Increased blood loss from access cannulation site during hemodialysis is associated with anemia and arteriovenous graft use.
Blood loss from the access cannulation site during hemodialysis (HD) treatment is inevitable. Nevertheless, during HD, excessive blood loss from the cannulation site is not uncommon. The clinical characteristics associated with it and whether such blood loss could impact on patient outcomes is unknown. This pilot study aims to identify the prevalence and risk factors associated with excessive bleeding (≥ 4 mL/session) from dialysis access cannulation site during regular HD treatments. Stable end-stage renal disease patients receiving maintenance HD via arteriovenous fistula (AVF) or graft (AVG) were included in this study (N = 361). They were closely monitored for one month for the occurrence of excessive access bleeding during each HD session. A total of 4152 sessions of HD were performed during the study period and 143 patients (39.6%) had at least one episode of excessive bleeding from the vascular access (≥ 4 mL/session). Individuals experiencing excessive bleeding episodes had a significantly lower hemoglobin level, higher rate of diabetes, central venous stenosis, longer dialysis vintage, lower serum albumin level, longer hemostasis time and higher AVG and anti-platelet agent use (all P < 0.05). In the multivariable logistic regression model, longer dialysis vintage, central venous stenosis, lower hemoglobin level, and AVG usage were independently associated with occurrence of excessive access bleeding. AVG users also clustered with other risk factors for excessive access bleeding. Our study identified the novel associations between excessive cannulation site bleeding with dialysis vintage, anemia and AVG usage. The significance and impact of long-term chronic, intermittent bleeding from dialysis access should be further explored.
Department of Nursing, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.
Chi-Lin
CL
Lin
Hung-Yuan
HY
Chen
Shu-Chen
SC
Huang
Shih-Ping
SP
Hsu
Mei-Fen
MF
Pai
Yu-Sen
YS
Peng
Yen-Ling
YL
Chiu
D000368:Aged; D000740:Anemia / Q000150:complications / Q000453:epidemiology; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D002404:Catheterization / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010865:Pilot Projects; D015995:Prevalence; D006435:Renal Dialysis / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors
Anemia; Arteriovenous Graft; Bleeding; Hemodialysis; Vascular Access