Variability in Reasons for Hemodialysis Catheter Use by Race, Sex, and Geography

Findings From the ESRD Clinical Performance Measures Project

Sari Hopson, Diane Frankenfield, Michael Rocco, William McClellan

Research output: Contribution to journalArticle

Abstract

Background: Race, sex, and geographic differences in hemodialysis vascular access use have been reported, but differences in reasons for catheter use have not been assessed. Study Design: Cross-sectional. Setting & Participants: Data obtained from the 2005 Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures Project for adult hemodialysis patients. Predictors: Race, sex, and geographic region. Outcomes & Measurements: Reasons for catheter use were categorized as short term and long term. Race, sex, and geographic associations with reasons were assessed by using bivariate analyses and multivariate logistic regression. Results: Of 8,479 hemodialysis patients, 3,302 (39%) used a fistula, 2,725 (32%) used a graft, and 2,299 (27%) used a catheter. We placed 857 patients with a catheter (37%) in the short-term-reason cohort and 1,404 (61%) in the long-term-reason cohort, and 38 (2%) lacked information to be placed. Reasons for catheter use were independently associated with race, sex, and geographic region. Whites were 43%, 49%, and 34% less likely than African Americans to use a catheter because of graft maturation, graft interruption, and all vascular access sites exhausted and 70% and 40% more likely because of fistula maturation and no fistula or graft surgically planned, respectively. Men were 50% less likely than women to use a catheter because of graft interruption and 80% more likely because of fistula maturation. Geographic end-stage renal disease network was associated with catheter use because of fistula maturation (P = 0.03), no fistula or graft surgically created (P <0.001), and no fistula or graft surgically planned (P = 0.05). Limitations: The cross-sectional study design precludes our ability to assess trends over time in reasons for catheter use. Associations were assessed for a limited set of variables. Conclusion: Race, sex, and geographic differences in reasons for hemodialysis catheter use exist. Understanding these differences may aid in developing strategies to decrease catheter initiation rates.

Original languageEnglish (US)
Pages (from-to)753-760
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume52
Issue number4
DOIs
StatePublished - Oct 2008

Fingerprint

Geography
Chronic Kidney Failure
Renal Dialysis
Catheters
Fistula
Transplants
Sex Characteristics
Blood Vessels
Cross-Sectional Studies
Medicaid
Medicare
African Americans
Multivariate Analysis
Logistic Models

Keywords

  • catheter
  • Hemodialysis
  • vascular access

ASJC Scopus subject areas

  • Nephrology

Cite this

Variability in Reasons for Hemodialysis Catheter Use by Race, Sex, and Geography : Findings From the ESRD Clinical Performance Measures Project. / Hopson, Sari; Frankenfield, Diane; Rocco, Michael; McClellan, William.

In: American Journal of Kidney Diseases, Vol. 52, No. 4, 10.2008, p. 753-760.

Research output: Contribution to journalArticle

Hopson, Sari ; Frankenfield, Diane ; Rocco, Michael ; McClellan, William. / Variability in Reasons for Hemodialysis Catheter Use by Race, Sex, and Geography : Findings From the ESRD Clinical Performance Measures Project. In: American Journal of Kidney Diseases. 2008 ; Vol. 52, No. 4. pp. 753-760.
@article{c1e56ec406534dfbb7c8bc6d6bd25367,
title = "Variability in Reasons for Hemodialysis Catheter Use by Race, Sex, and Geography: Findings From the ESRD Clinical Performance Measures Project",
abstract = "Background: Race, sex, and geographic differences in hemodialysis vascular access use have been reported, but differences in reasons for catheter use have not been assessed. Study Design: Cross-sectional. Setting & Participants: Data obtained from the 2005 Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures Project for adult hemodialysis patients. Predictors: Race, sex, and geographic region. Outcomes & Measurements: Reasons for catheter use were categorized as short term and long term. Race, sex, and geographic associations with reasons were assessed by using bivariate analyses and multivariate logistic regression. Results: Of 8,479 hemodialysis patients, 3,302 (39{\%}) used a fistula, 2,725 (32{\%}) used a graft, and 2,299 (27{\%}) used a catheter. We placed 857 patients with a catheter (37{\%}) in the short-term-reason cohort and 1,404 (61{\%}) in the long-term-reason cohort, and 38 (2{\%}) lacked information to be placed. Reasons for catheter use were independently associated with race, sex, and geographic region. Whites were 43{\%}, 49{\%}, and 34{\%} less likely than African Americans to use a catheter because of graft maturation, graft interruption, and all vascular access sites exhausted and 70{\%} and 40{\%} more likely because of fistula maturation and no fistula or graft surgically planned, respectively. Men were 50{\%} less likely than women to use a catheter because of graft interruption and 80{\%} more likely because of fistula maturation. Geographic end-stage renal disease network was associated with catheter use because of fistula maturation (P = 0.03), no fistula or graft surgically created (P <0.001), and no fistula or graft surgically planned (P = 0.05). Limitations: The cross-sectional study design precludes our ability to assess trends over time in reasons for catheter use. Associations were assessed for a limited set of variables. Conclusion: Race, sex, and geographic differences in reasons for hemodialysis catheter use exist. Understanding these differences may aid in developing strategies to decrease catheter initiation rates.",
keywords = "catheter, Hemodialysis, vascular access",
author = "Sari Hopson and Diane Frankenfield and Michael Rocco and William McClellan",
year = "2008",
month = "10",
doi = "10.1053/j.ajkd.2008.04.007",
language = "English (US)",
volume = "52",
pages = "753--760",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Variability in Reasons for Hemodialysis Catheter Use by Race, Sex, and Geography

