Dialysis – Transplantation

Kidney International (2004) 66, 2429–2436; doi:10.1111/j.1523-1755.2004.66020.x

Relationship among catheter insertions, vascular access infections, and anemia management in hemodialysis patients

TRICIA L ROBERTS, GREGORIO T OBRADOR, WENDY L ST. PETER, BRIAN J G PEREIRA and ALLAN J COLLINS

Nephrology Analytical Services, Minneapolis Medical Research Foundation, Minneapolis, Minnesota; Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts; Universidad Panamericana School of Medicine, Mexico City, Mexico; and University of Minnesota, Minneapolis, Minnesota

Correspondence: Allan J. Collins, M.D., FACP, Nephrology Analytical Services, Minneapolis Medical Research Foundation, 914 South 8th St., Suite D-206, Minneapolis, MN 55404. E-mail:acollins@nephrology.org

Received 27 February 2004; Revised 1 June 2004; Accepted 11 June 2004.

Top

Abstract

Relationship among catheter insertions, vascular access infections, and anemia management in hemodialysis patients.

Background

 

Arteriovenous fistulas are the recommended permanent vascular access (VA) for chronic hemodialysis. However, in the United States most patients begin chronic hemodialysis with a catheter. Recent data suggest that VA type contributes to recombinant human erythropoietin (rHuEPO) resistance. We examined catheter insertions, VA infections, and anemia management in Medicare, rHuEPO-treated, chronic hemodialysis patients.

Methods

 

We compared hemoglobin values and rHuEPO and intravenous iron dosing with concurrent catheter insertions and VA infections in 186,348 period-prevalent patients in 2000. We studied anemia management after catheter insertions and VA infections in 67,410 incident patients from 1997 to 1999. Multiple linear regression models examined follow-up hemoglobin and rHuEPO dose per week (rHuEPO/wk) by numbers of catheter insertions and hospitalizations for VA infection.

Results

 

In the prevalent cohort, increasing temporary and permanent catheter insertions and VA infections were associated with slightly lower hemoglobin, higher rHuEPO doses, and higher intravenous iron doses. In the incident cohort, compared to patients with no VA infections or no catheter insertions (temporary or permanent), respectively, patients with 2+ VA infections or 2+ catheter insertions had 0.12 g/dL and 0.06 g/dL lower mean hemoglobin (P = 0.0028 and P < 0.0001), and 25.7% and 12.2% higher mean rHuEPO/wk (P < 0.0001).

Conclusion

 

Higher rHuEPO doses may be required to maintain similar or slightly lower mean hemoglobin values among chronic hemodialysis patients with higher numbers of catheter insertions and VA infections, compared to patients without any.

Keywords:

anemia, catheters, indwelling, erythropoietin, recombinant, infection, kidney failure, chronic, renal dialysis

Extra navigation

.
ADVERTISEMENT