Researchers: Lower mortality among dialysis patients with fistulas might be due to underlying differences of patient groups

Death rates in patients who had an arteriovenous fistula created prior to starting dialysis were lower than rates in patients who started dialysis using a catheter, according to an analysis of adults who initiated hemodialysis between 2004 and 2012. But only 2.3% of deaths were related to complications of vascular access, suggesting that a fistula attempt could be a surrogate marker for a healthy patient who has had good care prior to starting dialysis while catheters were used preferentially in patients with acute kidney injury, short life expectancy, and in those with poor blood vessels, the study authors said.

Researchers led by Rob Quinn, MD, PhD, FRCPC and Pietro Ravani, MD, MSc, PhD, from the University of Calgary, in Canada, conducted a retrospective cohort study on a total of 2,300 patients aged ≥18 years who initiated hemodialysis between 2004 and 2012 at five Canadian dialysis programs.

“Predialysis fistula attempt may associate with a lower risk of mortality,” the authors wrote. “However, the excess mortality observed in patients treated with catheters does not appear to be due to direct, access-related complications but is likely the result of residual confounding, unmeasured comorbidity, or treatment selection bias.”

According to the U.S. Renal Data System, mortality rates among dialysis patients dropped more than 20% from 2007 to 2012. “The decline in mortality rates is coincident with a fall in catheter placement rates and rise in fistula placements as well as other changes in practice,” said Allan Collins, MD, president of the PEER Kidney Care Initiative, during a presentation of the data at Kidney Week 2015. -by Rebecca Zumoff

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