Kidney Week

Abstract: SA-PO1098

Prevalence and Conversion Rates of Central Venous Catheters in Hemodialysis: A Comparative Study of Public US and Mexican Dialysis Providers

Session Information

• Vascular Access - II
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 704 Dialysis: Vascular Access

Authors

• Maggiani, Pablo, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico

Pablo Maggiani,

• Sheth, Shimul, Renal Research Institute, New York, New York, United States

Shimul Sheth,

• Raimann, Jochen G., Renal Research Institute, New York, New York, United States

Jochen G. Raimann,

• Chavez, Jonathan, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico

Jonathan Chavez,

• Font, Jorge Jaime, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico

Jorge Jaime Font,

• Torres, Jose Antonio, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico

Jose Antonio Torres,

• Moreno, Rodolfo Alejandro, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico

Rodolfo Alejandro Moreno,

• Valdivia cerda, Veronica, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico

Veronica Valdivia cerda,

• Cervantes, Cynthia G., Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico

Cynthia G. Cervantes,

• Flores, Christian Perez, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico

Christian Perez Flores,

• Lopez, Marisol, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico

Marisol Lopez,

• Kotanko, Peter, Renal Research Institute, New York, New York, United States

Peter Kotanko,

• Garcia-Garcia, Guillermo, Hospital Civil De Guadalajara, University of Guadalajara, Zapopan, JALISCO, Mexico

Guillermo Garcia-Garcia,

Background

Central venous catheter (CVC) as vascular access in hemodialysis (HD) associates with adverse outcomes. Early CVC-to-fistula conversion has been associated with improved outcomes. While socioeconomic disparities between the U.S. and Mexico exist, not much is known about how CVC prevalence and conversion rates compare

Methods

We retrospectively studied incident HD patients at the Hospital Civil de Guadalajara Fray Antonio Alcalde (HC) and the U.S. Renal Research Institute clinics (RRI) between 2014-2018. We compared CVC rates at HD initiation and conversion rates between months 1 and 6 between HC and RRI. Data were presented as mean±SD and count(%), rates were compared using χ² tests. A logistic regression model was built to identify factors associated with continued CVC status

Results

Patient characteristics and CVC conversion rates are shown in Table 1. During the observation period 174 and 824 patients started HD in HC and RRI, respectively. At HD initiation CVC prevalence was 97% at HC and 69% at RRI, respectively. The CVC conversion rate between months 1 and 6 was 10.6% in HC and 28.1% in RRI, respectively (p=0.0004). Albumin was the only significant variable associated with continuous CVC status in the RRI group (OR 0.52, CI 95% 0.37-0.44). An association was observed, although not significant between diabetes and the persistence of the catheter in HC patients (OR 0.5, CI 95% 0.13-4.19)

Conclusion

CVC prevalence and conversion rates differ between RRI and HC. Higher CVC prevalence in HC patients at HD initiation is likely due to more frequent “crashing” into HD, less pre-dialysis care, and socioeconomic disparities, reflecting the realities of an urban public hospital providing HD to a largely uninsured population. The presence of diabetes in HC seems to contribute as a barrier to CVC conversion, perhaps due to the economic cost that it entails. The impact of CVC conversion rates on patient outcomes warrants future studies