Initial Vascular Access Type in Patients with a Failed Renal Transplant

Background and objectives Permanent hemodialysis vascular access is crucial for RRT in ESRD patients and patients with failed renal transplants, because central venous catheters are associated with greater risk of infection and mortality than arteriovenous fistulae or arteriovenous grafts. The objective of this study was to determine the types of vascular access used by patients initiating hemodialysis after a failed renal transplant. Design, setting, participants, & measurements Data from the US Renal Data System database on 16,728 patients with a failed renal transplant and 509,643 patients with native kidney failure who initiated dialysis between January 1, 2006, and September 30, 2011 were examined. Results At initiation of dialysis, of patients with a failed transplant, 27.7% ( n =4636) used an arteriovenous fistula, 6.9% ( n =1146) used an arteriovenous graft, and 65.4% ( n =10,946) used a central venous catheter. Conversely, 80.8% ( n =411,997) of patients with native kidney failure initiated dialysis with a central venous catheter ( P Conclusions Central venous catheters are used in nearly two thirds of failed renal transplant patients. These patients are usually followed closely by transplant physicians before developing ESRD after a failed transplant, but the relatively low prevalence of arteriovenous fistulae/arteriovenous grafts in this group at initiation of dialysis needs to be investigated more thoroughly.