Factors Associated with the Initial Vascular Access Choice and Median Utilization Time in Hemodialysis Patients

The aim of the study was to elucidate predictors associated with the initial choice of vascular access (VA) type. The secondary aim was to determine the initial VA's median utilization time and the factors governing it. This prospective cohort study included 387 hemodialysis (HD) patients admitted to the Clinic for Hemodialysis, Clinical Center University of Sarajevo, in consecutive order between January 2006 and December 2016. We selected the primary predictors for the initial VA type using a random forest algorithm. We further quantified factors governing the initial choice of VA: temporary catheters (TCs), compared to arteriovenous fistula (AVF), using multivariate logistic regression. Finally, we used log-rank and Cox regression models to estimate the median time on each initial VA and find predictors governing it. Of the 387 patients, 265 (68.5%) used TC at dialysis initiation and 122 (31.5%) AVF. Predictors of the TC's versus AVF's initial use were older age (odds ratio = 1.02; confidence interval [CI] = 1.0, 1.03; P = 0.03) and primary cause of chronic kidney disease, particularly diabetes, compared to all other causes of kidney disease. Median time on initial AVF was 57.0 months (95% CI = 36.9, 64.1), and on initial TC 4.99 months (95% CI = 2.69, 8.48). Younger age (hazard ratio [HR] = 0.98; 95% CI = 0.97, 0.99; P = 0.01), male sex (HR = 1.51; 95% CI = 1.05, 2.19; P = 0.03), and hypertension (HR = 1.63; 95% CI = 1.13, 2.36; P = 0.01) predicted median time on initial TC, while older age (HR for patients aged > 70 years = 1.86; 95% CI = 1.09, 3.17; P = 0.02), and diabetes (HR = 1.97; 95% CI = 1.19, 3.24; P = 0.01), predicted median time on initial AVF. These results point to late VA referrals and delays in transitioning to permanent VA.