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Study explains higher risk of death for patients on hemodialysis vs. home-based dialysis

Toronto, April 27, 2011

By Leslie Shepherd

The use of central venous catheters may explain the higher death rate in kidney patients on hemodialysis compared to those on peritoneal, or home-based, dialysis, according to a new study by Dr. Jeffrey Perl.

A study of more than 38,500 Canadian patients starting dialysis between 2001 and 2008 found that 63 per cent started hemodialysis (HD) using a central catheter placed into one of the large veins. In hemodialysis, conducted in a hospital, blood is removed from the body, filtered and then returned. Another 17 per cent started HD using an arteriovenous fistula (AVF) or arteriovenous graft (AVG)—surgically created access sites that reduce the rates of infection and other complications related to central catheters.

The rest started on peritoneal dialysis, performed at home, where cleansing fluids are pumped into a patient’s abdomen through a catheter tube. The fluid removes toxins and water from the blood using the peritoneum, the membrane lining the abdomen, as a filter.

During the first year of the study, the risk of death for patients starting HD with a central catheter was 80 percent higher than for patients who started on PD. The risk of death in the first year for patients who started hemodialysis with an AVF/AVG was similar to that of the PD group. The catheters are associated with higher rates of infection.

In the five years after starting dialysis, the risk of death was still 20 percent higher in patients who started HD with a central catheter, compared to the PD group. The survival rate for patients who started HD with an AVF/AVG remained similar to that for patients who started on PD.

The study appears in the current issue of the Journal of the American Society of Nephrology.

Some past studies have shown that patients on PD are at lower risk of death during the first year or two on dialysis, compared to patients on HD.

"Our results emphasize the importance of predialysis care and education, and the need to avoid central venous catheter use in our HD patients," said Perl, a staff nephrologist.