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Deprecated: Implicit conversion from float 276.79999999999995 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Am+J+Kidney+Dis 2014 ; 64 (6): 954-61 Nephropedia Template TP
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Vascular Access Type, Inflammatory Markers, and Mortality in Incident Hemodialysis Patients: The Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study #MMPMID25266479
Banerjee T; Kim SJ; Astor B; Shafi T; Coresh J; Powe NR
Am J Kidney Dis 2014[Dec]; 64 (6): 954-61 PMID25266479show ga
Background: Few reports have shown an association between access type and inflammatory markers in a longitudinal cohort. We investigated the role of access type on serial inflammatory markers and the role of inflammatory markers in mediating the association of access type and the risk of mortality in a prospective study of incident dialysis patients. Study Design: Cohort study, post-hoc analysis of Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. Setting & Participants: In 583 participants, inflammation was assessed by measuring serum C-reactive protein (CRP) and interleukin 6 (IL-6) after access placement and at multiple time points during 3 years? follow-up. Type of access was categorized as central venous catheter (CVC), arteriovenous graft (AVG), and arteriovenous fistula (AVF) and changes over time were recorded. Predictor: Access type, age, gender, race, body mass index, diabetes, cardiovascular disease, serum albumin. Outcomes: CRP, IL-6, and mortality Measurements: We used mixed-effects pattern mixture (MEPM) models to study the association between access type and repeated measures of inflammation and survival analysis to investigate the association of access type and mortality, adjusting for predictors. Results: In a MEPM model, compared to AVF, the presence of a CVC and an AVG were associated with 62% (p=0.02) and 30% (p=0.05) increase in the average CRP levels, respectively. Cox proportional hazards model yielded non-significant associations of CVC and AVG use (vs. AVF) with the risk of mortality when adjusted for inflammatory markers. Higher levels of CRP were associated with increased risk of CVC failure than lower levels of CRP. Limitations: CRP, IL-6 measurements not performed for all hemodialysis patients. Conclusions: CVCs, compared to AVFs, are associated with a greater state of inflammation in incident hemodialysis patients and the association of catheter use and mortality may be mediated by access-induced inflammation. Our findings support recommendations for the early removal or avoidance of CVC placements.