Murea M, et al. - Longitudinal transitions between tunneled central venous catheters (TCVC)-based and arteriovenous accesses (AVA)-based hemodialysis (HD) outcomes were analyzed as per placement order. Researchers observed that on the basis of the sequence of placement, HD vascular access outcomes differed. Despite frequent AVA placements, only half of patients effectively achieved a “permanent” vascular access and used an AVA for the majority of HD treatments.

Methods

• This study included 391 patients initiating chronic HD via a TCVC between 2012 and 2013 at 12 outpatient academic dialysis units.
• Over a mean (SD) of 2.8 (0.9) years, chronological distributions of HD vascular accesses were recorded and then sequentially grouped into periods for TCVC-delivered and AVA-delivered (AVF or AVG) HD.
• On the basis of access placement sequence and type, adjusting for age, primary AVA failure and cumulative access survival were assessed.

Results

• Data reported 497 AVA placement surgeries in 92.3% (361/391) of patients.
• The analysis of the initial 3 surgeries revealed that primary AVF failure rates increased with each successive fistula placement (p = 0.008).
• Findings demonstrated that among the 82.9% (324/391) of TCVC patients successfully converted to an AVA, 30.9% returned to a TCVC, followed by a 58.0% conversion rate to another AVA.
• It was also reported that annual per-patient vascular access transition rates were 2.02 (0.09) HD periods using a TCVC and 0.54 (0.03) HD periods using an AVA.
• In addition, comparing the first AVA used with the second, cumulative access survivals were 701.0 (370.0) vs. 426.5 (275.0) days, respectively.
• Researchers observed that, excluding those never converting to an AVF or AVG, 169 (52.2%) subsequently converted from a TCVC to a permanent access and received HD via AVA for ≥80% of treatments.