title: Vascular access for long-term hemodialysis/hemodiafiltration patients in Japan.
abstract: BACKGROUND
  Many patients are receiving long-term hemodialysis (HD) or hemodiafiltration (HDF) treatment in Japan. Vascular access is a lifeline for patients on HD or HDF, and proper maintenance of vascular access is one of the key factors that make long-term HD and HDF possible. We investigated the conditions of vascular access in patients undergoing chronic HD or HDF in our hospital group in Japan to assess the relationship between the type of vascular access and long-term treatment.
  
  
  METHODS
  We studied the conditions of vascular access in 899 patients who were on chronic HD or HDF, including patients who had been on dialysis for over 20 years as of December 2014.
  
  
  RESULTS
  There were 125 patients who had been on dialysis treatment for over 20 years, with the longest dialysis vintage being 37 years, and they accounted for 13.9% of the total number of subjects. The primary disease was diabetes in two cases and chronic glomerulonephritis in the rest. There were 105 patients with an arteriovenous fistula and only 20 with an arteriovenous graft (AVG) (16.0%), whereas 91 had an AVG (11.7%) among the 774 patients who had been on dialysis treatment for less than 20 years, which indicated that the percentage of patients with an AVG increased with dialysis vintage.
  
  
  CONCLUSIONS
  An arteriovenous fistula was the main type of vascular access used in patients who had been on dialysis treatment for over 20 years, which is very rare, even on the global scale. However, switching to an AVG is unavoidable in cases of vein deterioration due to long-term use. Access via an AVG is expected to increase further in long-term patients in the future.
authors.affiliation: Department of Kidney Disease (Dialysis and Transplantation), Kawashima Hospital, Tokushima, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tsuchida
authors.forename: Kojiro
authors.initials: K
authors.lastname: Nagai
authors.forename: Jun
authors.initials: J
authors.lastname: Minakuchi
authors.forename: Shu
authors.initials: S
authors.lastname: Kawashima
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D013997:Time Factors; D058017:Vascular Grafting / Q000706:statistics & numerical data*