Access-related
bacteremia is an important cause of morbidity in chronic
hemodialysis patients. The incidence of
bacteremia is higher in patients dialyzing through a tunneled
central venous catheter (
TCVC) compared with an
arteriovenous fistula (AVF). Our aim was to explore if this is explained by patient comorbidity. Two groups of chronic
hemodialysis outpatients were compared: all patients who dialyzed through a
TCVC at any time during 2003 and were fit enough to subsequently have a functioning AVF or renal transplant even if it was after 2003 (Group 1; n=93); and all patients who dialyzed through a
TCVC in 2003 and were not fit enough to have a functioning AVF or renal transplant (Group 2; n=119). Episodes of
bacteremia (n=71) were identified and those not related to access were excluded. Patients in Group 1 were younger than Group 2 (57.5 years vs. 64.8 years; P=0.001). The incidences of
bacteremia in Groups 1 and 2 were, respectively, 0.31 and 0.44 episodes per 1000 patient days while dialyzing through an AVF (P=0.77), and 2.21 and 2.27 per 1000 days while dialyzing through a
TCVC (P=0.91). The 3-year actual survival from January 1, 2003 to January 1, 2006 was significantly higher in Group 1 than in Group 2 (80.6% vs. 26.1%; P<0.0001) confirming the higher comorbidity of the patients in Group 2. Patients dialyzing through a
TCVC (compared with an AVF) have a significantly higher risk of access-related
bacteremia, irrespective of comorbidity.