Abstract

Introduction: The type of vascular access used by haemodialysis patients is thought to be one of the predictors of patient survival. However, many previous studies have been unable to separate the effect of access type from the effects of other differences between patients groups or have included incident patients. Some centres report excellent outcomes using dialysis catheters in stable prevalent patients and challenge the current guidelines about the use of long term catheters. This is an observational UK centre level study reporting on the relationship between the percentage of established prevalent patients using definitive access and the subsequent 1 year survival. Method: Vascular access audit data from 2005 and UKRR survival data at 1 year for patients who had been on HD for over 3 months was obtained from the UKRR database. Regression analysis was used to assess the amount of variation in 1 year survival that could be explained by the percentage of patients using an AVF or AVG in a centre. Results: From the renal centres reporting to the UKRR in 2005, 16,984 patients had vascular access data. The mean centre level 1 year survival was 86.4% (95% CI: 82.2–90.9) and was 86.9% (95% CI: 82.8–91.2) after censoring for transplantation. The mean percentage of haemodialysis patients using definitive access (AVF or AVG) in a centre was 69.8% (SD 10.4). A small positive association was found between the percentage of HD patients using an AVF or AVG in a centre and 1 year uncensored survival (β = 0.06, p = 0.04). The type of access in use was able to explain 6% of the variation in centre level survival. Conclusions: To some extent, this study has repeated work done by DOPPS and in the US but for the first time has studied only prevalent dialysis patients and looked at the UK dialysis population. Whilst increased venous catheter use was associated with an increase in one year mortality of prevalent established haemodialysis patients, this effect was very small and only accounted for some 6% of the variation in one year mortality between renal centres. Further work using data from the current large vascular access audit needs to be done to further elucidate best practice within the UK.

Full Text
Paper version not known

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.