Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Hemodialysis.com Editor Marie Benz: What are the main findings of the study?

In this original retrospective cohort study, we identified that a sizeable proportion of patients initiate chronic dialysis after an illness-induced rapid loss of GFR.

These patients are at high risk of death compared to those without an acute illness event, and virtually all of them initiate dialysis with a central venous catheter (CVC).

After excluding this "acute start" subgroup, there is a reduction in the hazard ratio for mortality, comparing patients receiving dialysis with a CVC to those with alternative dialysis access (arteriovenous fistula or peritoneal dialysis catheter).

Furthermore, the actual proportion of deaths directly attributed to the CVC (i.e. catheter-related sepsis or mechanical CVC complications) was low in this study.

Hemodialysis.com: Were any of the findings unexpected?

There were no unexpected findings in this study.

Hemodialysis.com: What should clinicians and patients take away from your report? 

While we are not suggesting that CVCs are the optimal form of access, the primary consideration from this study is that the mortality risk associated with CVC use may have been overestimated in previous studies that did not consider the potential confounding effect of an "acute start".  

Hemodialysis.com: What recommendations do you have for future research as a result of this study?  

Performing a similar analysis in a much larger cohort of dialysis patients would be an important undertaking to validate the findings of this single center study.

Reference:

The impact of an "acute dialysis start" on the mortality attributed to the use of central venous catheters: a retrospective cohort study.
Tennankore KK, Soroka SD, Kiberd BA.
BMC Nephrol 2012 Jul 30;13(1):72. [Epub ahead of print]