Mortality by Vascular Access Type

Live query on ptdata — state = 'Dead', grouped by access.

Generated: 2026-09-21 23:14

Total deaths

289

Catheter-related deaths

60.6 %

175 patients

AVF deaths

25.6 %

74 patients

Highest-rate access

PERM

54.5% crude death rate

Deaths by access type (counts)

Share of deaths

Crude death rate per access type (deaths ÷ all patients ever on that access)

Crude rate is not risk-adjusted (age, diabetes and vintage differ between access groups) — but it is the fastest signal for whether catheters are over-represented among your deaths.

Automatic analysis

Total deaths analysed: 289.

Suggested action: Use this page together with the whole-cohort access distribution to interpret ratios.

60.6% of deaths (175 patients) occurred in patients on catheters (PERM + SUB).

Suggested action: Catheter reduction is your highest-yield mortality intervention. Launch a Fistula-First programme: early vein mapping, timely surgical referral, and a catheter-removal target of <10% prevalent use.

Crude death rate is 54.5% on PERM vs 46.3% on AVF (+8.2 percentage points).

Suggested action: Consistent with international data — catheters drive mortality. Use this to justify resource requests for access surgery and interventional radiology.

Highest crude death rate is on PERM (54.5%).

Suggested action: Audit the PERM subgroup: was the catheter unavoidable (emergency start, poor veins) or avoidable (late referral, delayed surgery)?

What this parameter means

The type of vascular access a patient was using when they died. Access type is one of the strongest modifiable predictors of survival in dialysis. Central venous catheters are associated with 2–3× the mortality of arteriovenous fistulas, mostly through bloodstream infection, thrombosis and inadequate dialysis dose.

Access types explained

AVF — native arteriovenous fistula. First choice, lowest infection, best survival.
AVG — prosthetic graft. Higher infection and thrombosis than AVF.
PERM — tunnelled central catheter. Long-term use is a red flag.
SUB — subclavian / temporary central catheter. Emergency or bridging; ideal is < 10% of prevalent use.

Why catheter patients die more

Catheter-related bloodstream infection (CRBSI)
Central venous stenosis and thrombosis
Chronic inflammation (high CRP) and ESA resistance
Under-dialysis from low achievable blood flow
Bacterial endocarditis and metastatic infection
Often a marker of late referral, frailty or comorbidity

Why a unit ends up catheter-heavy

Late nephrology referral — crash-landing on dialysis
Long wait for access surgery or interventional radiology
Fistula failure without a repeat-creation programme
Insufficient pre-dialysis vein mapping and vessel preservation
Cannulation skill gaps that push staff to keep catheters
Elderly / frail patients not referred for AVF creation

Action plan — catheter reduction, review every 6 months

Target prevalent catheter use < 10%. Report it monthly on this page as the counterpart to the death distribution.
Early referral. Every patient with eGFR < 20 should have a vascular mapping and surgical referral — before dialysis starts.
Fistula-First protocol. Document the reason for every catheter insertion (emergency start, no suitable veins, patient refusal). Audit the "avoidable" category.
Cannulation training. Skilled buttonhole or rope-ladder cannulation reduces early AVF failure and delays conversion back to catheters.
Access surveillance programme. Flow monitoring every 3 months; pre-emptive angioplasty for stenosis > 50%.
CRBSI bundle. Hand hygiene, hub disinfection, sterile dressing, antimicrobial locks; target < 1 CRBSI per 1000 catheter-days.
Interventional capacity. Track wait time from referral to access creation and from dysfunction to intervention — these are the two bottlenecks that keep catheters alive.
Crude death rates are not risk-adjusted. Complement this page with an age- and diabetes-stratified analysis (next parameter) to be sure catheter use itself is driving mortality in your population, not just serving as a marker for it.

Data table

Access type	Deaths	% of deaths	Patients ever on access	Crude death rate
PERM	158	54.7%	290	54.5%
AVF	74	25.6%	160	46.3%
SUB	17	5.9%	36	47.2%
AVG	40	13.8%	79	50.6%
Total	289	100%	565	—

✍️ Author: Ahmed Mohmad Rashyd Musleh Registered Staff Nurse