venous Catheter Use to Permanent Vascular Access Among ESRD Patients. In: American Journal of Kidney Diseases. 2007 ; Vol. 49, No. 2. pp. 276-283.
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abstract = "Background: Early arteriovenous fistula (AVF) creation is necessary to curb the use of central venous catheters (CVCs) and reduce their complications. We sought to examine patient characteristics that may influence persistent CVC use 90 days after dialysis therapy initiation among patients using a CVC. Methods: Data from the 1999 to 2003 Clinical Performance Measures Project was linked to the Centers for Medicare & Medicaid Services Medical Evidence (2728) form. Results: Most patients (59.4{\%}) starting dialysis with a CVC failed to transition to permanent access within 90 days, whereas 25.4{\%} received a graft and only 15.2{\%} received an AVF. Older patients (>75 years) were more than 2-fold more likely to remain CVC dependent at 90 days (P = 0.0.001) compared with those younger than 50 years. In addition, race and sex were highly predictive of CVC dependence at 90 days; black females, white females, and black males were 75{\%} (P <0.001), 61{\%} (P <0.001), and 35{\%} (P = 0.023) more likely than white males to maintain CVC use, whereas patients with ischemic heart disease and peripheral vascular disease were 35{\%} (P = 0.023) and 39{\%} (P = 0.007) more likely to remain CVC dependent at 90 days, respectively. Conclusion: Prolonged CVC dependence is more likely to occur among patients of older age, females, blacks, and those with cardiovascular comorbidity, suggesting inadequate or late access referral or greater primary access failure. Our findings suggest possible missed opportunities for early conversion of patients to permanent vascular access that may vary by race and sex.",
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