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Related Experiment Videos

Temporary vascular access for first dialysis is common, undesirable and usually avoidable.

A M Chesser1, L R Baker

  • 1Department of Nephrology, St. Bartholomew's Hospital, London, United Kingdom.

Clinical Nephrology
|May 7, 1999
PubMed
Summary

Patients needing temporary vascular access for initial dialysis face higher mortality risks. Timely referral and planning for permanent dialysis access, like arteriovenous fistulas, can improve patient outcomes and avoid temporary measures.

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Area of Science:

  • Nephrology
  • Vascular Access
  • Renal Replacement Therapy

Background:

  • Patients with end-stage renal failure ideally start dialysis with permanent vascular access (arteriovenous fistula or peritoneal catheter).
  • Temporary vascular access for initial hemodialysis should be avoided when technically feasible.
  • This study investigated the incidence, outcomes, and preventability of temporary access use.

Purpose of the Study:

  • To determine the frequency of temporary vascular access use in patients starting dialysis.
  • To analyze the consequences of requiring temporary access, including early mortality.
  • To identify factors contributing to the need for temporary access and assess its avoidability.

Main Methods:

  • Retrospective analysis of 178 patients commencing dialysis between August 1993 and April 1995.

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  • Patients categorized by type of initial access (permanent vs. temporary).
  • Subgroup analysis of temporary access patients based on referral timing (≥12 weeks vs. late referral).

    • Main Results:

    • A high proportion of patients required temporary vascular access: 74/82 for hemodialysis and 53/96 for peritoneal dialysis.
    • Late referral (47 patients) and renal service delays (35 patients) were primary reasons for temporary access.
    • Mortality within 90 days was significantly higher for patients requiring temporary access (25/127) compared to those with permanent access (1/51).

    Conclusions:

    • Late presentation to renal services before initiating dialysis is linked to increased early mortality.
    • Late referral or presentation significantly increases the likelihood of needing temporary vascular access for the first dialysis.
    • Improved management and timely planning can reduce the need for temporary vascular access, potentially improving patient survival.