title: Vascular access for long-term hemodialysis/hemodiafiltration patients.
abstract: OBJECTIVE
  We investigated the characteristics of patients who received long-term hemodialysis/hemodiafiltration (HD/HDF) treatment for over 30 years at our group of hospitals and type of vascular access (VA) used.
  
  
  METHODS
  As of August 2014, 950 patients were receiving HD/HDF treatment at one of our hospitals. Of those, we investigated 41 (4.3%) undergoing long-term treatment in regard to their characteristics and VA type. The items subjected to analysis were sex, primary illness, age at time of dialysis initiation, present age, duration (years) of HD/HDF, type of arteriovenous fistula (AVF) and arteriovenous graft (AVG), history of surgery and AVF persistence rate.
  
  
  RESULTS
  The subjects consisted of 22 men and 19 women, and their mean HD/HDF duration was 33.4 ± 2.8 years. For primary illness, the majority (n = 31) had chronic glomerulonephritis. The age at time of dialysis initiation was 31.7 ± 7.76 years and present age was 64.5 ± 7.65 years. They had received 3.8 VA surgeries. For present VA type, 23 patients (56.0%) had an AVF and 13 (31.7%) an AVG, while 4 AVF patients (9.7%) had a history of AVG use. One patient (2.4%) had a superficialized artery. The mean HD/HDF duration of the 13 AVG patients was 7 years and the longest was 18 years. AVF persistence rate estimated by the Kaplan-Meier method was 75% at 30 years after dialysis initiation.
  
  
  CONCLUSIONS
  The present results suggest that the ratio of patients with AVG increased with prolonged HD/HDF treatment. AVG has a higher probability of complications and lower patency as compared to AVF, thus careful management is needed. On the other hand, AVG contributes more to a good long prognosis, as it offers efficient dialysis. In cases of vascular deterioration due to long-term hemodialysis, it is inevitable to change from AVF to AVG, thus the ratio of AVG patients is expected to increase in cases of long-term HD/HDF.
authors.affiliation: Department of Kidney Disease (Artificial Kidney and Kidney Transplantation), Kawashima Hospital, Tokushima - Japan.
authors.forename: Narushi
authors.initials: N
authors.lastname: Yokota
authors.affiliation: Department of Nephrology, Tokushima University, Tokushima - Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Nagai
authors.affiliation: Department of Kidney Disease (Artificial Kidney and Kidney Transplantation), Kawashima Hospital, Tokushima - Japan.
authors.forename: Daigo
authors.initials: D
authors.lastname: Okada
authors.affiliation: Department of Kidney Disease (Artificial Kidney and Kidney Transplantation), Kawashima Hospital, Tokushima - Japan.
authors.forename: Yasuto
authors.initials: Y
authors.lastname: Muromiya
authors.affiliation: Department of Kidney Disease (Artificial Kidney and Kidney Transplantation), Kawashima Hospital, Tokushima - Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Suenaga
authors.affiliation: Department of Kidney Disease (Artificial Kidney and Kidney Transplantation), Kawashima Hospital, Tokushima - Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Department of Kidney Disease (Artificial Kidney and Kidney Transplantation), Kawashima Hospital, Tokushima - Japan.
authors.forename: Kana
authors.initials: K
authors.lastname: Kawahara
authors.affiliation: Department of Urology, Tokushima University, Tokushima - Japan.
authors.forename: Hiro-omi
authors.initials: HO
authors.lastname: Kanayama
authors.affiliation: Department of Kidney Disease (Artificial Kidney and Kidney Transplantation), Kawashima Hospital, Tokushima - Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Minakuchi
authors.affiliation: Department of Kidney Disease (Artificial Kidney and Kidney Transplantation), Kawashima Hospital, Tokushima - Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tsuchida
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome