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Vascular Access in Hemodialysis: Peculiarities in a Low-Income Setting, Pattern, Prevalence and Relationship with
P K Uduagbamen1, M Sanusi2, F O Soyinka1
1Division of Nephrology and Hypertension, Ben Carson (Snr) School of Medicine, Babcock University Teaching Hospital, IlishanRemo, Ogun State, Nigeria. Email: petr.uduagbamen@gmail.com; Tel: 2348065505539.
Insights
Arteriovenous fistula (AVF) offers better dialysis outcomes, including improved blood pressure control and dialysis dose, compared to tunneled dialysis catheters (TDCs). AVF use is associated with male gender, older age, and health insurance, while TDCs are more common in diabetics.
Area of Science:
- Nephrology
- Vascular Surgery
- Public Health
Background:
- Dialysis vascular access is critical for patient outcomes, influencing dialysis dose and quality of life.
- Assessing different vascular access types can minimize peri-dialytic complications and improve patient survival.
Purpose of the Study:
- To compare the effectiveness and patient characteristics associated with arteriovenous fistula (AVF) versus tunneled dialysis catheters (TDCs).
Main Methods:
- A retrospective, age and sex-matched comparative study.
- Assessed dialysis sessions involving TDCs and AVF.
Main Results:
- AVF use was associated with better blood pressure control, fluid and solute clearance, and higher dialysis dose.
- Intradialytic hypotension and dialysis termination were more frequent with AVF, while intradialytic hypotension was commoner with TDCs.
- Predictors for AVF included male gender, older age, health insurance, and treatment compliance.
Conclusions:
- AVF demonstrates superior performance in dialysis delivery and patient management compared to TDCs.
- Vascular access choice impacts patient demographics and treatment adherence.
- Optimizing vascular access selection is crucial for improving hemodialysis outcomes.
Objectives:
Dialysis vascular access has remained a major determinant of intra and inter-dialytic events and the dialysis dose, and this impacts the quality of life, morbidity and mortality of dialysis patients. Assessing the different access types would help minimize peri-dialytic events and improve outcome.
Methods:
This was a retrospective, age and sex-matched, comparative study that assessed dialysis sessions with tunneled dialysis catheters (TDCs) with arteriovenous fistula (AVF).
Results:
Two hundred and four participants with 1062 sessions were involved. The male participants had 66.7% of all sessions, 60.6% of sessions with TDCs and 87.3% of sessions with AVF, P=0.001. The elderly constituted 23.5% of all participants but 37.7% of sessions with AVF, P=0.04. The percentage of the health-insured was more in sessions with AVF compared to the study population, P<0.001. Diabetics were more likely to use the TDCs, P=0.06. Participants using AVF were more likely to receive full dialysis and erythropoietin treatment, P<0.001. Intradialytic hypotension and dialysis termination were commoner with AVF than TDCs, P=0.03 and P=0.04 respectively. The dialysis dose was higher with AVF than TDCs, P=0.02. Predictors of AVF as dialysis access were male gender, advancing age, health insurance and full treatment compliance.
Conclusion:
There is predominance of venous catheters in our dialysis population. The AVF gave better BP control, fluid and solute clearance, and dialysis dose, and was commoner with males, the health insured and older participants. Intradialytic hypotension was commoner with AVF as IDHT was commoner with TDCs.
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