For patients undergoing hemodialysis, the use of catheters for vascular access is associated with the highest risk of death, infections, and cardiovascular events compared with arteriovenous fistula or graft, according to a review and meta-analysis published online ahead of print in the Journal of the American Society of Nephrology.

Pietro Ravani, MD, PhD, of the University of Calgary in Canada, and colleagues reviewed 62 cohort studies involving 586,337 participants to assess the correlation between type of vascular access (central venous catheter, arteriovenous fistula, and arteriovenous graft), and the risk of mortality, infection, and major cardiovascular events.

In a random-effects meta-analysis, the researchers found that participants using catheters had a significant 53% increased risk of all-cause mortality, a significant twofold increased risk of fatal infections, and a significant 38% increased risk of cardiovascular events compared to those with fistulas. The corresponding risks were also significantly increased for participants with catheters versus grafts (38%, 49%, and 26% increased risk, respectively). Patients with grafts had significantly increased risks of all-cause mortality and fatal infection  compared to those with fistulas, but the investigators observed no significant difference in the risk of cardiovascular events. There was a high risk of bias, especially selection bias.

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“In summary, several important clinical outcomes are associated with the type of vascular access used for hemodialysis,” the researchers wrote. “The strongest associations with adverse events are observed in persons using catheters, with the lowest risk being observed in persons using fistulas.”