The impact of extended-hours home hemodialysis and buttonhole cannulation technique on hospitalization rates for septic events related to dialysis access

Carolyn L Van Eps, Mark Jones, Tsun Ng, David W Johnson, Scott B Campbell, Nicole M Isbel, David W Mudge, Elaine Beller, Carmel M Hawley

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Abstract

Few studies adequately document adverse events in patients receiving long, slow, and overnight hemodialysis (NHD). Concerns about high rates of dialysis access complications have been raised. This is an observational cohort study comparing hospital admission rates for vascular access complications between alternate nightly NHD (n=63) and conventional hemodialysis (n=172) patients established on chronic hemodialysis for at least 3 months. Overall, hospital admission rates and hospital admission rates for cardiac and all infective events are also reported. The NHD cohort was younger and less likely to be female, diabetic, or have ischemic heart disease than the conventional hemodialysis cohort. When NHD and buttonhole cannulation technique were used simultaneously, there was a demonstrated increased risk of septic dialysis access events: incidence rate ratio 3.0 (95% confidence interval 1.04-8.66) (P=0.04). The majority of blood culture isolates in NHD patients were gram-positive organisms, particularly Staphylococcus aureus. Alternate nightly NHD did not significantly change total hospital admissions or hospital admissions for indications other than dialysis access complications, compared with conventional hemodialysis. Our data suggest that buttonhole cannulation technique should be used with caution in patients performing extended-hours hemodialysis as this combination appears to increase the risk of septic access complications. Randomized-controlled trials are needed to confirm these findings.

Original languageEnglish
Pages (from-to)451-63
Number of pages13
JournalHemodialysis International
Volume14
Issue number4
DOIs
Publication statusPublished - 2010

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Home Hemodialysis
Catheterization
Renal Dialysis
Dialysis
Hospitalization
Observational Studies
Myocardial Ischemia
Blood Vessels
Staphylococcus aureus
Cohort Studies
Randomized Controlled Trials
Confidence Intervals
Incidence

Cite this

Van Eps, Carolyn L ; Jones, Mark ; Ng, Tsun ; Johnson, David W ; Campbell, Scott B ; Isbel, Nicole M ; Mudge, David W ; Beller, Elaine ; Hawley, Carmel M. / The impact of extended-hours home hemodialysis and buttonhole cannulation technique on hospitalization rates for septic events related to dialysis access. In: Hemodialysis International. 2010 ; Vol. 14, No. 4. pp. 451-63.
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abstract = "Few studies adequately document adverse events in patients receiving long, slow, and overnight hemodialysis (NHD). Concerns about high rates of dialysis access complications have been raised. This is an observational cohort study comparing hospital admission rates for vascular access complications between alternate nightly NHD (n=63) and conventional hemodialysis (n=172) patients established on chronic hemodialysis for at least 3 months. Overall, hospital admission rates and hospital admission rates for cardiac and all infective events are also reported. The NHD cohort was younger and less likely to be female, diabetic, or have ischemic heart disease than the conventional hemodialysis cohort. When NHD and buttonhole cannulation technique were used simultaneously, there was a demonstrated increased risk of septic dialysis access events: incidence rate ratio 3.0 (95{\%} confidence interval 1.04-8.66) (P=0.04). The majority of blood culture isolates in NHD patients were gram-positive organisms, particularly Staphylococcus aureus. Alternate nightly NHD did not significantly change total hospital admissions or hospital admissions for indications other than dialysis access complications, compared with conventional hemodialysis. Our data suggest that buttonhole cannulation technique should be used with caution in patients performing extended-hours hemodialysis as this combination appears to increase the risk of septic access complications. Randomized-controlled trials are needed to confirm these findings.",
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The impact of extended-hours home hemodialysis and buttonhole cannulation technique on hospitalization rates for septic events related to dialysis access. / Van Eps, Carolyn L; Jones, Mark; Ng, Tsun; Johnson, David W; Campbell, Scott B; Isbel, Nicole M; Mudge, David W; Beller, Elaine; Hawley, Carmel M.

In: Hemodialysis International, Vol. 14, No. 4, 2010, p. 451-63.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Van Eps, Carolyn L

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AU - Ng, Tsun

AU - Johnson, David W

AU - Campbell, Scott B

AU - Isbel, Nicole M

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AU - Beller, Elaine

AU - Hawley, Carmel M

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