Abstract: TH-PO0956
Trends in the Comparative Mortality Risk of Hemodialysis Catheters
Session Information
- Vascular Access: Research and Cases
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Roetker, Nicholas S., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
- Wetmore, James B., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
- Liu, Jiannong, Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
- Gilbertson, David T., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
- Johansen, Kirsten L., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
Background
Guidelines favor arteriovenous (AV) access over catheters for hemodialysis (HD) due in part to lower infection risk. Yet, catheter use has risen in recent years. Using US Renal Data System data, we evaluated whether the mortality risk between AV access and catheter users during the first 18 months of HD has changed over time.
Methods
We studied community-dwelling adults (aged 18–85 years) initiating HD with a catheter in 2013–2022, excluding those with a maturing AV access to prevent immortal time bias. We emulated a target trial comparing transition to AV access versus continuous catheter use via a clone-censor-weighting approach (Figure). Discrete-time pooled logistic regression modeled the 18-month cumulative risk of death by HD initiation year. We accounted for protocol non-adherence using censoring weights and treated modality changes as competing events.
Results
Among 536,836 incident patients, 62,944 and 70,111 deaths occurred in the emulated AV access and catheter protocols, respectively. Although overall 18-month mortality declined across the study period, it remained consistently lower for the AV access group (Table). However, as death rates declined, the absolute risk difference attenuated from –6.4% (95% CI –6.9%, –5.9%) in 2013 to –4.6% (95% CI –5.0%, –4.3%) in 2022, though relative risk remained stable. Consequently, the estimated number of patients needing to switch to AV access to prevent one death increased from 16 to 22. Bloodstream infection-related deaths showed similar patterns.
Conclusion
Declining mortality rates among patients receiving HD over the past decade may alter the risk calculus for vascular access. While stable risk ratios suggest AV accesses maintain a consistent relative survival benefit over catheters, lower overall 18-month mortality means the absolute excess risk associated with catheter use has diminished. Advances in catheter technology and management may make their use increasingly tolerable.
Figure. Clone-censor-weighting design
Table
Funding
- NIDDK Support