“There are only two types of catheters: those that are infected and those that will be infected.” Gerald Schulman, MD Professor of Medicine, Vanderbilt University
Within the hemodialysis community, central venous catheters (CVC) are considered the least desirable type of vascular access because they are prone to infection. At one hemodialysis convention a respected nephrologist simply stated, “Catheters kill.” He followed saying that he would hope to see the day when they are no longer used at all.
One of the goals of the current CME-sponsored Fistula First – Catheter Last Initiative is to decrease the use of long term catheters for more than 90 days to less than 10 percent of patients on hemodialysis. University of Toronto nephrologists Charmaine Lok and colleagues have analyzed US Renal Data and report the following:1
- Approximately 80% of North American patients initiate hemodialysis with a catheter.
- After four months of dialysis initiation approximately 50% of patients are still on catheters. KDOQI Guidelines recommend 10%.
- HD catheters pose the highest risk of bacteremia, sepsis, and death compared with other vascular access types; approximately 30% of patients using a central venous catheter experience a bacteremic or septic episode.
- The risk of a sepsis-attributable death for HD catheter patients is 100 times that of the general population; the rate of sepsis in patients with a catheter was 1.6 times higher than the rate of infection (2007 data).
- Mortality from sepsis within three months of initiating dialysis was 4.3 times greater in patients who initiate dialysis with a catheter compared to an AV fistula.
- Hospitalization due to sepsis within three to twelve months of initiating dialysis was 3.2 and 2.5 times higher, respectively, for catheters compared with fistulas.
- Patients with a prevalent (permanent) catheter had a seven-fold higher likelihood of having an access related infection compared to patients with an AV fistula or graft.
- Patient who had a catheter to initiate hemodialysis were 3.8 times more likely to have a catheter-associated infection than those with an AV fistula or AV graft (2010 data).
1 Lok CE, Thumma JR, McCullough KP, Gillespie BW, Fluck RJ, Marshall MR, Kawanishi H, Robinson BM, Pisoni RL, "Catheter-related Infection and Septicemia: Impact of Seasonality and Modifiable Practices from the DOPPS, Semin Dial. 2014 Jan;27(1):72-7.