ABSTRACT. Vascular access complications are common in patients with end-stage kidney
disease who are receiving maintenance hemodialysis (HD) and are responsible for an enormous
burden of morbidity and mortality among these patients. Differences in the all-cause mortality
rate and hospitalization between dialysis catheter use and arteriovenous (AV) vascular access use
have not been documented in our HD population. We performed a 12-month prospective analysis
of our HD patients from four dialysis centers. We examined all-cause mortality and hospitalization
in patients being dialyzed through HD catheters as compared to patients with AV access. A
total of 382 patients were included in the study. Of these, 88 had catheters and 294 had AV
accesses. Seventy-eight percent of all catheters were temporary nontunneled dialysis catheters.
The overall gross mortality rate for all patients was 14.7%. Gross mortality was significantly
lower among AV access group compared to the catheter group (12.2% vs. 22.7%; P = 0.015).
Catheter use was associated with a relative hazard ratio (HR) of 1.85 [95% confidence interval
(CI), 1.13–3.03] compared with use of an AV access. Hospitalization rate was also significantly
lower among patients with AV access versus patients who used catheters (27.6% vs. 46.6%; P =
0.006). The risk of hospitalization was also higher in catheter users with a relative HR of 1.69
(95% CI, 1.26–2.26) compared with use of AV access. In our HD population where the majority
of catheters were temporary nontunneled catheters, dialysis catheter use was associated with
higher mortality and increased hospitalization rates compared with AV access. These results
emphasize the urgent need to minimize the use of dialysis catheters, in order to reduce mortality
and hospitalization rates among HD patients.