Vascular access survival and morbidity on daily dialysis: a comparative analysis of home and limited care haemodialysis.
BACKGROUND
Concerns about vascular access failure may have limited the widespread use of daily haemodialysis (DHD). We assessed the incidence and type of vascular access complications during DHD and other schedules, both at home and on limited care haemodialysis.


METHODS
All patients were treated in a limited care and home haemodialysis unit with a stable caregiver team (November 1998-November 2002). Vascular access failure, surgical treatment, angioplasty and declotting were studied alone or in combination by univariate and multivariate models. We analysed the effects of age, sex, comorbidity, previous vascular events, schedule, setting of treatment (home, limited care), dialysis follow-up, vascular access (native vs prosthetic, first vs subsequent) and setting of vascular access creation. 'Intention to treat' and 'per protocol' analyses were performed.


RESULTS
In 2160 patient-months (home dialysis: DHD 400 months, non-DHD 655 months; limited care: DHD 208 months; non-DHD 897 months), 57 adverse events occurred (27 failures), in which 30 were at home (nine DHD) and 27 were in limited care (five DHD). The probability of remaining free from adverse events at 6 and 12 months was 89% and 80% on DHD and 79% and 76% on other schedules ('intention to treat'). Univariate analyses revealed a significant difference for the setting of the vascular access creation (lower risk of vascular access complications in our centre) and sex (male sex was protective). Logistic regression and Cox analyses confirmed the role for the setting of the vascular access creation.


CONCLUSIONS
Although DHD did not appear as a risk factor for vascular access morbidity or failure at home or in a limited care centre setting, the setting of vascular access creation may influence its success.
Piccoli
Giorgina Barbara
GB
Chair of Nephrology, University of Turin, Italy. gbpiccoli@hotmail.com
Bermond
Francesca
F
Mezza
Elisabetta
E
Burdese
Manuel
M
Fop
Fabrizio
F
Mangiarotti
Giovanni
G
Pacitti
Alfonso
A
Maffei
Stefano
S
Martina
Guido
G
Jeantet
Alberto
A
Segoloni
Giuseppe Paolo
GP
Piccoli
Giuseppe
G
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D015897:Comorbidity; D005260:Female; D006437:Hemodialysis, Home; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D012307:Risk Factors