Abstract
The arteriovenous fistula (AVF) has long been considered the optimal vascular access. However, the evolving characteristics of the ageing dialysis population limit the creation of an AVF in all patients. Thus, more patients start hemodialysis (HD) with a central venous catheter (CVC) rather than an AVF, and the supremacy of the AVF has recently been questioned. The aim of this study was to analyze the incidence and rate of access complications in 100 patients between 2010 and 2015. A total of 63 patients started HD with an AVF, while 37 began HD with a CVC. We found no differences in patient survival according to the vascular access in use at the beginning of dialysis, but patients were more likely to die while undergoing dialysis by means of a CVC than an AVF. Patients started on dialysis with a CVC had more cardiovascular disease, while patients who began dialysis with an AVF presented more hypertension. Fistulas presented a longer survival time despite more hospital admissions, but CVCs bore a higher risk of infections. Our results suggest that starting dialysis with a CVC does not confer a greater risk of death.
Highlights
Extracorporeal hemodialysis (HD) represents the most widely diffused renal replacement therapy and, in Europe in 2016, there were about 301,134 patients on regular renal replacement therapy according to the European Renal Association-European Dialysis and Transplantation Association reports [1]
We divided the patients into two groups: patients who started dialysis with a functioning arteriovenous fistula (63) or patients who started dialysis with a central venous catheter (38) (Table 1)
We found no differences in age (68.43 ± 13.07 vs. 69.14 ± 16.48 years, arteriovenous fistula (AVF) vs. central venous catheter (CVC), p = NS) (Figure 1) or sex (AVF 47 males, CVC 22 males, p = NS) (Figure 2) between the two groups
Summary
Extracorporeal hemodialysis (HD) represents the most widely diffused renal replacement therapy and, in Europe in 2016, there were about 301,134 patients on regular renal replacement therapy according to the European Renal Association-European Dialysis and Transplantation Association reports [1]. The three most commonly used vascular accesses for extracorporeal hemodialysis are autologous arteriovenous fistulas (AVFs), prosthetic grafts (AVGs), and central venous catheters (CVCs). The relative risk of death in incident patients using CVCs is 2- to 3-fold higher than those using an arteriovenous access [13]. This is true regardless of whether the overall mortality or the cause-specific mortality are examined, especially if the cause of death is infection-related [13]. Patients dialyzing with a catheter are, on average, older, present more comorbidities, have lower serum albumin levels, and have a poor functional status, all of which are factors that are generally associated with an increased mortality risk [13]
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