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Association between dialysis access and dialysis withdrawal in the first 12 months after dialysis initiation


Chen, J and Brown, M and Jose, MD and Brennan, F and Johnson, D and Roberts, M and Wong, G and Hassan, HC and Kennard, A and Walker, R and Davies, C and Boudville, N and Barlace, M and Lim, W, Association between dialysis access and dialysis withdrawal in the first 12 months after dialysis initiation, Asian Pacific Society of Nephrology, 28- August-1 September, pp. 22. ISSN 1320-5358 (2021) [Conference Extract]

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DOI: doi:10.1111/nep.13725


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

Item Details

Item Type:Conference Extract
Keywords:chronic kidney disease, dialysis, end-stage kidney disease, transplant
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Nephrology and urology
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Jose, MD (Professor Matthew Jose)
ID Code:148640
Year Published:2021
Deposited By:Medicine
Deposited On:2022-01-31
Last Modified:2022-08-30

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