T2 - Findings From the ESRD Clinical Performance Measures Project

AU - Hopson, Sari

AU - Frankenfield, Diane

AU - Rocco, Michael

AU - McClellan, William

PY - 2008/10

Y1 - 2008/10

N2 - Background: Race, sex, and geographic differences in hemodialysis vascular access use have been reported, but differences in reasons for catheter use have not been assessed. Study Design: Cross-sectional. Setting & Participants: Data obtained from the 2005 Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures Project for adult hemodialysis patients. Predictors: Race, sex, and geographic region. Outcomes & Measurements: Reasons for catheter use were categorized as short term and long term. Race, sex, and geographic associations with reasons were assessed by using bivariate analyses and multivariate logistic regression. Results: Of 8,479 hemodialysis patients, 3,302 (39%) used a fistula, 2,725 (32%) used a graft, and 2,299 (27%) used a catheter. We placed 857 patients with a catheter (37%) in the short-term-reason cohort and 1,404 (61%) in the long-term-reason cohort, and 38 (2%) lacked information to be placed. Reasons for catheter use were independently associated with race, sex, and geographic region. Whites were 43%, 49%, and 34% less likely than African Americans to use a catheter because of graft maturation, graft interruption, and all vascular access sites exhausted and 70% and 40% more likely because of fistula maturation and no fistula or graft surgically planned, respectively. Men were 50% less likely than women to use a catheter because of graft interruption and 80% more likely because of fistula maturation. Geographic end-stage renal disease network was associated with catheter use because of fistula maturation (P = 0.03), no fistula or graft surgically created (P <0.001), and no fistula or graft surgically planned (P = 0.05). Limitations: The cross-sectional study design precludes our ability to assess trends over time in reasons for catheter use. Associations were assessed for a limited set of variables. Conclusion: Race, sex, and geographic differences in reasons for hemodialysis catheter use exist. Understanding these differences may aid in developing strategies to decrease catheter initiation rates.

AB - Background: Race, sex, and geographic differences in hemodialysis vascular access use have been reported, but differences in reasons for catheter use have not been assessed. Study Design: Cross-sectional. Setting & Participants: Data obtained from the 2005 Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures Project for adult hemodialysis patients. Predictors: Race, sex, and geographic region. Outcomes & Measurements: Reasons for catheter use were categorized as short term and long term. Race, sex, and geographic associations with reasons were assessed by using bivariate analyses and multivariate logistic regression. Results: Of 8,479 hemodialysis patients, 3,302 (39%) used a fistula, 2,725 (32%) used a graft, and 2,299 (27%) used a catheter. We placed 857 patients with a catheter (37%) in the short-term-reason cohort and 1,404 (61%) in the long-term-reason cohort, and 38 (2%) lacked information to be placed. Reasons for catheter use were independently associated with race, sex, and geographic region. Whites were 43%, 49%, and 34% less likely than African Americans to use a catheter because of graft maturation, graft interruption, and all vascular access sites exhausted and 70% and 40% more likely because of fistula maturation and no fistula or graft surgically planned, respectively. Men were 50% less likely than women to use a catheter because of graft interruption and 80% more likely because of fistula maturation. Geographic end-stage renal disease network was associated with catheter use because of fistula maturation (P = 0.03), no fistula or graft surgically created (P <0.001), and no fistula or graft surgically planned (P = 0.05). Limitations: The cross-sectional study design precludes our ability to assess trends over time in reasons for catheter use. Associations were assessed for a limited set of variables. Conclusion: Race, sex, and geographic differences in reasons for hemodialysis catheter use exist. Understanding these differences may aid in developing strategies to decrease catheter initiation rates.

KW - catheter

KW - Hemodialysis

KW - vascular access

UR - http://www.scopus.com/inward/record.url?scp=52049094351&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=52049094351&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2008.04.007

DO - 10.1053/j.ajkd.2008.04.007

M3 - Article

VL - 52

SP - 753

EP - 760

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 4

ER -