Risk factors affecting arteriovenous access patency in nocturnal home hemodialysis patients


Intensive hemodialysis is associated with more frequent arteriovenous (AV) access complications. We performed a retrospective cohort study to ascertain potential risk factors associated with access dysfunction in a cohort of nocturnal home hemodialysis (HHD) patients.

Consecutive patients undergoing HHD from October 1999 to November 2015 using an AV access were included. Patient demographics and clinical variables were collected. Primary outcome was defined as any access dysfunction including thrombosis, stenosis, or intervention. Frequent dysfunction was defined as > 2 events per access year. Factors associated with access dysfunction and abandonment were studied using logistic regression and Cox regression analysis, respectively.

189 patients were included. 62.4% were male, and 77.2% had an AV fistula. The median duration of follow-up was 60.3 months. 105 patients (56%) had access dysfunction, resulting in an incidence of 66.2 events per 100 access years. History of renal transplant (OR 0.44, 95% CI 0.22 - 0.91), the use of AV graft (OR 9.23, 95% CI 3.41 - 25.00), and vintage of AV access (OR 1.01 per month, 95% CI 1.00 - 1.02) were significant predictors of access dysfunction. Patients with AV grafts (OR 7.11, 95% CI 2.71 - 18.69) and history of access dysfunction prior to HHD (OR 4.51, 95% CI 1.65 - 12.34) had more frequent dysfunction.

AV accesses appear to have a finite duration of functionality, with history of renal transplant being a protective factor, and more dysfunction was found in AV grafts. Access-related factors account for frequent dysfunction rather than patient or HHD factors. The role of access surveillance, especially in patients having high risk of dysfunction, remains to be investigated.
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