{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:39:22Z","timestamp":1792687162228,"version":"4.5.0"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"abstract":"\n Background:<\/jats:title>\n Guidelines favor arteriovenous (AV) access over central venous catheters (CVCs) for hemodialysis due in part to lower infection risk. Nevertheless, most patients initiate hemodialysis with a CVC. We used US Renal Data System data to evaluate whether the comparative mortality risk of these vascular access strategies has changed over time among patients with incident kidney failure.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n In this observational study, we evaluated community-dwelling, functionally independent adults (aged 18\u201385 years) initiating hemodialysis with a CVC in 2013\u20132022, excluding those with a maturing AV access to prevent immortal time bias. We used the clone-censor-weighting approach, a causal inference method for evaluating dynamic treatment patterns, to compare continuous CVC use versus transition to an AV access. Inverse-probability-of-censoring weighted discrete-time pooled logistic regression modeled the 18-month cumulative risk of death by hemodialysis initiation year, with modality changes treated as competing events.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Among 536,836 incident patients, 71,443 and 63,875 deaths occurred in the CVC and AV access groups, respectively. From 2013 to 2022, the adjusted 18-month cumulative risk of death declined from 26.8% to 21.3% in the CVC group, and from 20.9% to 17.1% in the AV access group. Correspondingly, the absolute risk difference comparing CVC versus AV access attenuated by nearly 30% (from 5.9 [95% CI 5.4, 6.3] to 4.2 [95% CI 3.9, 4.5] deaths per 100 patients), whereas the relative risk declined by 3% (from 1.28 [95% CI 1.26, 1.30] to 1.25 [95% CI 1.23, 1.27]). Bloodstream infection-related deaths showed similar declining risk patterns, with a proportionally larger attenuation in absolute risk difference and a greater decline in relative risk between groups.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Mortality rates declined among patients initiating hemodialysis with a CVC over the past decade, which has led to a reduction in the absolute excess risk associated with continued CVC use.<\/jats:p>\n <\/jats:sec>","DOI":"10.1681\/asn.0000001293","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:00:27Z","timestamp":1792684827000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Mortality of Patients with Central Venous Catheters versus Arteriovenous Accesses for Hemodialysis"],"prefix":"10.1681","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5386-3289","authenticated-orcid":false,"given":"Nicholas S.","family":"Roetker","sequence":"first","affiliation":[{"name":"Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA"},{"name":"Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1380-8597","authenticated-orcid":false,"given":"James B.","family":"Wetmore","sequence":"additional","affiliation":[{"name":"Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA"},{"name":"Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA"},{"name":"Division of Nephrology, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2460-9542","authenticated-orcid":false,"given":"Jiannong","family":"Liu","sequence":"additional","affiliation":[{"name":"Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T.","family":"Gilbertson","sequence":"additional","affiliation":[{"name":"Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA"},{"name":"Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6421-361X","authenticated-orcid":false,"given":"Kirsten L.","family":"Johansen","sequence":"additional","affiliation":[{"name":"Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA"},{"name":"Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA"},{"name":"Division of Nephrology, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,22]]},"container-title":["Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1681\/ASN.0000001293","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:00:27Z","timestamp":1792684827000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1681\/ASN.0000001293"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,22]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1681\/asn.0000001293","relation":{},"ISSN":["1046-6673","1533-3450"],"issn-type":[{"value":"1046-6673","type":"print"},{"value":"1533-3450","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,22]]},"assertion":[{"value":"2026-06-29","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}