The impact of Vascular Access on the Adequacy of Dialysis and the Outcome of the Dialysis Treatment: One Center Experience

Abstract

Introduction:Chronic kidney disease (CKD) is a gradually reduction in glomerular filtration rate (GFR) caused by destruction of a large number of nephrons. Kidney failure is the final stage of CKD with GFR <15ml/min/1.73m2 or requiring dialysis. Patients must provide vascular access, which is also the “life line” and “Achilles heel” of hemodialysis treatment.Aim:The purpose of this research is to show the demographic structure of the hemodialysis center in Konjic, and also demonstrate the impact of vascular access to the adequacy and the outcome of dialysis treatment.Methods:This cross-sectional study included 36 patients on hemodialysis in Center in Konjic from September 2010 to December 2014. The method of collecting data is performed through medical records and the quality of dialysis is taken to be Kt/V> 1.2. Statistical analysis was performed using SPSS software and Student T-test.Results:The mortality of patients treated by dialysis is 37.8%. The ratio of male and female patients is 55.6% vs. 44.5%, with an average age of 52.91±14.36 years and an average duration of hemodialysis of five years. The highest percentage of patients dialyzed through arterio-venous fistula (AVF) on the forearm (72.2%). In that patients the most common complication is thrombosis with 30.5%, which require recanalization in 11% and replacement in 19.5% of patients. Of the other dialysis patients, 16.7% of patients are dialyzed via a temporary and 11.1% via a permanent catheter (the most common complication in that patients is infection in 83.3% cases) in v.subclavia. Although the AVF is more frequently, experience shows frequent implantation of a permanent catheter in elderly patients due to the less quality of their blood vessels. Although the Kt/V by patients who are dialyzed through temporary catheter is less than 1.2 and by the other two access is greater than 1.2, our results confirm that vascular access does not have an influence on quality of dialysis. Average Kt/V shows that the adequate dialysis dose is delivered in this Center, which means that despite the impact of vascular access in HD quality, other factors also can affect on dialysis treatment, which was noticed by patients and staff.Conclusion:Despite the largest mortality rate in patients with a permanent catheter and least in patients with AVF, the type of vascular access does not affect the outcome of dialysis treatment.

Factors influencing arteriovenous fistulas: A multicenter study

“…Kt/V value alone not enough to identify AVF dysfunction, however, and it is recommended to evaluate this parameter together with physical examination [2]. Optimum blood pump speed increases dialysis adequacy, decreases patient morbidity and mortality, and increases quality of life [34,35]. The KDOQI guidelines recommend monitoring changes in Kt/V ratio and target blood flow rate.…”

Vascular access and its complications in patients with chronic kidney disease on haemodialysis: a retrospective analysis

“…These complications are similar to previous reports. 6,[9][10][11][12][13][14][15][16][17] The complications reported by Mahakalkar et al in patients with AVF were oedema, infection, bleeding at operative site, ecchymosis at the operative site.14 However, Susan et al reported early complications as thrombus, haematoma, bleeding and wound infection, and late complications as thrombosis, pseudoaneurysm. 15 In another study, majority of patients with AVF had steal phenomenon and distal edema.…”

“…13 Another study reported most common complication in patient with AVF was thrombosis (30.5%). 6 Another study reported data of 96 patients with 104 femoral catheters used for 1 to 26 days. Infection was the major complication reported with double-lumen femoral vein catheters consistent with our study.…”

“…The infection was the most commonly reported complication. 6 The paper presents results of a study that evaluated the various types of vascular access in patients with CKD on haemodialysis and the vascular access location, failure rate and associated complications.…”

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

“…Като причина за по-ниските показатели при пациентите от II група се прие дисфункцията на катетъра -невъзможност за достигане стойност на дебита над 250 мл/мин (12,16,20). Това най-често е свързано с неправилна позиция на РС непосредствено след поставянето му -прегъване на катетъра в подкожния тунел, а на по-късен етап във връзка с дислокация поради нарушена фиксация в областта на подкожния тунел -при по-дълги срокове на използване кожата изтънява, развиват се декубитуси и РС става нестабилен (2,6,22). В дългосрочен план дисфункцията на катетъра може да се предизвика и от интралуменни тромботични частици, тромбоза на РС поради неправилно запълване с хепаринизиран серум, усукване, пречупване на РС в областта на тунела (6,9,15,21).…”