Higher Death Rates Seen in Central Line Dialysis Patients: Study

Doctors Lounge (http://www.doctorslounge.com/index.php/news/hd/19539)

Randy Dotinga HealthDay Reporter

THURSDAY, April 21 (HealthDay News) -- Doctors should avoid delivering hemodialysis to kidney failure patients through a central line catheter because that method is associated with a higher risk of death shortly after beginning dialysis, a new study contends.

Researchers examined the medical records of more than 38,500 Canadian patients who began dialysis from 2001-08. Patients who received hemodialysis through a central line catheter into a large vein had an 80 percent higher risk of death in the first year after starting dialysis than patients who received:

• Peritoneal dialysis (through a tube into the abdomen).
• Dialysis through an arteriovenous fistula (in which a surgeon connects an artery directly to a vein).
• Dialysis through an arteriovenous graft (in which a surgeon connects an artery to a vein with a synthetic tube, or graft, implanted under the skin in one arm).

Both the surgically created fistula and graft access sites are at less risk of infection than a central line, with a fistula least likely to become infected, the study authors said. Among central line patients, the risk of death was 20 percent higher five years after dialysis began than in the others. "Our results emphasize the importance of predialysis care and education, and the need to avoid central venous catheter use in our [hemodialysis] patients," Dr. Jeffrey Perl, of St. Michael's Hospital in Toronto, said in an American Society of Nephrology news release.

The researchers cautioned that the study was observational, not a randomized controlled trial, and that there was no information on the reasons why patients started dialysis with a central catheter vs. the other methods.

The study appeared in the Journal of the American Society of Nephrology.

In the study, about 63 percent of the patients received hemodialysis using a central line catheter, 17 percent began the treatment with an arteriovenous fistula or graft, and 19 percent performed peritoneal dialysis on themselves at home.

Those who got treatment through an arteriovenous fistula or graft when starting hemodialysis survived at about the same rate as those on dialysis through a tube in the abdomen.

Prior research has also suggested that peritoneal patients have a lower risk of death, Perl said.