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The risks of vascular access.

Peter G Blake, Robert R Quinn, Matthew J Oliver

Kidney International

|September 1, 2012

Summary

This summary is machine-generated.

Fatal vascular access hemorrhage is a serious complication of hemodialysis (HD) that may be more common than previously thought. This study suggests reassessing common assumptions about the safety of different HD access types, especially for high-risk patients.

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Area of Science:

Nephrology
Vascular Surgery
Public Health

Background:

Vascular access hemorrhage is a rare but fatal complication of hemodialysis (HD).
Previous assumptions suggest fistulas are safest and cuffed catheters are riskiest for HD access.
The actual incidence and risk factors for fatal vascular access hemorrhage require further investigation.

Purpose of the Study:

To investigate the incidence of fatal vascular access hemorrhage in US hemodialysis patients.
To compare the risk of fatal hemorrhage between different types of vascular access (fistulas, grafts, catheters).
To identify patient characteristics associated with increased risk of fatal hemorrhage.

Main Methods:

Retrospective analysis of a large cohort of US hemodialysis patients.
Examination of mortality data linked to vascular access type.
Statistical analysis to determine the association between access type, prior hemorrhage, and fatal outcomes.

Main Results:

Fatal vascular access hemorrhage accounts for 0.4-1.6% of deaths in US HD patients.
Hemorrhage is more frequent with arteriovenous grafts than fistulas.
Patients with a history of previous access hemorrhages are at higher risk.

Conclusions:

The incidence of fatal vascular access hemorrhage may be underestimated.
Current perceptions of vascular access safety (fistula vs. catheter) need reevaluation.
Older, sicker patients with a history of hemorrhage require careful consideration regarding access type selection.