Promoting AVF use seems to have done little to change the frequency of CVC use, study shows.


SAN FRANCISCO—The use of central venous catheters (CVC) for dialysis access has not changed despite an increase in arteriovenous fistula (AVF) use, researchers reported here during Renal Week 2007.

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Researchers at Emory University in Atlanta analyzed data reported from the hemodialysis units in ESRD Network 6 since the inception of Fistula First initiative, examining data of 26,054 patients who received hemodialysis at 384 centers in Georgia, North Carolina, and South Carolina between January 2004 and January 2006. The patients had a mean age of 59 years; the group was 67% African-American and 51% male.


Baseline CVC use was 26% and did not change despite a significant increase in AVF placement during the study period (from 4.6% to 6.2%). The percent CVC with a nonfunctioning AVF increased from 4.6% to 6.2%. In addition, the researchers found that the CVC used for more than 90 days decreased whereas CVC use for fewer than 90 days increased from 5.6% to 7.1%. And there was no change in CVC used with a non- functioning arteriovenous graft.


The Fistula First Project began in 2003 to promote greater AVF use. Yet, there has been a perception among many nephrologists in the United States that catheter use has still been increasing since the project was started.


“What we are showing is that at least catheters use is not going up. Maybe with more time, possibly in three or four years, we might see a significant reduction [in catheter use] but we want to make sure that happens,” said lead the investigator Rafiq El Hammali, MD, a former nephrology fellow who is in private practice in Atlanta.


According to Dr. Hammali, the data collection system needs to more adequately address what is happening with catheters used with nonfunctioning AV fistulas once they are placed in patients.