Dialysis patients using catheters to access the blood have the highest risks for death, infections, and cardiovascular events compared with patients using other types of vascular access, according to an analysis appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The authors note that more research is needed to determine individual patients' risks, however.
For kidney disease patients who must undergo dialysis, experts recommend an arteriovenous fistula, which is created by connecting patient's own vein and artery to form a long-lasting site through which blood can be removed and returned. Alternatively, a patient may use an arteriovenous graft, which is a plastic conduit between an artery and a vein. Many patients use a catheter instead for several reasons, including inadequate preparation for dialysis, avoidance of surgery or fear of needles, as attachment to the dialysis machine via a catheter does not require needles. Also, an arteriovenous fistula or graft is not possible in all patients, especially those who are sicker.
To compare different types of vascular access for dialysis, Pietro Ravani, MD, PhD (University of Calgary, Canada) and his colleagues reviewed the medical literature, evaluating the associations between arteriovenous fistula, arteriovenous graft, and central venous catheter with risk for death, infection, and major heart-related events such as heart attacks and strokes. The researchers identified 67 studies comprising 586,337 participants.