#1678 The relationship between national dialysis catheter rates and kidney transplantations
Authors: Hofmann Amun 
Published: May 2024

Abstract

Background and Aims
Vascular access for chronic hemodialysis is either achieved by an arteriovenous fistula or graft (AVF/G) or central venous catheter (CVC) and AVF/Gs have been repeatedly reported to be superior to CVCs and guidelines usually recommend it as the preferred vascular access. AVF/Gs are associated with better quality of dialysis, less complications, and a lower mortality than CVCs. This has led to initiatives such as Fistula First that aimed at maximizing AVF/Gs rates and national healthcare systems now frequently evaluate their efficiency of care for end-stage renal disease (ESRD) patients based on this metric. However, transplant activity might be a significant confounding factor since high transplant rates and therefore limited transition phases might contribute to a higher acceptance of CVCs in patients awaiting kidney transplantation.
I aimed at investigating the relationship between CVC rates and transplant activity in different countries by analyzing data from national dialysis and transplant registries.

Method
Data was obtained from national transplant and dialysis registries including Argentina (2012-2021), Australia (2004-2022), Austria (2005-2022), New Zealand (2005-2022), Sweden (2011-2022), Turkey (2004-2022), and the USA (2012-2021). Population estimates were obtained from the World Bank. The conducted analyses included unadjusted correlation analysis as well as multivariate regression analysis.

Results
The study sample included data from 7 different countries spanning from North and South America, over Europe and Asia to Oceania covering data from 107 annual reports. CVC rates and transplant activity per million showed a weak positive correlation (0.283, 95% CI: 0.093–0.454) within the same year (Fig. 1). When correlating catheter rates with transplant activity of the previous year, the association increased slightly (0.357, 95% CI: 0.173–0.517). The change of incidence of ESRD or hemodialysis patients (depending on data availability) showed a moderate correlation with the change of catheter rates (0.507, 95% CI: 0.272-0.685). A regression model including the incidence of ESRD improved model fit compared to a model that uses only transplant activity to estimate catheter rates.

Conclusion
Even though most healthcare systems, clinicians, and epidemiologists recommend low CVC rates, a thorough evaluation of the care of ESRD patients requires the adjustment of several contributing factors, primarily kidney transplantation activity. Higher kidney transplantation rates are associated with higher CVC rates which might be due to reduced waiting times until transplantation. An increase in kidney transplantations might especially increase CVC-based dialysis in the subsequent year. There is some evidence that the incidence of ESRD in general or hemodialysis in specific additionally affects CVC rates. Increasing incidence of ESRD is associated with increasing catheter rates, indicating that healthcare systems might struggle to adapt to short-term changes regarding access demands.