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Vascular access for home haemodialysis
Julien Al Shakarchi1, C Day2, N Inston1
11 Department of Renal Surgery, University Hospital Birmingham, Birmingham, UK.
The Journal of Vascular Access
|March 23, 2018
Summary
Home haemodialysis is safe and effective. Arteriovenous fistulas are recommended for vascular access due to low complication and intervention rates in home haemodialysis patients.
Area of Science:
- Nephrology
- Vascular Access
- Dialysis
Background:
- Home haemodialysis offers improved quality of life but lacks data on optimal vascular access.
- Vascular access is critical for successful home haemodialysis.
- Limited evidence exists regarding the best vascular access for home haemodialysis.
Purpose of the Study:
- To evaluate the effectiveness and safety of different vascular access types for home haemodialysis.
- To compare complication and intervention rates between arteriovenous fistulas and tunnelled dialysis catheters in home haemodialysis.
- To identify the optimal vascular access for patients undergoing home haemodialysis.
Main Methods:
- Retrospective cohort study of 74 patients initiating home haemodialysis (2011-2016).
- Primary outcomes: access-related hospital admissions and interventions.
- Analysis of arteriovenous fistula, arteriovenous graft, and tunnelled dialysis catheter usage and outcomes.
Main Results:
- Arteriovenous fistulas were the primary access for most patients (62/74).
- Interventional rates were low for arteriovenous fistulas/grafts (0.32/access-year) and tunnelled dialysis catheters (0.4/access-year).
- Hospital admission rates for home haemodialysis patients were 0.33/patient-year.
Conclusions:
- Home haemodialysis is feasible and safe within a managed program.
- Arteriovenous fistulas are recommended for home haemodialysis due to low complication and intervention rates.
- Optimized vascular access management is key for successful home haemodialysis.
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