BACKGROUND: Few reports have shown an association between access type and inflammatory marker levels in a longitudinal cohort. We investigated the role of access type on serial levels of inflammatory markers and the role of inflammatory markers in mediating the association of access type and risk of mortality in a prospective study of incident dialysis @entity1 . STUDY DESIGN: Cohort study, post hoc analysis of the @entity454 ( @entity454 ) Study. SETTING _ @entity1 : In 583 @entity1 , @entity32 was assessed by measuring serum @entity1851 ( @entity1851 ) and @entity650 ( @entity650 ) after access placement and at multiple times during 3 years' follow-up. Type of access was categorized as central venous catheter (CVC), arteriovenous graft (AVG), and @entity2548 ( @entity2548 ), and changes over time were recorded. PREDICTOR: Access type, age, sex, race, body mass index, @entity6 , @entity65 , and serum albumin level. OUTCOMES: @entity1851 level, @entity650 level, and mortality. MEASUREMENTS: We used mixed-effects pattern mixture models to study the association between access type and repeated measurements of @entity32 and survival analysis to investigate the association of access type and mortality, adjusting for predictors. RESULTS: In a mixed-effects pattern mixture model, compared with AVFs, the presence of CVCs and AVGs was associated with 62% (P=0.02) and 30% (P=0.05) increases in average @entity1851 levels, respectively. A Cox proportional hazards model yielded nonsignificant associations of CVC and AVG use (vs AVFs) with risk of mortality when adjusted for inflammatory marker levels. Higher @entity1851 levels were associated with increased risk of CVC failure than lower @entity1851 levels. LIMITATIONS: @entity1851 and @entity650 measurements not performed for all hemodialysis @entity1 . CONCLUSIONS: CVCs, compared with AVFs, are associated with a greater state of @entity32 in incident hemodialysis @entity1 , and the association of catheter use and mortality may be mediated by access-induced @entity32 . Our findings support recommendations for the early removal or avoidance of CVC placements.

Vascular Access Type, Inflammatory Markers, and Mortality in  Incident Hemodialysis @entity1 : The Choices for Healthy  Outcomes in Caring for XXXX ( @entity454 ) Study.

@entity1 :: ('9606', 'Species') :: ['participants', 'patients', 'PARTICIPANTS'] @entity32 :: ('MESH:D007249', 'Disease') :: ['inflammation'] @entity650 :: ('3569', 'Gene') :: ['IL-6', 'interleukin 6'] @entity454 :: ('MESH:D007676', 'Disease') :: ['CHOICE', 'Choices for Healthy Outcomes in Caring for ESRD'] @entity6 :: ('MESH:D003920', 'Disease') :: ['diabetes'] @entity2548 :: ('MESH:D001164', 'Disease') :: ['AVF', 'arteriovenous fistula'] @entity65 :: ('MESH:D002318', 'Disease') :: ['cardiovascular disease'] @entity1851 :: ('1401', 'Gene') :: ['C-reactive protein', 'CRP']
@entity454 :: (MESH:D007676,Disease) :: ['End-Stage Renal Disease']
