The Type of Vascular Access and the Incidence of Mortality in Japanese Dialysis Patients

Abstract

Objective The National Kidney Foundation (NKF) Kidney Disease Outcome Quality Initiative (KDOQI) guidelines have recommended the use of arteriovenous fistula (AVF) at the initiation of dialysis. However, there are significant differences in the dialysis environments of Japan and the United States, and there are few people who receive hemodialysis via a central venous catheter (CVC) in Japan. The aim of the present study was to examine the association between the type of vascular access at the initiation of dialysis and the incidence of mortality in Japan. Methods This study was a prospective, multicenter, cohort study. The data was collected by the Aichi Cohort study of Prognosis in Patients newly initiated into dialysis (AICOPP) in which 18 Japanese tertiary care centers participated. The present study enrolled 1,524 patients who were newly introduced to dialysis (the patients started maintenance dialysis between October 2011 and September 2013). After excluding 183 patients with missing data, 1,341 patients were enrolled. The Cox proportional hazards model was used to evaluate mortality based on the type of vascular access. The types of vascular access were divided into four categories: AVF, arteriovenous graft (AVG), CVC changed to AVF during the course (CAVF), CVC changed to AVG during the course (CAVG). Results A multivariate analysis revealed that AVG, CAVF and CAVG were associated with a higher risk of mortality in comparison to AVF [hazard ratio (HR), 1.60; p=0.048; HR, 2.26; p= 0.003; and HR, 2.45; p=0.001, respectively]. Conclusion The research proved that the survival rate among patients in whom hemodialysis was initiated with AVF was significantly higher than that in patients in whom hemodialysis was initiated with AVG or CVC.

Emergent initiation of dialysis is related to an increase in both mortality and medical costs

“…Rayner et al reported that 15-50% of patients undergoing dialysis were initiated using temporary catheters 29 . Some reports have described that emergent initiation using a short-term CVC is associated with high rates of www.nature.com/scientificreports/ mortality and hospitalization [20][21][22]30 . In this study, 47% of all patients experienced emergent initiation, which was not much different from that found in pre-existing studies.…”

“…There are many problems associated with dialysis care such as too many cases of emergent dialysis that need to use a central venous catheter (CVC), life-prolonging dialysis, and early death after initiation of dialysis therapy. In particular, some studies report that the unplanned initiation of dialysis using a CVC is associated with mortality [20][21][22] . As this emergent initiation of dialysis increases mortality and costs, the challenge is to find ways of avoiding its use.…”

Determinants of Increased Central Excess Pressure in Dialysis: Role of Dialysis Modality and Arteriovenous Fistula

“…Indeed, epidemiological observational studies using administrative databases show that hemodialysis with an AVF gives a better survival advantage over the use of central venous catheters. [33][34][35][36] However, this view has recently been challenged as the survival advantage of native AVF is more likely related to general better health of patients referred for AVF creation and who develop a functioning AVF. [37][38][39] While it could be proposed that AVF may have potential protective effects through reduction in blood pressure, AVF also bypasses part of the blood flow that is destined to organ perfusion, increases heart rate, myocardial contractility and stroke volume and cardiac output.…”

Arteriovenous access in hemodialysis: A multidisciplinary perspective for future solutions

“…The tertiary option is a central dialysis catheter that is partly placed in a subcutaneous tunnel (tunneled dialysis catheter (TDC)). [3][4][5] The reason for creating autogenous AVFs is that observational studies show a lower incidence of post-operative complications and fewer endovascular and surgical revisions for AVF failure in comparison with AVGs. In addition, the use of TDCs results in a significantly higher morbidity and mortality rate.…”

“…The placement of a central dialysis catheter is mainly used in emergency situations and in chronic HD if VA by AVF or AVS is not plausible. [3][4][5] AVF is used more frequently, also in elderly patients, in Japan, while in Europe and United States often HD is initiated by the use of an AVS or TDC. 6 In addition, over time, more upper-arm AVF and AVG are placed especially in Europe and United States.…”