Blood access and daily hemodialysis: clinical experience and review of the literature.
The present authors studied longevity and complications with fistulae, grafts, and central venous catheters in 23 patients on daily hemodialysis for a total of 409 patient months (mean 18 +/- 10 months) and 9,209 dialyses. Fourteen patients had fistulae, five had grafts, and four had catheters. These required one, one, and two replacements respectively during a total observation time of 254, 105, and 50 patient months. Fistulae required 0.05 replacements per year vs. 0.11 replacements per year for grafts and 0.48 replacements per year for catheters (p = 0.042, fistulae vs. other accesses). Cumulative survival at 15 months was 100% for fistulae, 80% for grafts, and 20% for catheters, and at 3 years it was 80% for fistulae and grafts. No catheter survived beyond 15 months (p = 0.041). Twenty-seven events required hospitalization or an outpatient intervention. Fistulae had 0.52 events per patient year, grafts 1.37 events per patient year, and catheters 1.44 events per patient year (p = 0.080, fistulae vs. other accesses). Patients with fistulae reported more problems between dialyses, these occurring on 3.2% of the observation days compared with 0.2% for grafts and 0.4% for catheters (p < 0.0001). Eighty-five percent of these problems were pain and redness at the access site. During dialysis, there were more problems with catheters (9.1% vs. fistulae 2.7% and grafts 0.9%, p < 0.0001). Complications and survival data were similar to those reported with daily hemodialysis by others and better than data from reports of access problems with conventional three times weekly hemodialysis. In conclusion, daily hemodialysis does not adversely affect the usual types of blood access. Survival was best and need for intervention was least with fistulae and worst with catheters. Grafts, when functioning, had fewer problems both between and during dialyses.
Kiellstrand
Carl M
CM
Aksys Ltd., Lincolnshire, Illinois, USA.
Blagg
Christopher R
CR
Twardowski
Zbylut J
ZJ
Bower
John
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology*; D006437:Hemodialysis, Home; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires; D016896:Treatment Outcome