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ORIGINAL ARTICLE  VASCULAR ACCESS Freefree

International Angiology 2020 December;39(6):525-31

DOI: 10.23736/S0392-9590.20.04401-6

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Vascular access as a survival factor for the hemodialysis population: a retrospective study

Martina ZAVACKA 1, Aurel ZELKO 2, Andrea MADARASOVA GECKOVA 2, 3, Maria MAJERNIKOVA 4, Jana POBEHOVA 1, Peter ZAVACKY 5

1 Clinic of Vascular Surgery, East Slovak Institute of Cardiovascular Diseases, Kosice, Slovak Republic; 2 Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovak Republic; 3 Olomouc University Social Health Institute, Palacky University of Olomouc, Olomouc, Czech Republic; 4 First Clinic of Surgery, Louis Pasteur University Hospital, Kosice, Slovak Republic; 5 Fresenius Medical Care - Dialysis Services Slovakia, Louis Pasteur University Hospital, Kosice, Slovak Republic



BACKGROUND: The creation of vascular access is an essential condition for providing hemodialysis, which remains the only option for most patients suffering from end-stage renal disease. Selection of the type of vascular access affects patients’ clinical outcomes, access maintenance frequency, risk of infection and major adverse cardiac events during dialysis. To improve the decision-making process, we performed a retrospective clinical data analysis of dialyzed patients and critically compared the survival rates between two types of vascular access applied during dialysis therapy during a 5 years follow-up period.
METHODS: Using nationally representative data from 18 dialysis centers across Slovakia, we explore and compare survival rates of 960 adult patients undergoing hemodialysis using either a central venous catheter (CVC) or an arteriovenous fistula (AVF). Length of dialysis, protein malnutrition and comorbidities were examined as possible covariates that might influence survival rates.
RESULTS: Chances of surviving for a one-year period were higher by 52% in AVF patients compared to CVC patients (HR 1.52; 95% CI 1.27-1.83; P<0.001) regardless of age, sex, nutritional status, time spent on dialysis and comorbidities. The presence of cardiac congestion (HR 1.26 [95% CI 1.06-1.50], P<0.01) and malnutrition (protein malnutrition: HR 0.98 [95% CI 0.96-1.00], P<0.05; lean tissue index: HR 0.79 [95% CI 0.67-0.93], P<0.01) decreases chances for survival.
CONCLUSIONS: A functional arteriovenous fistula is a significant predictor of survival in the population dependent on hemodialysis, independently of sociodemographic parameters and serious comorbidities. Therefore, if various types of vascular accesses are applicable for the patient, AVF should be prioritized over CVC.


KEY WORDS: Vascular access devices; Renal dialysis; Survival rate

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