Variability in reasons for hemodialysis catheter use by race, sex, and geography: findings from the ESRD Clinical Performance Measures Project

Am J Kidney Dis. 2008 Oct;52(4):753-60. doi: 10.1053/j.ajkd.2008.04.007. Epub 2008 Jun 2.

Abstract

Background: Race, sex, and geographic differences in hemodialysis vascular access use have been reported, but differences in reasons for catheter use have not been assessed.

Study design: Cross-sectional.

Setting & participants: Data obtained from the 2005 Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures Project for adult hemodialysis patients.

Predictors: Race, sex, and geographic region.

Outcomes & measurements: Reasons for catheter use were categorized as short term and long term. Race, sex, and geographic associations with reasons were assessed by using bivariate analyses and multivariate logistic regression.

Results: Of 8,479 hemodialysis patients, 3,302 (39%) used a fistula, 2,725 (32%) used a graft, and 2,299 (27%) used a catheter. We placed 857 patients with a catheter (37%) in the short-term-reason cohort and 1,404 (61%) in the long-term-reason cohort, and 38 (2%) lacked information to be placed. Reasons for catheter use were independently associated with race, sex, and geographic region. Whites were 43%, 49%, and 34% less likely than African Americans to use a catheter because of graft maturation, graft interruption, and all vascular access sites exhausted and 70% and 40% more likely because of fistula maturation and no fistula or graft surgically planned, respectively. Men were 50% less likely than women to use a catheter because of graft interruption and 80% more likely because of fistula maturation. Geographic end-stage renal disease network was associated with catheter use because of fistula maturation (P = 0.03), no fistula or graft surgically created (P < 0.001), and no fistula or graft surgically planned (P = 0.05).

Limitations: The cross-sectional study design precludes our ability to assess trends over time in reasons for catheter use. Associations were assessed for a limited set of variables.

Conclusion: Race, sex, and geographic differences in reasons for hemodialysis catheter use exist. Understanding these differences may aid in developing strategies to decrease catheter initiation rates.

Publication types

  • Comparative Study

MeSH terms

  • African Americans*
  • Arteriovenous Shunt, Surgical / statistics & numerical data
  • Catheterization, Central Venous / statistics & numerical data*
  • Cross-Sectional Studies
  • European Continental Ancestry Group*
  • Female
  • Healthcare Disparities
  • Humans
  • Kidney Failure, Chronic / therapy*
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Patient Education as Topic
  • Renal Dialysis / methods*
  • Retrospective Studies
  • Sex Factors
  • Transplants / statistics & numerical data
  • United States