Time to thrombectomy is associated with increased risk for dialysis catheter placement

J Ren Care. 2019 Dec;45(4):232-238. doi: 10.1111/jorc.12295. Epub 2019 Aug 26.

Abstract

Background: Arteriovenous dialysis access, fistulae (AVF) or grafts (AVG), are associated with significant rates of thrombosis. Timely thrombectomy may have a significant impact on immediate and long-term access survival. However, switching to a catheter is associated with higher rates of morbidity and mortality compared with those who have an AVF or AVG.

Objectives: The goal of this study was to evaluate whether time to thrombectomy increases the risk for loss of dialysis access and subsequent placement of a dialysis catheter at hospital discharge, at 6 months, 12 months, and data at any time after discharge.

Methods: Using retrospective data, 444 patients were identified as having undergone thrombectomy for dialysis access dysfunction between January 2008 and April 2015, with 122 hospital admissions primarily for thrombectomy.

Results: The mean age was 60.4 years, 65% were male, and 44.3% had an arteriovenous fistula as their dialysis access. The mean time to thrombectomy was 10.8 hours, and 14 patients utilised a catheter for haemodialysis as primary access upon discharge. After adjustment for prior access intervention, access type, and time to thrombectomy, the adjusted odds ratios (AOR) of a one-day delay in thrombectomy was associated with a twofold increase in requirement for catheter at discharge and at 6 months. This association remained present at any time after discharge.

Conclusion: In this study of patients cared for within an academic health system, a single day delay in thrombectomy nearly doubled the risk of needing a dialysis catheter at hospital discharge, 6 months, or any time after discharge.

Keywords: Arteriovenous fistula; Arteriovenous graft; Dialysis catheter; Thrombectomy.

MeSH terms

  • Adult
  • Aged
  • Arteriovenous Fistula
  • Catheterization / standards*
  • Catheters, Indwelling / adverse effects*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Renal Dialysis / instrumentation
  • Renal Dialysis / methods
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / therapy
  • Retrospective Studies
  • Risk Factors
  • Thrombectomy / classification
  • Thrombectomy / standards*
  • Time Factors*
  • Treatment Outcome