Impact of type of vascular access on clinical outcomes in peritoneal dialysis patients transitioning to haemodialysis: an ANZDATA study

TL;DR

This study finds that using an arterio-venous access when switching from peritoneal to hemodialysis improves survival and transplant rates but reduces the chance of returning to peritoneal dialysis.

Contribution

The study provides new evidence on the impact of vascular access type during dialysis transition on clinical outcomes in PD patients.

Findings

AVA transfer was associated with lower all-cause mortality compared to CVC transfer.

Infection-related mortality was significantly reduced with AVA transfer.

AVA transfer increased the likelihood of kidney transplantation but decreased the chance of returning to PD.

Abstract

Type of vascular access used for haemodialysis is associated with long-term outcomes. However, the effect of access on haemodialysis transfer for peritoneal dialysis (PD) patients has not been fully explored.

A retrospective cohort study was performed in incident adult PD patients from the Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry who transferred to haemodialysis between 2004 and 2022. Associations between vascular access on transfer [central venous catheter (CVC) or arterio-venous access (AVA)] and clinical outcomes (all-cause mortality, cause-specific mortality, kidney transplantation and return to PD) were compared using Cox proportional hazards analysis and competing risk models.

Of 6824 patients, 65% used a CVC on transfer and 35% an AVA. Variability of access type at transfer between centres was high (range 13%–98% for CVC). AVA transfer was associated with a longer PD vintage (1.6 versus 1.2 years, P < .001) and inadequate PD as a cause of transfer (29% versus 15%, P < .001). All-cause mortality was lower for AVA transfer compared with a CVC [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.66–0.77]. The risk was lowest for infection-related mortality (HR 0.59, 95% CI 0.45–0.77) Kidney transplantation was more likely in AVA transfer compared with a CVC (HR 1.18, 95% CI 1.05–1.33), but return to PD was less likely (HR 0.67, 95% CI 0.59–0.71). Results remained consistent in the competing risk analysis.

Patients who transferred with an AVA, compared with a CVC, showed better survival and kidney transplantation rates, but were less likely to return to PD.

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