Evaluation of vascular access complications in acute and chronic hemodialysis

Area of Science:

• Nephrology
• Vascular Surgery

Background:

• Vascular access is crucial for hemodialysis (HD) in patients with end-stage renal disease (ESRD).
• Temporary venous catheters and arteriovenous fistulas (AVFs) are common access methods.
• Complications associated with vascular access impact patient outcomes and survival.

Purpose of the Study:

• To determine the incidence of vascular access (VA)-related complications in temporary venous catheters used for acute HD.
• To compare the survival rates of chronic HD patients initiating HD with a catheter versus an AVF.
• To evaluate complications associated with both temporary venous catheters and AVFs.

Main Methods:

• Patients were divided into two groups: Group I (652 patients) received temporary venous catheters, and Group II (80 patients) had AVFs established.
• Complications were recorded for different catheter insertion sites (femoral, jugular, subclavian) and for AVFs.
• Patient survival at 12 months was compared between the two groups.

Main Results:

• Femoral catheterization showed a 1% bleeding rate, 5% punctured artery bleeding, and 40% infection/removal incidence. Other complications included hematoma (0.5%) and thrombosis (7.5%).
• Jugular and subclavian approaches had infection rates of 20% and 45.5%, respectively, with thrombosis and dysfunction also noted.
• AVF complications included edema (17.5%), hematoma (6.3%), trauma (2.5%), and stenosis (18.8%).
• Patients initiating HD with a catheter had significantly lower 12-month survival (60%) compared to those with an AVF (83%).

Conclusions:

• Temporary venous catheters for HD are associated with a higher incidence of complications and increased patient mortality.
• Arteriovenous fistulas demonstrate better outcomes and survival rates for chronic HD patients.
• Routine quality assessment of AVFs using Doppler ultrasound is recommended to optimize vascular access.