An analysis of central venous catheter-based hemodialysis starts
.

Most patients in the United States initiate hemodialysis (HD) with a central venous catheter (CVC) despite a significantly increased morbidity and mortality associated with their use. Reasons for CVC-based starts have been identified, but the relative frequency of each is less clear. The aim of this retrospective chart review was to determine the most proximate cause for CVC-based HD initiations, and to determine the relative frequency of each cause. Out of 136 consecutive patients who started HD with a CVC, the most common reason was an urgent need for dialysis in a patient previously unknown to nephrology presenting acutely with end-stage renal disease (31%). Among patients known to nephrology, the most common reasons for a CVC-based start were a more rapid than expected kidney disease progression and/or acute on chronic kidney disease (CKD) (26.4%), a non-working (18.7%) or immature (11%) arteriovenous (AV) access at the time of dialysis initiation, and lack of AV access either due to patient refusal (16.5%) or failure to follow-up with fistula planning appointments (9.9%). Strategies addressing these factors are needed to ensure more patients start dialysis with a permanent access in place.