#2778 The Charlson Index can be used prospectively to identify patients who will need a close follow up of surveillance for the vascular access

Abstract

Abstract Background and Aims The primary screening methods for monitoring vascular access in haemodialysis involve measuring access blood flow and dialysis venous pressure. However, challenges are present in both aspects, potentially hindering the attainment of desired results. Research in this field is crucial to identify the optimal combination of intensive clinical monitoring and supplementary surveillance for effective outcomes. For this reason, we aim to describe the impact of comorbidities and patency of native arteriovenous fistulae (nAVF). Method Descriptive study of prevalent patients on haemodialysis, carried out by consulting electronic medical records over a period of 35 months. Demographic and vascular access-related variables were included. Primary and secondary patency was calculated for all accesses. Patients with upper limb AVF were classified according to distal and proximal access location; and the Charlson Index was used to categorise patients according to comorbidities. Kaplan Meyer survival curves were used to contrast the impact of comorbidities on the different patency. Results 52 patients, age 70.7 ± 1.57 years, 69.2% male, 42.3% diabetic, Charlson index with a median of 7 (6.5 - 7.73), 98.1% with a native fistula, the most frequent nAVF location in our population was humerocephalic (63.5%) and a predominance of the left upper extremity (65.4%). According to the location of the access, adjusted by the Charlson index, it is evident that in proximal accesses (humerocephalic and basilic humerus nAVF), with a Charlson Index less than or equal to 7, the time required to reach an event was statistically significantly longer (Log Rank Test (Mantel-Cox): primary patency p=0.057 and secondary patency p=0.069). This comparison was not significant in distal fistulas. Conclusion Using the Charlson comorbidity index information, we transformed it into an accessible and valuable tool for maintaining vascular access patency. Close follow-up in patients with proximal nAVF and high Charlson comorbidity index could be beneficial.