The impact of extended-hours home hemodialysis and buttonhole cannulation technique on hospitalization rates for septic events related to dialysis access

Hemodial Int. 2010 Oct;14(4):451-63. doi: 10.1111/j.1542-4758.2010.00463.x.


Few studies adequately document adverse events in patients receiving long, slow, and overnight hemodialysis (NHD). Concerns about high rates of dialysis access complications have been raised. This is an observational cohort study comparing hospital admission rates for vascular access complications between alternate nightly NHD (n=63) and conventional hemodialysis (n=172) patients established on chronic hemodialysis for at least 3 months. Overall, hospital admission rates and hospital admission rates for cardiac and all infective events are also reported. The NHD cohort was younger and less likely to be female, diabetic, or have ischemic heart disease than the conventional hemodialysis cohort. When NHD and buttonhole cannulation technique were used simultaneously, there was a demonstrated increased risk of septic dialysis access events: incidence rate ratio 3.0 (95% confidence interval 1.04-8.66) (P=0.04). The majority of blood culture isolates in NHD patients were gram-positive organisms, particularly Staphylococcus aureus. Alternate nightly NHD did not significantly change total hospital admissions or hospital admissions for indications other than dialysis access complications, compared with conventional hemodialysis. Our data suggest that buttonhole cannulation technique should be used with caution in patients performing extended-hours hemodialysis as this combination appears to increase the risk of septic access complications. Randomized-controlled trials are needed to confirm these findings.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / etiology
  • Catheterization / adverse effects*
  • Catheterization / methods
  • Catheters, Indwelling / adverse effects*
  • Cohort Studies
  • Female
  • Hemodialysis, Home / adverse effects*
  • Hemodialysis, Home / methods
  • Hemodialysis, Home / mortality
  • Hospitalization
  • Humans
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Queensland / epidemiology
  • Renal Dialysis / adverse effects
  • Renal Dialysis / methods
  • Renal Dialysis / mortality
  • Retrospective Studies
  • Risk Factors
  • Sepsis / etiology*
  • Staphylococcal Infections / etiology
  • Time Factors