(Hemodialysis) Catheter Reduction Reduces Mortality
Steve Wilson, PhD1; Tracy J. Mayne, PhD1; David Madigan, PhD2 John Robertson, MD3; Janet Holland, RN, CNN3; Abbe Volz3
1DaVita Clinical Research, Minneapolis, MN; 2Columbia University, New York, NY; 3DaVita, Inc., Denver, CA
1. What are the main findings of the study?
From 2007 - 2009, there was no change in the percent of patients starting dialysis with a CVC. Over this same period, there was an 11% relative and 5% absolute decrease in catheters among prevalent HD patients. Catheter survival time decreased over this period as well. The combination of decreased placement and shorter catheter survival resulted in a decrease of 61 catheter days per 100 patient years. While mortality dropped in this population during this time of decreased catheter utilization, multiple quality improvement initiatives likely contributed to this decrease.
2. Were any of the findings unexpected?
No, this study confirms the trend in reduction of mortality with catheter
3. What should clinicians and patients take away from this study?
Targeted catheter initiatives can decrease both placement of new catheters and total catheter time. Less progress has been made on the utilization of catheters among incident patients, which falls outside of the control of dialysis organizations.
4. What recommendations do you have for nephrology health care providers as a result of your study?
Vascular access should be proactively discussed in CKD patients at risk of going on dialysis to reduce morality from catheters in incident patients.