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Predictors of Central Venous Catheter Use at the Initiation of Hemodialysis
Author(s) -
Wasse Haimanot,
Speckman Rebecca A.,
Frankenfield Diane L.,
Rocco Michael V.,
McClellan William M.
Publication year - 2008
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/j.1525-139x.2008.00447.x
Subject(s) - medicine , dialysis , central venous catheter , hemodialysis , end stage renal disease , hypoalbuminemia , arteriovenous fistula , dialysis adequacy , anemia , odds ratio , intensive care medicine , catheter , surgery
Central venous catheter (CVC) use at hemodialysis (HD) initiation remains high, despite reports of CVC‐associated morbidity and mortality, and efforts at early arteriovenous fistula placement. In order to determine predictors of CVC use at the start of HD, data from the end‐stage renal disease (ESRD) Clinical Performance Measures (CPM) Project was linked to the Centers for Medicare & Medicaid Services Medical Evidence (2728) Form. Of the 4071 incident hemodialysis patients in study years 1999–2003, 71.6% used a CVC at dialysis initiation. After controlling for demographic and co‐morbid variables, patients with a CVC were 24% more likely to be female ( p = 0.006), and 38% more likely to have ischemic heart disease ( p = 0.002), while those with obesity (BMI ≥30) were 24% less likely to start dialysis with a CVC ( p = 0.006). Pre‐ESRD hypoalbuminemia (<3.5 g/dl) was associated with a twofold higher risk of CVC use ( p = <0.001), while patients with pre‐ESRD anemia (hgb <11 g/dl) were 29% more likely to use a CVC at dialysis initiation ( p = 0.006) compared to those with hemoglobin ≥11 g/dl. Patients receiving predialysis erythropoietin had a 41% lower odds of CVC use at dialysis initiation ( p = <0.001). Finally, dialysis year was predictive of CVC use; in 2002, 76% of patients initiated dialysis with a CVC compared with 66% in 1998 ( p < 0.001). Overall, female gender, ischemic heart disease, lack of obesity, factors suggesting poor pre‐ESRD care, and successive year of dialysis initiation were predictive of CVC use at hemodialysis initiation.