Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study

Abstract

ObjectivesTo investigate the impact of vascular access flow (Qa) on vascular and all-cause mortality in chronic haemodialysis (HD) patients.DesignObservational cohort study.SettingSingle centre.ParticipantsAdult chronic HD patients at the HD unit of Shin Kong Wu Ho-Su Memorial Hospital between 1 January 2003 and 31 December 2003 were recruited. Patients were excluded if they had arteriovenous fistula or arteriovenous graft failure within 3 months before the date of Qa measurement, were aged <18 years and had Qa levels of ≥2000mL/min. A total of 378 adult chronic HD patients were eventually enrolled for the study.InterventionsThe selected patients were evaluated with Qa and cardiac index (CI). They were divided into four groups according to three Qa cut-off points (500, 1000 and 1500 mL/min).Primary and secondary outcome measuresShort-term and long-term vascular (cardiovascular or cerebrovascular) and all-cause mortality.ResultsQa was positively correlated with CI (r=0.48, p<0.001). A Qa level of <1000 mL/min was independently associated with 1-year all-cause mortality (adjusted OR, 6.04; 95% CI 1.64 to 22.16; p=0.007). Kaplan-Meier analysis revealed that the cumulative incidence rates of all-cause and vascular mortality were significantly higher in the patients with a Qa level of <1000 mL/min (log-rank test; all p<0.01). Furthermore, a Qa level of <1000 mL/min was independently associated with long-term all-cause mortality (adjusted HR, 1.62; 95% CI 1.11 to 2.37; p=0.013); however, the risk of vascular mortality did not significantly increase after adjustment for confounders.ConclusionsQa is moderately correlated with cardiac function, and a Qa level of <1000 mL/min is an independent risk factor for both short-term and long-term all-cause mortality in chronic HD patients.

Factors influencing arteriovenous fistulas: A multicenter study

“…In the current study, the mean duration of active AVF use was 4.15 ± 3.70 years. This finding is similar to that reported in a study of 378 chronic HD patients by Wu et al [17]. When the duration of HD and the duration of use of the most recently created AVF were evaluated, we noted that longer times were associated with lower risk of failure but higher risk of developing stenosis and ischemic symptoms.…”

“…There are studies in the literature about the physical examination of AVF and factors affecting AVF survival [9,[12][13][14][15][16][17]. However, we know of no study that has investigated correlations between AVF physical examination and dialytic parameters (Kt/V, dialysis pump speed, etc.)…”

The Role of Oxidative Stress Markers in Predicting Acute Thrombotic Occlusion of Haemodialysis Vascular Access and Progressive Stenotic Dysfunction Demanding Angioplasty

“…Complications associated with established VA sites are important causes of morbidity and mortality in patients receiving regular HD. The most frequent complication leading to failure of the VA site is thrombosis [ 1 ]. The likelihood of thrombosis depends on multiple factors, including the development of myointimal hyperplasia, anatomic configuration of the fistula or graft constructed, site of arteriovenous anastomosis, selection of prosthetic material, and intrinsic clotting ability; however, the adequacy of the patient’s veins and arteries is probably most important.…”

“…Durable and functional dialysis vascular access (VA) is important for every haemodialysis (HD) patient. VA dysfunction increases the morbidity and mortality in HD patients [ 1 ]. The most common cause of VA dysfunction is stenosis at the arteriovenous anastomosis due to progressive neointimal proliferation and extracellular matrix deposition.…”

Association of Dysfunction of Vascular Access for Hemodialysis With Major Adverse Cardiovascular Events ― A Group-Based Trajectory Model Analysis ―

“…A recent study disclosed that blood flow <1,000 mL/min is an independent risk factor for both short-term and long-term all-cause mortality in chronic hemodialysis patients. 34 Other than diabetes, hypoalbuminemia is also a predictor of either recurrent AVG dysfunction or recurrent bacteremia in permanent double-lumen catheters. 35,36 The mechanism by which hypoalbuminemia contributes to recurrent synthetic vascular access failure may be related to inflammation because hypoalbuminemia is considered as a marker of an inflammatory state in dialysis patients.…”