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.