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Association between dialysis access and dialysis withdrawal in the first 12 months after dialysis initiation
Aim: To assess the association between dialysis access and dialysis withdrawal in the first 12 months after dialysis initiation.
Background: Dialysis withdrawal is a major cause of early mortality in patients initiated on dialysis, and haemodialysis via central venous catheter (CVC) is known to be associated with early mortality. The association between dialysis modality and early mortality post-dialysis initiation is inconsistent.
Methods: Using data from the Australian and New Zealand Dialysis and Transplant Registry, we examined the association between dialysis access (categorised as peritoneal dialysis (PD), haemodialysis via arteriovenous fistula [AVF], and haemodialysis via CVC) and early death attributed to dialysis withdrawal (stratified by 0-6 months and >6-12 months) in incident adultdialysis patients in Australia between 2005 and 2018 using adjusted competing risk analyses.
Results: Of 31,579 incident dialysis patients, 1205 (4%) patients experienceddeath attributed to dialysis withdrawal within 12 months post-dialysis initiation, with 161 (13%) initiated on dialysis via PD, 223 (19%) on haemodialysis via AVF, and 821 (68%) on haemodialysis via CVC. Comparedto patients on PD, the adjusted subdistribution hazard ratios (SHRs) for dialysis withdrawal between 0-6 months were 1.12 (95%CI 0.82-1.54) for haemodialysis via AVF, and 2.89 (2.20-3.78) for haemodialysis via CVC. The adjusted SHRs for dialysis withdrawal between >6-12 months were 0.92 (0.70-1.23) for haemodialysis via AVF, and 1.88 (1.48-2.40) for haemodialysis via CVC. No interaction was observed between dialysis access and late referral or body mass index.
Conclusions: Patients initiated on PD and haemodialysis via AVF had similar early dialysis withdrawal risk, whereas the risk significantly increased in patients initiated on haemodialysis via CVC with greater magnitude in the first six months post-dialysis initiation
Publication titleAsian Pacific Society of Nephrology
Volume26 Suppl. 2
Department/SchoolTasmanian School of Medicine
Place of publicationAustralia
Event title56th Annual Scientific Meeting of the Australian and New Zealand Society of Nephrology
Date of Event (Start Date)2021-08-28
Date of Event (End Date)2021-09-01