Abstract: FR-PO544
Use of Central Venous Catheter (CVC) as Vascular Access at Hemodialysis Entry in Brazil: Impact on 2-Year Mortality
Session Information
- Dialysis Vascular Access
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Schittine Bezerra Lomba, Guilherme, Universidade Federal Fluminense Hospital Universitario Antonio Pedro, Niteroi, RJ, Brazil
- Da Silva, Angelica P., Universidade Federal Fluminense Hospital Universitario Antonio Pedro, Niteroi, RJ, Brazil
- Nerbass, Fabiana Baggio, Pró-Rim Foundation, Joinville, SC, Brazil
- Lima, Helbert N., Universidade da Regiao de Joinville, Joinville, SC, Brazil
- Sesso, Ricardo, Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, SP, Brazil
- Lugon, Jocemir R., Universidade Federal Fluminense Hospital Universitario Antonio Pedro, Niteroi, RJ, Brazil
Background
The recommended access for starting HD is arteriovenous fistula (AVF), but CVC is frequently used. Its use has been associated with higher mortality worldwide, but Brazilian data on this is scarce. Using data from the Brazilian Dialysis Registry, we aimed to evaluate the time trend of CVC use at the start of HD and assess its impact on all-cause mortality over 2 years.
Methods
This was a national registry-based retrospective cohort study with data of ≥18-year incident HD patients from Jan-2011 to Dec-2023. The variable of primary interest was the initial vascular access: CVC or AVF/graft. The main outcome was all-cause 2-year mortality. For analyses, we used the Kaplan-Meier method and Cox proportional hazards regression.
Results
We studied 10,466 patients. The mean age was 58±16 years; 60% were male, and 33% had diabetes. CVC use at HD entry increased in the last 10 years (Fig. 1). Two-year survival curves are in Fig. 2. In a univariate Cox regression model, the HR of CVC use was 2.56 (95%CI 2.10-3.14); after adjustment for age, sex, BMI, diabetes, hypertension, Hep B and C, HIV, albumin, and Hb, it was 1.92 (95%CI 1.30-2.83). Other independent variables associated with mortality were: age (HR 1.04; 95%CI 1.03-1.05), BMI (HR 0.97; 95%CI 0.95-0.99), albumin (g/L) (HR 0.91; 95%CI 0.89-0.93), and Hb (g/L) (HR 0.96; 95%CI 0.95-0.97).
Conclusion
CVC use was associated with a 2-fold increase in the risk of 2-year mortality. The upward trend in CVC use in Brazil is worrying and calls for changes in medical care aimed at the early implementation of permanent vascular access for HD start.
Fig 1. Time trend of CVC use in Brazil
Fig 2. KM curves