title: Excessive Access Cannulation Site Bleeding Predicts Long-Term All-Cause Mortality in Chronic Hemodialysis Patients.
abstract: Our group has previously reported that excessive vascular access bleeding during dialysis treatment in stable hemodialysis (HD) patients was associated with anemia and may indicate poorer health. The association between excessive blood loss from access cannulation site and clinical outcomes was unknown. We hypothesized that excessive access bleeding may have an impact on all-cause and cardiovascular (CV) mortality in this population. We prospectively conducted an observational, longitudinal study of 360 HD patients. Excessive access bleeding was defined as at least an occurrence of blood loss greater than 4 mL per HD session during a study period of one month. During a median follow-up of 83 months, all-cause mortality and CV mortality were registered. Outcomes were analyzed by Kaplan-Meier and Cox proportional hazards regression analyses. A total of 118 (32.8%) participants died and 54 of these were from CV death. Using a multivariate Cox proportional hazards regression, access bleeding was found to be an independent predictor of all-cause mortality (HR 1.67, 95% CI 0.96-2.91, P = 0.070) but not for CV death (HR 1.53, 95% CI 0.88-2.68, P = 0.135). Our study identified that excessive access cannulation site bleeding could be a novel marker for increased risk of death in HD patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Wan-Chuan
authors.initials: WC
authors.lastname: Tsai
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hung-Yuan
authors.initials: HY
authors.lastname: Chen
authors.affiliation: Department of Nursing, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Chi-Lin
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Department of Nursing, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Huang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Hsu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Mei-Fen
authors.initials: MF
authors.lastname: Pai
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Peng
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Graduate Program in Biomedical Informatics, Yuan Ze University, Tao-Yuan, Taiwan.
authors.forename: Yen-Ling
authors.initials: YL
authors.lastname: Chiu
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality*; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D005544:Forecasting; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects
keywords: Bleeding; Cardiovascular; Hemodialysis; Mortality; Vascular access