# Associations between initial dialysis access types and death from dialysis withdrawal in incident patients with kidney failure

## TL;DR

Patients starting dialysis with a central venous catheter have higher early death rates from dialysis withdrawal compared to other methods.

## Contribution

This study identifies a time-dependent association between initial dialysis access type and death from dialysis withdrawal.

## Key findings

- Patients initiated on HD-CVC had higher early death from dialysis withdrawal compared to HD-AVF or PD-PDC.
- The increased risk of death from dialysis withdrawal diminished after 3 years on dialysis.
- No significant difference in withdrawal risk was found between HD-AVF and PD-PDC.

## Abstract

Patients receiving haemodialysis via a central venous catheter (HD-CVC) have been shown to have an increased risk of all-cause mortality. It is unclear whether death from dialysis withdrawal is associated with the high mortality risk observed in patients initiated on HD-CVC.

Using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we examined the association between initial dialysis access [HD-CVC, haemodialysis via arteriovenous fistula (HD-AVF), and peritoneal dialysis (PD) via PD catheter (PD-PDC)] and death from dialysis withdrawal in adult patients starting dialysis in Australia between 2005 and 2022, analysed by time-stratified adjusted Cox regression with propensity score-matched cohorts.

Of 47 412 incident patients followed for a median of 2.65 years (interquartile range 1.19–4.87), 8170 (17%) died from dialysis withdrawal. Compared with patients initiated on HD-AVF, patients initiated on HD-CVC were more likely to experience death from dialysis withdrawal in the first 3 years after dialysis initiation, but not after 3 years [adjusted hazard ratios 2.43 (95% confidence interval 1.95–3.02), 2.06 (1.67–2.53), 1.57 (1.40–1.76), and 1.06 (0.97–1.15) for 0–6 months, >6–12 months, >1–3 years, and >3 years after dialysis initiation, respectively]. Comparison between patients initiated on HD-CVD and PD-PDC showed similar estimates. No difference in withdrawal risk was observed between patients initiated on HD-AVF and PD-PDC.

Patients initiated on HD-CVC were twice as likely to experience early death from dialysis withdrawal compared with patients who had initiated dialysis with HD-AVF or PD-PDC. The increased risks diminished over time and were not observed after 3 years on dialysis.