Survival of Vascular Accesses in Chronic Hemodialysis Patients

Abstract

<b><i>Background/Aims:</i></b> Vascular access (VA) is the highest risk factor for blood infections, hospitalization, and mortality of patients undergoing hemodialysis (HD). The risk of mortality while using a catheter is greater than that while using grafts. The objective of this article is to know the survival rate in relation to the type of VA. <b><i>Methods:</i></b> A retrospective cohort of HD patients was studied. The data gathered included age, gender, first VA at the surrogate site, days between the first and second access, number of accesses, and anatomical site of VA placement. Mean differences were estimated using χ<sup>2</sup> or Student’s <i>t</i> test. Survival was calculated using the Kaplan-Meier curves and included in tables. Statistical significance was established as <i>p</i> < 0.05. The statistical computer software package SPSSw v25 was used for the analysis. <b><i>Results:</i></b> A total of 896 patients were included with a mean age of 47.88 years (SD ± 16.52), the duration of the first VA was 398.81 days (±565.79), the mean number of VAs used was 2.26 (±1.15), and the median time undergoing HD was 728.73 days. The duration of catheter placement was 330.42 days, and 728.60 days for fistula use (<i>p</i> = 0.001). The mean number of days of renal replacement was 611.59 days for catheter and 1,495.25 days for internal arteriovenous fistula (IAVF) patients (<i>p</i> = 0.001). <b><i>Conclusions:</i></b> The survival of the initial VA is greater for the IAVF, followed by the tunneled catheters and the lowest by the non-tunneled catheters, which continue to be frequently used in our setting.

Survival Analysis of Tunneled Cuffed Central Venous Catheters in Maintenance Hemodialysis Patients: A Retrospective Study in China

“…In a cohort of 5,466 patients, the survival rate at 5 years was 48% in central venous catheter (CVC) patients, including TCCs and non-tunneled catheters A recent study reported that the survival of CVC-Tuff in 1 ear was 93.59% [8]. Our data showed that the 1-year and 5-year survival rates of TCCs were 97.3% and 43.3%, respectively, which is consistent with results of the above two studies [7,8]. Min et al [9] showed a median survival time of 45.0 (95% CI, 29.3-69.7) months for TCCs, which differs from 2) in the study by Min et al [9], the average age of HD patients was 68.6 ± 14.6 years and diabetes was observed in 35.6% of the patients, whereas our data showed an average age of 65.0 ± 15.5 years, with diabetes in 25.3% of the patients.…”

“…In a cohort of 5,466 patients, the survival rate at 5 years was 48% in central venous catheter (CVC) patients, including TCCs and non-tunneled catheters [ 7 ]. A recent study reported that the survival of CVC-Tuff in 1 ear was 93.59% [ 8 ]. Our data showed that the 1-year and 5-year survival rates of TCCs were 97.3% and 43.3%, respectively, which is consistent with results of the above two studies [ 7 , 8 ].…”

“…A recent study reported that the survival of CVC-Tuff in 1 ear was 93.59% [ 8 ]. Our data showed that the 1-year and 5-year survival rates of TCCs were 97.3% and 43.3%, respectively, which is consistent with results of the above two studies [ 7 , 8 ]. Min et al [ 9 ] showed a median survival time of 45.0 (95% CI, 29.3–69.7) months for TCCs, which differs from our data (median survival time: 58 months).…”

“…The KDOQI 2019 guidelines [ 11 ] suggested that when CVCs need to be used and the use time is expected to exceed 3 months, the CVC placement sequence is as follows: internal jugular, external jugular, femoral, and subclavian. Santos-Ontiveros et al [ 8 ] showed that the right jugular vein was the most commonly used for catheterization. In our study, the right internal jugular vein was predominantly used.…”

Is central venous catheter in haemodialysis still the main factor of mortality after hospitalization?

“…Some reports suggest that CVC is associated with a higher mortality risk than AVF. It is worth mentioning that the survival of patients with stage 5 CKD has improved considerably over the years (7)(8)(9).…”