Analysis of Different Vascular Accesses on Dialysis Quality and Infection Risk Factors of Hemodialysis Patients

Abstract

Objective. To explore the influence of different vascular accesses on dialysis quality and infection risk factors of hemodialysis patients. Methods. A total of 162 patients with end-stage renal disease admitted to our hospital from February 2018 to July 2020 were divided into two groups: cuff tunnel conduit (CTC) group and native arteriovenous fistula (AVF) group. Peripheral blood was collected before and 6 months after dialysis. The incidence of vascular recirculation was measured, and the risk factors of infection were analyzed. Results. The levels of HB, Alb, CRP, BUN, Scr, and TP after dialysis in the two groups were lower than those before dialysis ( P < 0.05 ). The Kt/V of patients in both groups did not exceed 1.2, and the URR value exceeded 60%. The results of independent-samples T test analysis documented that the Kt/V level of patients in the AVF group was higher than that of those in the CTC group after dialysis ( P < 0.05 ). The results of the urea method revealed that 22 of 68 patients (32.35%) in the CVC group and 21 of 94 (22.34%) in the AVF group had vascular pathway recirculation. The χ2 test showed that there was no remarkable difference in the incidence of vascular pathway recirculation between both groups ( P > 0.05 ). However, the results of the nonurea method revealed that the incidence of vascular pathway recirculation in the AVF group was lower than that in the CVC group ( P < 0.05 ). Multivariate logistic regression was used to further analyze the factors with statistical significance in the single factor results. It showed that age >60 years, dialysis duration >1 year, dialysis times, diabetes, hypertension, and CTC were all independent risk factors causing vascular access infection. Conclusion. If all conditions permit, AVF hemodialysis is a better choice for patients with end-stage renal disease. For the elderly, long-term hemodialysis, and those with diabetes and hypertension, it is necessary to make detailed plans, strengthen the operation proficiency of CTC, and reduce the incidence of infection.

Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres

“…Nevertheless, a secondary effect of the increase in CVC use is the lower delivered HD dose, which can determine worse clinical outcomes in the near future [ 25 , 26 ].…”

AV Fistula—the Gold Standard for the Adequacy of Hemodialysis Treatment and Achieved Quality of life in Patients with ESRD

“…Публикуваните през последните десет години данни показват, че преживяемостта на пациентите на диализа е пряко свързана с доставената диализна доза (14,17,21,24). Подобрени са нивата на преживяемост при по-високи получени диализни дози по отношение на всички основни причини за смъртност, включително исхемичната болест на сърцето, други сърдечносъдови и мозъчносъдови заболявания, инфекции.…”

“…то пряко корелира с по-високите нива на заболеваемост, смъртност и влошен хранителен статус (17,23,26). От друга страна, резултатите, съобщени от развитите страни като САЩ според годишния доклад за 2017 г., над 90% от пациентите са имали Kt/V> 1,2, са свързани с пониска заболеваемост (15,29,31), което показва, че получената диализна доза има пряка зависимост от организацията на здравната система и социално-икономически фактори.…”

Population Pharmacokinetics of Vancomycin in Patients Receiving Hemodialysis in a Malian and a French Center and Simulation of the Optimal Loading Dose

“…5,6 Hemodialysis patients with an arteriovenous fistula have a lower risk of infection than those with a dialysis catheter. [7][8][9] Staphylococcus aureus is a frequently reported pathogen responsible for infections in hemodialysis patients. [10][11][12] Chronic kidney disease causes physiological changes that may alter the absorption, distribution, metabolism, and elimination of antibiotics, especially during renal excretion.…”