Association of Four Types of Vascular Access Including Arterial Superficialization with Mortality in Maintenance Hemodialysis Patients: A Nationwide Cohort Study in Japan

Abstract

Introduction: Vascular access usage varies widely across countries. Previous studies have evaluated the association of clinical outcomes with the three types of vascular access, namely arteriovenous fistula (AVF), arteriovenous graft (AVG), and tunneled and cuffed central venous catheter (TC-CVC). However, little is known regarding the association between arterial superficialization (AS) and the mortality of patients. Methods: A nationwide cohort study was conducted using data from the Japanese Society for Dialysis Therapy Renal Data Registry (2006–2007). We included patients aged ≥20 years undergoing hemodialysis with a dialysis vintage ≥6 months. The exposures of interest were the four types of vascular access: AVF, AVG, AS, and TC-CVC. Cox proportional hazards models were used to evaluate the associations of vascular access types with 1-year all-cause and cause-specific mortality. Results: A total of 183,490 maintenance hemodialysis patients were included: 90.7% with AVF, 6.9% with AVG, 2.0% with AS, and 0.4% with TC-CVC. During the 1-year follow-up period, 13,798 patients died. Compared to patients with AVF, those with AVG, AS, and TC-CVC had a significantly higher risk of all-cause mortality after adjustment for confounding factors; adjusted hazard ratios (95% confidence intervals): 1.30 (1.20–1.41), 1.56 (1.39–1.76), and 2.15 (1.77–2.61), respectively. Similar results were obtained for infection-related and cardiovascular mortality. Conclusion: This nationwide cohort study conducted in Japan suggested that AVF usage may have the lowest risk of all-cause mortality. The study also suggested that the usage of AS may be associated with better survival rates compared to those of TC-CVC in patients who are not suitable for AVF or AVG.

Successful Removal and Replacement of a Stuck Hemodialysis Catheter via Thoracotomy: Report of Two Cases and Literature Review

“…CVCs seem the only access for patients with exhausted vessel resources. However, Murakami et al [ 16 ] recently reported that there were four types of vascular access: AVF, AVG, arterial superficialization, and TC-CVC in Japan. They found that AVF usage may have the lowest risk of all-cause mortality.…”

Combined pre-dialysis systolic blood pressure and pulse rate assessment for all-cause and cardiovascular mortalities: A nationwide cohort study on patients undergoing haemodialysis

“…Because the JRDR only records the month of death, withdrawal of dialysis, and kidney transplantation without specific days, we assumed that each event occurred on the 15th day of the month for our estimations. 19,20…”

Point-of-Care Arterio-Venous Fistula Ultrasound in the Outpatient Hemodialysis Unit—A Survey on the Nurses’ Perspective

“…Arterio-venous fistulas (AVF) are regarded as the "gold standard" for vascular access in chronic hemodialysis (HD) patients [1] due to their extended use and association with overall lower morbidity and mortality [2]. Moreover, AVFs have lower complication rates than other vascular access (VA) types, such as central venous catheters (CVCs) or arteriovenous grafts (AVGs) [3], and they are associated with a better quality of life [4].…”