Why Catheters

1
Why Catheters?
2
Why Catheters?

• Catheters are more in the dialysis facilitys
  locus of control than AVFs or grafts
• The proportion of accesses by type are
  inter-related (changes in one, impact others)

What Are the Numbers?

• In 1999, approximately 350,000 patients with
  ESRD in the US
• Current growth of 6-7 each year
• 65 have of incident ESRD patients 2 or more
  co-morbidities and 25 have 4 or more
  co-morbidities
• Diabetes, HTN, CHF, ischemic CVD, PVD

3
What Are the Costs?

• Medicare spending is increasing 5-10 per year
• Projected costs of 28-30 billion per year by 2010
• Current costs placement management of vascular
  access are 1-1.5 billion/year

Disadvantages

• Excessive morbidity especially due to repeated
  thrombosis infection
• Risk of permanent central venous stenosis or
  occlusion
• Cosmetic appearance of an external device
• Typically have the shortest life expectancy of
  all permanent access
• Lower blood flow rates obligating longer dialysis
  times

4
Infections

• Vascular access accounts for 50-75 of all
  episodes of sepsis in chronic HD
• AV fistulas have an infection rate of 0.07
  episodes of bacteremia per 1000 patient days
• Versus
• Chronic catheters having a rate of 3.4-6.5
  episodes of bacteremia per 1000 patient days

Thrombosis

• AV fistulas have a thrombosis rate of 0.4-0.5
  occlusions per 1000 patient days
• Versus
• Chronic catheters at 1.6-8.6 occlusions per 1000
  patient days

5
For more information . . .

• Article in the August 2002 American Journal of
  Nephrology, pp. 2117-2124 National Profile of
  Practice Patterns for Hemodialysis Vascular
  Access in the U.S. Particularly, Table 5,
  Figure 1, and Figure 3.