Impact of Hemodialysis Catheter Dysfunction on Dialysis and Other Medical Services: An Observational Cohort Study
Table 4
Alternative specification of catheter dysfunction variable in repeated measures analysis* of medical services.
Type of medical service
Odds ratio**
95% confidence interval
-value
Lower
Upper
Missed session due to access problems
Blood flow rate ≥ 300 mL/min
Reference category
100–<150 mL/min
8.09
3.75
17.45
<0.001
150–<200 mL/min
15.79
11.13
22.40
<0.001
200–<250 mL/min
3.14
2.46
4.02
<0.001
250–<300 mL/min
1.59
1.22
2.07
0.001
Access procedure
Limited definition***
Blood flow rate ≥ 300 mL/min
Reference category
100–<150 mL/min
4.16
2.80
6.18
<0.001
150–<200 mL/min
4.14
3.38
5.08
<0.001
200–<250 mL/min
2.45
2.22
2.71
<0.001
250–<300 mL/min
1.78
1.63
1.93
<0.001
Expanded definition****
Blood flow rate ≥ 300 mL/min
Reference category
100–<150 mL/min
6.88
5.44
8.69
<0.001
150–<200 mL/min
5.63
4.88
6.49
<0.001
200–<250 mL/min
2.55
2.36
2.75
<0.001
250–<300 mL/min
1.72
1.61
1.83
<0.001
Missed session or access procedure
Blood flow rate ≥ 300 mL/min
Reference category
100–<150 mL/min
6.98
5.54
8.79
<0.001
150–<200 mL/min
5.81
5.05
6.69
<0.001
200–<250 mL/min
2.55
2.36
2.74
<0.001
250–<300 mL/min
1.72
1.61
1.83
<0.001
Hospitalization (any diagnosis)
Blood flow rate ≥ 300 mL/min
Reference category
100–<150 mL/min
1.59
1.01
2.51
0.05
150–<200 mL/min
1.49
1.18
1.87
0.001
200–<250 mL/min
1.24
1.13
1.37
<0.001
250–<300 mL/min
1.00
0.93
1.08
0.95
*Multivariate analyses included dialysis run time (minutes), age, gender, race, underlying cause of renal failure, dialysis vintage, ESRD Network, Charlson Comorbidity Index, and whether the patient was incident to catheter dialysis, as covariables.
**Odds of medical service before the next dialysis session among those with versus without catheter dysfunction in the preceding session.
***Consists of injection for catheter evaluation with fluoroscopy (36598); thrombolytic declotting of catheter (36593); mechanical removal of clot (36596); mechanical removal of intraluminal (intracatheter) obstructive material (75902); injection of “TPA” (J2997).
****Consists of those procedures included in the limited definition, plus tunneled catheter exchange or replacement (36581), and the combination of removal of tunneled catheter (36589) plus tunneled catheter insertion (36558).
