Factors Associated With Tunneled Dialysis Catheter Placement at the Time of Initial Hemodialysis Arteriovenous Access Creation
*Tyler Ryan1, Alik Farber1, *Thomas W Cheng1, *Stephen Raulli1, *Kristiana Sather2, *Quinten Dicken1, *Yixin Zhang1, Jeffrey J Siracuse1
1Boston University School of Medicine, Boston, MA;2University of Minnesota, Minneapolis, MN
Objective: Arteriovenous (AV) access is the preferred modality for hemodialysis (HD) to avoid complications associated with tunneled dialysis catheters (TDCs). Despite efforts to create timely AV access, many patients still initiate HD through TDCs. Our goal was to analyze those at higher risk for having a TDC during their first AV access creation and how this impacts survival. Design: Single-center case-control study Setting: Urban safety net hospital Patients: 509 first-time AV access creations between 2014 and 2019 were included with 55% having a TDC present. The mean patient age was 59.7 years and 58.7% were male. Previous peritoneal and HD patients were excluded. Main Outcome Measure: Demographic variables, clinical variables, and survival Results: Access types were brachiocephalic (47.2%), brachiobasilic (22.4%), radiocephalic (15.5%), prosthetic graft (12.6%), and other (4.1%). Patients with a TDC compared to non-TDC patients were more likely to be non-obese (68.9% vs 54.2%), be homeless (10.4% vs 4.8%), have undergone inpatient access creation (44.6% vs 18.8%), have not seen a primary care physician within 1 year preoperatively (45.7% vs 11.4%), and have not seen a nephrologist within 3 months preoperatively (60.7% vs 7.0%; P<.05 for all). On multivariable analysis, having a TDC at first AV access creation was associated with no nephrologist seen within three months preoperatively (OR 25, 95% CI 12.5-100, P<.001), homelessness (OR 2.60, 95% CI 1.08-6.24, P=.03), and non-obesity (OR 1.79, 95% CI 1.11-2.86, P=.02). One-year survival was similar for the TDC (95%) and non-TDC patients (94.8%) (P=.36). Conclusions: Poor access to nephrology care and homelessness were associated having a TDC during first time AV access creation. Decreasing barriers to subspecialists and targeted improvements in high-risk populations may improve care.
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