Use of a central venous catheter as vascular access at the start of a regular hemodialysis program: impact on mortality over 2 years

BACKGROUND: The recommended access for starting chronic hemodialysis (HD) is an arteriovenous fistula (AVF), but a (CVC) continues to be frequently used. Worldwide, its use has been associated with higher mortality, but data from Brazil are lacking. METHODS: Analytical, observational, and retrospective cohort study that aimed at analyzing the data available in the Brazilian Monthly Dialysis Registry database from Jan/2011 to Dec/2023. Using data from this registry, we evaluated the frequency of CVC use (regardless of whether tunneled or non-tunneled) at the start of HD across 13 years and assessed its impact on all-cause mortality over 2 years. RESULTS: We studied 10,182 patients. The mean age was 59 (47-69) years; 59% were male, and 33% had diabetes. CVC use at HD entry increased substantially in the last 10 years. The 2-year mortality rates for CVC and primary AVF/graft users were 20% and 9%, respectively, P < 0.001. In the fully adjusted multivariate model, the use of CVC persisted significantly associated with mortality (HR 1.69, 95%CI 1.23-2.25, P=0.001). Other variables directly associated with mortality were age (HR 1.04, 95%CI 1.03-1.05, P=0.001), and serum ferritin (HR 1.18, 95%CI 1.06-1.30, P=0.002). Serum albumin (HR 0.86, 95%CI 0.84-0.88, P<0.001) and URR (HR 0.97, 95%CI 0.96-0.97, P<0.001) emerged as protective factors. CONCLUSIONS: CVC use was associated with a 1.69-fold increased risk of 2-year mortality. The increasing use of CVCs in Brazil is concerning and highlights the need for public health strategies promoting timely permanent vascular access before HD initiation.