Risk factors of vascular access failure in patients on hemodialysis.
BACKGROUND
The aim of this study was primarily to determine if there was any relationship between hemoglobin levels and vascular access (VA) survival. In addition, other risk factors were evaluated with special stress on sex, age, diabetes mellitus, smoking, and medications.


METHODS
This study comprised 200 patients who had been on renal replacement therapy for more than 1 month through a permanent VA. The patients were categorized based on their mean blood hemoglobin levels. The possible risk factors for VA failure were also evaluated which included age at the beginning of hemodialysis, sex, diabetes mellitus, baseline levels of intact parathyroid hormone, and antihypertensive therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.


RESULTS
The younger the age the longer the duration of survival of left radial, left brachial, and right radial fistulas; however, sex had no significant impact on the duration of fistulas. Diabetic patients were more likely to have failed VA compared to nondiabetics. In addition, optimization of hemoglobin levels between 10 g/dL and 12 g/dL was associated with longer fistula survival. A higher risk of right radial arteriovenous fistula failure among hypertensive patients who received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers compared to those without these drugs.


CONCLUSIONS
Severe anemia, age, diabetes mellitus, and smoking are the main risk factors of VA failure. Our study showed that patients on hemodialysis should benefit from anemia correction, with a target hemoglobin level between 10 g/dL and 12 g/dL, without incurring any increased risk of VA failure.
Gheith
Osama Ashry
OA
Urology and Nephrology Center, Mansoura, Egypt. ogeith@yahoo.com
Kamal
Mohamed M
MM
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000740:Anemia / Q000150:complications; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D016019:Survival Analysis; D017211:Treatment Failure; D055815:Young Adult
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors