Prior central venous catheter placement and age are associated with earlier intervention after permanent hemodialysis access creation

Ramtin Talebi; Ramin Talebi; Joshua Chen; Angela Yang; Sanath Patil; Paul J DiMuzio; Babak Abai; Dawn M Salvatore; Michael J Nooromid

doi:10.1111/hdi.13180

Prior central venous catheter placement and age are associated with earlier intervention after permanent hemodialysis access creation

Hemodial Int. 2024 Oct 24. doi: 10.1111/hdi.13180. Online ahead of print.

Authors

Ramtin Talebi¹, Ramin Talebi¹, Joshua Chen¹, Angela Yang¹, Sanath Patil¹, Paul J DiMuzio², Babak Abai², Dawn M Salvatore², Michael J Nooromid²

Affiliations

¹ Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
² Department of Surgery, Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

PMID: 39449270
DOI: 10.1111/hdi.13180

Abstract

Introduction: Arteriovenous fistulas (AVFs) and grafts are essential for long-term hemodialysis access in patients with end-stage renal disease. However, complications and access failure often necessitate re-intervention. In this study, we aim to delineate the factors associated with earlier failure of permanent hemodialysis access warranting revision procedures.

Methods: This retrospective study aimed to identify factors associated with increased revision rates in AVFs and arteriovenous grafts, using multivariate survival analysis. A cohort of 136 patients who underwent initial arteriovenous access creation between 2005 and 2022 was analyzed. Patient characteristics, including age, comorbidities, access type, and vascular anatomy, were extracted, and hazard ratios (HR) were calculated to identify independent predictors of needing revision.

Findings: A total of 119 patients were included in the final cohort, with a mean age of 55.2 years. Over 40% of patients had a previous central venous catheter placement, while 15% had a previous AVF. The majority of procedures were performed on the left side (74%), and brachiocephalic fistulas were most commonly created (41%). Univariate and multivariate Cox regression revealed that age (adjusted HR = 1.02, p = 0.01) and prior central venous catheter placement (adjusted HR = 1.77, p = 0.01) were independent predictors of earlier revision, while other variables such as sex, hypertension, and diabetes did not show significant associations. Patients with prior central venous catheter placement had a 77% increased risk of revision, even when adjusted for confounders.

Discussion: Understanding predictors of successful long-term access outcomes can guide decision-making regarding access type and alternative strategies. In our cohort, increased age and prior central venous catheter placement are associated with a shorter time to failure of permanent hemodialysis access and an increased risk of needing revision.

Keywords: arteriovenous fistula; hemodialysis; patient characteristics; revision; survival analysis; vascular access.