Nephrology Dialysis Transplantation, Vol 14, Issue 7 1651-1657, Copyright © 1999 by Oxford University Press
J Rodriguez, J Lopez, M Cleries, E Vela and R Registry Committee
Background: Vascular access (VA) continues to cause
problems in a proportion of haemodialysis (HD) patients. VA complications
are a major cause of hospitalization, with the resulting financial
consequences and human suffering. The purpose of the study was to assess
the types and duration of function of different modalities of VA in
Catalunya and to relate them to treatment characteristics, to study the
characteristics of patients who necessitated more than four VAs and to
describe the factors associated with the start of HD using a catheter.
Methods: The Catalan Renal Registry, using a
questionnaire, sampled the data of all patients alive on December 31, 1997
(n=3073). Data were analysed using the &khgr;2
test, ANOVA and logistic regression. Results: In 85.8%
of HD patients in Catalunya, an AV fistula was used, in 8.5% a vascular
graft and in 5.6% a catheter. In 48% of incident HD patients in 1997, a
catheter was necessary due to lack of an AV fistula. The use of grafts
increases with progressive time on dialysis, reaching >10% amongst
patients on dialysis for >7 years. The average time of function for
AV fistula was 4 years, for grafts 2 years and for catheters 9 months. A
total of 39.1% of patients required only one VA during the entire time on
HD, 29.9% two, 14.4% three, and 16.5% four or more. The duration of VA
function decreases with age. In patients with autosomal dominant polycystic
kidney disease and glomerulonephritis, the duration of VA function exceeds
4 years; it is 3 years in patients with vascular disease and 25 months in
diabetic patients. Conclusions: The most frequent
modality of VA used in Catalunya is the AV fistula. It is used more
frequently in male than in female patients. Approximately half of the
patients have no VA at the time of start of renal replacement therapy. Age,
duration of dialysis treatment and diabetes hae an adverse effect on the
duration of VA function. Repeated VA failure concerns a minority of
patients. Key words: AV fistula; haemodialysis;
vascular access
DIALYSIS AND TRANSPLANTATION NEWS
Vascular access for haemodialysis - an epidemiological study of the Catalan Renal Registry
Hospital General de la Vall d'Hebron, Hospital Clínic i Provincial de Barcelona and Catalan Health Service, Spain; Corresponding author at: Registre de malalts renals de Catalunya, Servei Català de la Salut, Travessera de les Corts, 131-159, Edifici Olimpia, E-08028 Barcelona, Spain
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