Catheters linked with high risk of infections, heart problems, and death in dialysis patients
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.
Among the major findings:
- Compared with individuals with fistulas, those using catheters had a 38% higher risk of experiencing a major heart-related event, a 53% higher risk of dying, and more than double the risk of developing fatal infections.
- Compared with individuals with fistulas, those with grafts had an 18% increased risk of dying and a 36% increased risk of developing fatal infections, but they did not have an increased risk of experiencing a major heart-related event.
- All analyses compared patients based on the access they achieved, irrespective of the access planned or attempted. (For example, the group of people using catheters also included patients in whom a fistula was unsuccessful.)
"Our findings are reflected in current clinical practice guidelines, which promote fistulas as the preferred form of bloodstream access in hemodialysis patients, said Dr. Ravani. He added that the studies they identified were of low quality, though. "Better-quality data are needed, but not from studies with the same design as those already available. In fact, our cumulative meta-analysis shows that this information was already available 10 years ago," he explained.
More information: The article, entitled "Associations Between Hemodialysis Access Type and Clinical Outcomes," will appear online on February 21, 2013, doi: 10.1681/ASN.2012070643
Journal reference: Journal of the American Society of Nephrology
Provided by American Society of Nephrology
- Hemodialysis vascular access modifies the association between dialysis modality and survival Apr 21, 2011 | not rated yet | 0
- Why does dialysis fail? Dec 22, 2010 | not rated yet | 0
- Drug does not increase suitability for dialysis of surgically-enlarged blood vessels May 13, 2008 | not rated yet | 0
- Knowledge unlocks key to healthier options for dialysis patients Apr 23, 2009 | not rated yet | 0
- Use of fish oil supplements does not significantly reduce rate of failure of grafts for hemodialysis May 02, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
(AP)—Government health officials are investigating several health problems reported with potentially contaminated medications made by a Tennessee specialty pharmacy.
Diseases, Conditions, Syndromes 19 hours ago | not rated yet | 0
(HealthDay)—Comorbid conditions often accompany alopecia areata, according to a study published online May 22 in JAMA Dermatology.
Diseases, Conditions, Syndromes 20 hours ago | not rated yet | 0
(HealthDay)—As a world-class golfer, Stacy Lewis' accomplishments are remarkable. But it was a physical challenge in her childhood that defined her ascent to the top of her sport.
Diseases, Conditions, Syndromes 21 hours ago | not rated yet | 0
Saudi Arabia said Friday it would send samples taken from animals possibly infected with a deadly SARS-like virus to the United States for testing in a bid to find the source of disease.
Diseases, Conditions, Syndromes May 24, 2013 | not rated yet | 0
The World Health Organization voiced deep concern Thursday over the SARS-like virus that has killed 22 people in less than a year, saying it might potentially spread more widely between humans.
Diseases, Conditions, Syndromes May 24, 2013 | 5 / 5 (1) | 0
Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...
3 hours ago | not rated yet | 4
Heart failure accelerates the aging process and brings on early andropausal syndrome (AS), according to research presented today at the Heart Failure Congress 2013. AS, also referred to as male 'menopause', was four times ...
3 hours ago | not rated yet | 1
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
21 hours ago | 3.7 / 5 (3) | 3 |
Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...
19 hours ago | 3 / 5 (2) | 0 |
(AP)—Department of Justice lawyers have again asked a federal appeals court in New York to delay lifting age restrictions and prescription requirements on an emergency contraceptive popularly known as the morning-after ...
2 hours ago | not rated yet | 0
Mortality and length of stay are highest in heart failure patients admitted in January, on Friday, and overnight, according to research presented today at the Heart Failure Congress 2013. The analysis of nearly 1 million ...
3 hours ago | not rated yet | 0