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Vascular access for haemodialysis--an epidemiological study of the Catalan Renal Registry
Insights
Arteriovenous fistulas are the preferred vascular access for hemodialysis patients in Catalunya, offering longer function than grafts or catheters. However, about half of patients start dialysis without adequate vascular access, and factors like age and diabetes impact access longevity.
Area of Science:
- Nephrology
- Vascular Surgery
- Public Health
Background:
- Vascular access (VA) complications significantly impact hemodialysis (HD) patient hospitalization and well-being.
- Understanding VA modality function is crucial for optimizing patient care and reducing healthcare burdens.
Purpose of the Study:
- To evaluate the types and functional duration of different VA modalities in Catalunya.
- To correlate VA function with patient and treatment characteristics.
- To identify factors associated with initiating HD via a catheter and patients requiring multiple VAs.
Main Methods:
- Analysis of data from the Catalan Renal Registry (n=3073) as of December 31, 1997.
- Utilized questionnaires for data collection.
- Employed chi-squared test, ANOVA, and logistic regression for statistical analysis.
Main Results:
- Arteriovenous (AV) fistulas were the predominant VA (85.8%), followed by grafts (8.5%) and catheters (5.6%).
- 48% of incident HD patients in 1997 required a catheter due to insufficient AV fistula.
- Average functional durations: AV fistula (4 years), grafts (2 years), catheters (9 months).
- VA function duration decreases with age and is shorter in diabetic patients.
- 16.5% of patients required four or more VAs.
Conclusions:
- AV fistulas are the most common VA in Catalunya, favored in male patients.
- Nearly half of patients initiate renal replacement therapy without established VA.
- Age, dialysis duration, and diabetes negatively influence VA functional longevity.
- Vascular access failure requiring multiple interventions affects a minority of patients.
Background:
Vascular access (VA) continues to cause problems in a proportion of haemodialysis (HD) patients. VA complications are a major cause of hospitalization, with the resulting financial consequences and human suffering. The purpose of the study was to assess the types and duration of function of different modalities of VA in Catalunya and to relate them to treatment characteristics, to study the characteristics of patients who necessitated more than four VAs and to describe the factors associated with the start of HD using a catheter.
Methods:
The Catalan Renal Registry, using a questionnaire, sampled the data of all patients alive on December 31, 1997 (n=3073). Data were analysed using the chi2 test, ANOVA and logistic regression.
Results:
In 85.8% of HD patients in Catalunya, an AV fistula was used, in 8.5% a vascular graft and in 5.6% a catheter. In 48% of incident HD patients in 1997, a catheter was necessary due to lack of an AV fistula. The use of grafts increases with progressive time on dialysis, reaching > 10% amongst patients on dialysis for >7 years. The average time of function for AV fistula was 4 years, for grafts 2 years and for catheters 9 months. A total of 39.1% of patients required only one VA during the entire time on HD, 29.9% two, 14.4% three, and 16.5% four or more. The duration of VA function decreases with age. In patients with autosomal dominant polycystic kidney disease and glomerulonephritis, the duration of VA function exceeds 4 years; it is 3 years in patients with vascular disease and 25 months in diabetic patients.
Conclusions:
The most frequent modality of VA used in Catalunya is the AV fistula. It is used more frequently in male than in female patients. Approximately half of the patients have no VA at the time of start of renal replacement therapy. Age, duration of dialysis treatment and diabetes have an adverse effect on the duration of VA function. Repeated VA failure concerns a minority of patients.