Kidney Week

Abstract: PUB133

Association Between Hemodialysis Access Type, Dialysis Adequacy, and Mortality

Session Information

• Publication Only

Category: Dialysis

• 803 Dialysis: Vascular Access

Authors

• Alwali, Abdalmahmoud, NYC Health + Hospitals/Harlem, New York, New York, United States

Abdalmahmoud Alwali, MD, MPH

• Hassan, Muhammad Zaigham, NYC Health + Hospitals/Harlem, New York, New York, United States

Muhammad Zaigham Hassan, MD

• Ahmed, Areeg, NYC Health + Hospitals/Harlem, New York, New York, United States

Areeg Ahmed, MD

• Konigbagbe, Oluwole Oluyinka Oluyemi, NYC Health + Hospitals/Harlem, New York, New York, United States

Oluwole Oluyinka Oluyemi Konigbagbe, MBBS

• Dowie, Donna, NYC Health + Hospitals/Harlem, New York, New York, United States

Donna Dowie, MD, MPH

• Thearle, Marie, NYC Health + Hospitals/Harlem, New York, New York, United States

Marie Thearle, MD, MHS

• Andrabi, Suhaib A., NYC Health + Hospitals/Harlem, New York, New York, United States

Suhaib A. Andrabi, MD, FASN

• Anderson, Herman L., NYC Health + Hospitals/Harlem, New York, New York, United States

Herman L. Anderson, MD

• Herbert, Leroy, NYC Health + Hospitals/Harlem, New York, New York, United States

Leroy Herbert, MD

Background

The vascular access used for hemodialysis (HD) may influence adequacy of dialysis, inflammation, and malnutrition, increasing mortality. This study investigated the association between HD access type, dialysis adequacy, and mortality.

Methods

retrospective cohort study of 239 patients (53.1% male; 75.7% Black, 16.3% Hispanic, 4.2% White/Other, 3.8% multiple races) from the NYC Health + Hospitals/Harlem HD registry, with de-identified electronic record data for 7342 patient-months between January 2017 and July 2024, including fractional urea clearance (spKt/V) and urea reduction rate (URR). Chi-squared tests assessed inadequate HD (spKt/V < 1.2) by access type. To account for repeated measures, multivariable mixed models adjusted for age, sex, race, and months on HD were used to determine differences by access type. Cox proportional hazards models evaluated mortality risk by access type, adjusting for demographics and spKt/V.

Results

In the cohort, 90 patients used an AV fistula, 25 an AV graft, and 124 a permcath, corresponding to 65.3%, 12.6%, and 22.1% of HD patient-months. Fistula use remained stable (~60%), graft use declined (20 to 5%), and permcath use increased (19 to 24%) from 2017 to 2024. Inadequate HD occurred in 6.4% of patient-months, with permcath users having >2-fold higher risk (12.5%) vs. fistula (4.6%) and graft users (5.4%; p<0.0001). Permcath users had lower spKt/V (1.61 vs. 1.73 (fistula) vs. 1.72 (graft); p<0.0001) and URR (73.7% vs. 75.9% (fistula) vs. 76.3% (graft); p<0.0001).
Seventy patients (29.3%) died. Survival analysis identified spKt/V (HRR: 0.88 [0.81, 0.96] per 0.1 increase; p=0.002), age (HRR: 1.45 [1.20, 1.77] per decade; p=0.0002), and access type (HRR: 1.94 [1.46, 2.57]; p<0.0001) as mortality predictors. Permcath use was associated with reduced survival throughout the study period, while graft and fistula users had comparable survival for the first eight years, graft users experiencing higher mortality afterward.

Conclusion

Permcath use is associated with episodes of inadequate dialysis and higher mortality risk, independent from degree of urea clearance. More studies are needed to determine if this reflects a direct effect or underlying comorbidities.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20259e6x0jd2