THURSDAY, April 21 (HealthDay News) -- Doctors should avoid
delivering hemodialysis to kidney failure patients through a
central line catheter because that method is associated with a
higher risk of death shortly after beginning dialysis, a new study
Researchers examined the medical records of more than 38,500
Canadian patients who began dialysis from 2001-08.
Patients who received hemodialysis through a central line
catheter into a large vein had an 80 percent higher risk of death
in the first year after starting dialysis than patients who
- Peritoneal dialysis (through a tube into the abdomen).
- Dialysis through an arteriovenous fistula (in which a surgeon
connects an artery directly to a vein).
- Dialysis through an arteriovenous graft (in which a surgeon
connects an artery to a vein with a synthetic tube, or graft,
implanted under the skin in one arm).
Both the surgically created fistula and graft access sites are
at less risk of infection than a central line, with a fistula least
likely to become infected, the study authors said.
Among central line patients, the risk of death was 20 percent
higher five years after dialysis began than in the others.
"Our results emphasize the importance of predialysis care and education, and the need to avoid central venous catheter use in our [hemodialysis] patients," Dr. Jeffrey Perl, of St. Michael's Hospital in Toronto, said in an American Society of Nephrology news release.
The researchers cautioned that the study was observational, not
a randomized controlled trial, and that there was no information on
the reasons why patients started dialysis with a central catheter
vs. the other methods.
The study appeared in the
Journal of the American Society of Nephrology.
In the study, about 63 percent of the patients received
hemodialysis using a central line catheter, 17 percent began the
treatment with an arteriovenous fistula or graft, and 19 percent
performed peritoneal dialysis on themselves at home.
Those who got treatment through an arteriovenous fistula or
graft when starting hemodialysis survived at about the same rate as
those on dialysis through a tube in the abdomen.
Prior research has also suggested that peritoneal patients have
a lower risk of death, Perl said.
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