Association of Dysfunction of Vascular Access for Hemodialysis With Major Adverse Cardiovascular Events　- A...

Area of Science:

• Nephrology
• Cardiology
• Clinical Epidemiology

Background:

• Vascular access dysfunction is an unconventional risk factor for major adverse cardiovascular events (MACE) in hemodialysis patients.
• Previous studies identified this association, but clinical application requires intuitive risk stratification.
• Group-based trajectory modeling was employed to identify patients at highest risk for MACE.

Purpose of the Study:

• To identify and categorize hemodialysis patients based on vascular access dysfunction trajectories.
• To determine the association between different dysfunction patterns and the risk of subsequent MACE.

Main Methods:

• A cohort of 9,711 hemodialysis patients with MACE and 19,422 matched controls (2001-2010) were analyzed.
• Vascular access dysfunction events in the 6 months prior to MACE or index dates were evaluated.
• Group-based trajectory modeling categorized patients into no, escalating, or persistent dysfunction groups.

Main Results:

• Three patient groups were identified: no dysfunction (n=26,744), escalating dysfunction (n=650), and persistent dysfunction (n=1,739).
• Patients with persistent vascular access dysfunction (group 3) exhibited the highest risk of subsequent MACE.
• Logistic regression showed an odds ratio of 2.47 for MACE in group 3 compared to group 1, after adjusting for confounders.

Conclusions:

• Uninterrupted or persistent clusters of vascular access dysfunction are significantly associated with an elevated risk of subsequent MACE in hemodialysis patients.
• This trajectory-based approach offers a more intuitive method for identifying high-risk individuals for MACE.
• Targeting vascular access dysfunction management may be crucial for cardiovascular event prevention in dialysis populations.