Comparative outcomes of arteriovenous accesses with and without tunneled hemodialysis catheters: A retrospective cohort study.

Abstract

This study compared patency rates of arteriovenous accesses with and without concurrent tunneled hemodialysis catheter (THC) use, addressing limited research on combined outcomes. A retrospective cohort analysis was conducted on patients undergoing arteriovenous access creation at a single hospital between January 2021 and December 2022. Primary outcomes were the 6-month primary patency rate and functional dialysis success. Secondary outcomes were the factors associated with each of these endpoints. Statistical analyses employed t tests, chi-square tests, logistic regression, and Kaplan-Meier survival curves. A total of 319 vascular accesses were included. The 6-month patency rate was significantly higher in the access-only group than in the access + THC group (87.04% vs 78.20%, P = .04). THC usage (odds ratio [OR] = 0.49, 95% confidence interval [CI]: 0.25-0.95, P = .03), graft usage (OR = 0.38, 95% CI: 0.18-0.82, P = .01), and higher hemoglobin levels (OR = 0.80, 95% CI: 0.65-0.96, P = .02) were associated with reduced patency rates. Functional dialysis success at 6 months did not differ significantly between groups (87.96% vs 83.89%, P = .21). However, older age (OR = 0.96, 95% CI: 0.93-0.99, P = .01), use of a cubital artery to an autologous vein (OR = 0.39, 95% CI: 0.19-0.82, P = .01) or graft (OR = 0.40, 95% CI: 0.17-0.97, P = .04), and higher hemoglobin levels (OR = 0.81, 95% CI: 0.66-0.99, P = .03) were associated with a lower likelihood of functional dialysis success. Concurrent THC use was independently associated with reduced 6-month primary patency without a corresponding reduction in the short-term delivery of dialysis, suggesting an increased need for interventions to maintain the access. Judicious use of THCs and careful consideration of the vascular access type are important to optimize vascular access outcomes in patients undergoing hemodialysis.