Identifying vascular access complications among ESRD patients in Europe. A prospective, multicenter study

The pilot project of the Research Board of the EDTNA/ERCA was aimed at reviewing the management of vascular access (VA) in European dialysis centres (see August 1999 NN&I). In Part 1 of this study, centre policies related to VA management were investigated. In Part 2, detailed in this article, individual patients were prospectively followed for one year to identify VA-related complications. A cohort of 1,380 adult patients randomly selected from 47 centres in 16 European countries was followed for one year using a computerised data collection system. Data were collected at baseline after 6 and 12 months and each time a VA complication occurred. At the start of the observation period, 77% of patients had a native arteriovenous (AV) fistula, 10% had an AV graft, and 13% had a catheter for access. A total of 489 complications were noted during the one-year period. Most frequently observed were thrombosis, stenosis, infection, bleeding, and flow problems. Hospitalisation (mean duration = 6.2 days) was required in 39% of patients with complications, and 29% of complications resulted in a definitive loss of VA. Complications were more frequently observed in patients with catheters (27%) and AV grafts (37%) compared to those with an AV fistula (15%). The risk of thrombosis was more than four times higher and the risk of bleeding was more than six times higher if an AV graft was used compared to an AV fistula. Catheters presented an eightfold increased risk for patients of developing infections and access flow problems. [figure: see text] This study revealed the high complication rate in VA and strengthened the notion that the AV fistula is the superior access.