Efectividad a largo plazo de una política continuada de acceso vascular autógeno para hemodiálisis desde una perspectiva centrada en el paciente

Abstract

ObjectiveThe guidelines recommend performing autologous vascular access rather than catheters or prosthetic grafts. An analysis is performed on the long-term effectiveness of a continued policy of priority autologous vascular access (CPAVA) in incident haemodialysis patients. Material and methodsA retrospective and observational study was conducted on 130 patients (mean age 62.3 years, 67% male), of whom 52.3% had a catheter as initial vascular access, and who started chronic haemodialysis between 2006-2009 in our centre and in whom a CPAVA was applied. Statistical analysis by intention to treat using Cox regression. ResultsThe first useful access (FUA) was autogenous in 118 patients (90.8%), and prosthetic in 12 (9.3%). More than one procedure was necessary to achieve a FUA in 41 (31.5%) patients. The probability of maintaining the dialysis throughout the FUA was 63.1 and 43.2%, at 1 and 5 years, respectively. During follow-up (mean=28.8 months), 75 patients (57.7%) required repairs or new accesses, extending the effectiveness of CPAVA to 86.5 and 68.8%, at 1 and 5 years, respectively. The effectiveness decreased if the patient required an initial catheter (HR: 3.2, P=.014), had higher initial glomerular filtration rates (HR: 1.1; P=.023), history of failed access before the FUA (HR: 3.9, P=.001), and in women (HR: 2, P =.077). ConclusionsThe effectiveness of a CPAVA is high. However, a third of patients require more than one procedure to achieve FUA. Several factors adversely affect the outcome of autogenous vascular access, showing the need for optimising the preoperative evaluation and follow-up.