📢 AV Fistula > AV Graft > Tunneled Catheter > Non-tunneled Catheter
Catheters should be the LAST resort, not the default.
⚠️ Why access type matters:
• Catheters have 2-3x higher infection risk compared to fistulas
• Catheters cause chronic inflammation (elevated CRP, ferritin) – harming anemia and nutrition
• Catheters are associated with higher mortality – up to 50% higher in first year
• Catheters have higher failure rates (thrombosis, stenosis, malfunction)
• Fistulas provide better dialysis adequacy (Kt/V) and lower recirculation
✅ Our unit's goal: Increase fistula prevalence, reduce catheter use. Every patient without a permanent access should be evaluated for fistula creation immediately. Catheters are a bridge, not a destination.
🆘 The hidden cost of catheters – inflammation:
Catheters create a continuous low-grade inflammatory state due to biofilm, recurrent subclinical infections, and endothelial injury. This drives:
• Erythropoietin resistance (more anemia, more EPO needed)
• Hypoalbuminemia (malnutrition/inflammation complex)
• Higher ferritin (functional iron deficiency – iron trapped in stores)
• Cardiovascular events (inflammation accelerates atherosclerosis)
Converting a catheter to a fistula is not just about infection – it reduces systemic inflammation and improves overall outcomes.
🏥 Practical recommendations for our dialysis unit
- Every incident patient should be referred for fistula creation at least 6-12 months before starting dialysis.
- Catheters should be removed as soon as a functional fistula is ready (typically 2-4 weeks after maturation).
- For patients with a catheter: Monitor CRP, ferritin, and albumin closely – these predict complications.
- Track access types monthly and aim for fistula prevalence >60-80% in prevalent patients.
- Educate patients: Fistula surgery is a one-time investment that pays back with fewer infections, better dialysis, and longer life.
🎯 Final conclusion
"Fistula First" is not a slogan – it is evidence-based medicine. Our own data (below) will likely show that patients with fistulas have lower ferritin, better hemoglobin, fewer hospitalizations, and longer survival compared to catheter-dependent patients.
Call to action: Review every catheter patient in our unit. Ask: "Why does this patient still have a catheter?" If there is no anatomical barrier, create a plan for fistula placement within 3 months.