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Comparison of vascular access use in hemodialysis patients in Isfahan in 2003 and 2013
1Department of Nephrology, Kidney Diseases Research Center, Isfahan, Iran.
Insights
Vascular access complications are a major concern for hemodialysis patients. This study found a significant decrease in arteriovenous fistula use and survival rates between 2003 and 2013 in Isfahan, with a rise in catheter use.
Area of Science:
- Nephrology
- Vascular Surgery
- Public Health
Background:
- Vascular access (VA) complications significantly impact hemodialysis (HD) patient morbidity and healthcare costs.
- Understanding trends in VA utilization is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the profile of VA use for HD in Isfahan dialysis units between 2003 and 2013.
- To analyze changes in VA type, survival rates, and patient demographics over a decade.
Main Methods:
- A cross-sectional observational study comparing data from 320 patients in 2003 with 536 patients in 2013.
- Data collected included VA type, number, survival, and demographic characteristics.
- Statistical analysis was performed to identify significant differences between the two time periods.
Main Results:
- The mean patient age increased, and diabetes mellitus became a more prevalent cause of end-stage renal disease.
- Arteriovenous fistula (AVF) use as a first dialysis access decreased from 60.6% to 35.4%.
- Overall AVF utilization dropped from 92.2% to 56.5%, with a marked decline in AVF survival rates, while tunneled catheter use increased.
Conclusions:
- There was a significant shift away from AVF use towards catheter-based vascular access in Isfahan between 2003 and 2013.
- The observed decrease in AVF utilization and survival necessitates further investigation and potential interventions to improve vascular access practices in hemodialysis patients.
Abstract:
Vascular access (VA) complications are the leading cause of morbidity in the hemodialysis (HD) population and responsible for high health care costs. This study was designed to compare the profile of VA use for HD in Isfahan dialysis units in 2003 and 2013. A cross-sectional observational study was conducted between January and March 2013 on 536 HD patients in seven units. The patients data about VA type, number, survival, and demographic characteristics were collected and compared with the data collected in year 2003 on 320 patients in the same city units. The mean age of patients increased from 51 ± 17 to 58 ± 15 years (P < 0.001). The most common etiology of end-stage renal disease was diabetes mellitus, but the percentage increased in 2013 (P = 0.001).The use of an arteriovenous fistula (AVF) as a first dialysis access fell from 60.6% in 2003 to 35.4% in 2013 (P < 0.001). At the time of study, AVFs were used in 92.2% of patients in 2003 versus 56.5% in 2013 (P < 0.001). The 1, 2, 3 and 5 years AVF survival was 80%, 78%, 73%, and 69%, respectively in 2003 versus 79.4%, 61.2%, 47.3%, and 31.5% in 2013. The AVFs proportions decreased and the tunneled catheters proportions increased while the proportion of temporary catheters decreased in 2013 compared with 2003.
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