Analysis of Vascular Access in Haemodialysis Patients - Single Center Experience

Characteristics of Vascular Access Cannulation Complications in End Stage Kidney Disease Patients in West Java from 2018 to 2022: A Retrospective Observational Study

Background

End-stage kidney disease (ESKD) is associated with a tremendous financial burden. Data in Indonesia shows an increasing number of patients with ESKD taking hemodialysis as a routine procedure every year. Establishment and maintenance of vascular access are important in the management of ESKD. Vascular complications that often arise due to hemodialysis are common and one of the main reasons for hospitalization. Cannulation complications ranged from minor hematomas to acute bleeding from pseudoaneurysms that required emergency surgical procedures. This study aims to assess the different clinicopathological characteristics of ESKD patients with vascular access cannulation complications and the surgical management related to the complications.

Materials and Methods

This research is a retrospective observational study. The research subjects in this study were ESKD patients in the vascular and endovascular surgery division of the tertiary hospital in West Java, Indonesia. There were 121 study subjects. Clinicopathological characteristics of vascular cannulation complications and surgical management are extracted from the medical record.

Results

Three major vascular complications were ruptured pseudoaneurysms 64/121 (52.9%), impending rupture pseudoaneurysms 28/121 (23.1%), and pseudoaneurysms 21/121 (17.4%). Common surgical procedures were ligation of the draining vein 47/121 (38.8%), arterial primary repair 28/121 (23.1%), and arterial patch repair 18/121 (14.9%). There was a significant relationship between symptoms of bleeding in ruptured pseudoaneurysms and bulging masses in pseudoaneurysms (p = 0.001). There was a significant relationship between the diameter of the vascular mass, vascular defect size, and hematoma and the type of surgical procedure taken (p < 0.010).

Conclusion

Ruptured, impending rupture, and pseudoaneurysms are major complications of vascular access in ESKD patients, and there was a significant relationship between the carried-out surgical procedure and the size of the vascular mass, defect, and hematoma.

Analysis of the vascular access service for patients on haemodialysis in Livingstone Hospital

BACKGROUND

Reliable vascular access is key to sustainable haemodialysis treatment. Guidelines recommend an arteriovenous fistula (AVF) as the preferred modality in preference to arteriovenous grafts (AVGs) or central venous catheters (CVCs). There are limited data on vascular access in sub-Saharan Africa. This study aimed to evaluate the vascular access used in a South African tertiary hospital and identify problems with achieving the recommended access goals.

METHODS

A cross-sectional analysis was performed of the haemodialysis programme at Livingstone Tertiary Hospital. Current and initial vascular access used, timing until the creation of permanent access, and any complications experienced were recorded.

RESULTS

CVCs were used in 56% of subjects, 38% were using an AVF and 5% were using an AVG. Only 12% of the group had no AVF attempt. The overwhelming majority (95%) had dialysis initiated with a CVC. The rate of pre-emptive AVF creation was low and a delay in AVF creation was seen in 63% of patients. Central venous stenosis or occlusion was present in 26% of patients and likely due to prior or current CVC use.

CONCLUSIONS

The prevalence of CVC use was high and there were significant delays to AVF creation. High rates of central venous stenosis compromise future AVF use and are likely due to prolonged CVC use. Changes needed to improve the vascular access service include a multidisciplinary access clinic, dedicated theatre list, vascular access co-ordinator and further data collection to continually evaluate the vascular access service.

Antiplatelet agents maintain arteriovenous fistula and graft function in patients receiving hemodialysis: A nationwide case-control study

Background

In this study, we evaluated the effects of various medications on the patency of vascular access (VA) for hemodialysis.

Methods

We analyzed data from the Longitudinal Health Insurance Database of Taiwan. We adopted a case–control study design within a cohort of patients who had received regular hemodialysis between 2002 and 2012; 34,354 patients with first VA failure were identified, and the duration from VA creation date to the first VA failure date was calculated. We then classified these patients into two groups, namely arteriovenous fistula (AVF, n = 25,933) and arteriovenous graft (AVG, n = 8,421). Each group was further divided into two subgroups, namely short-term (<1 year) and long-term (≥1 year) patency.

Results

The risk factors for early VA failure were age ≥65 years, diabetes mellitus, hyperlipidemia, cerebral vascular disease, congestive heart failure, peripheral artery disease, and sepsis. Male sex, hypertension, cancer, and peptic ulcer were associated with early AVF failure. Antiplatelet therapy increased the AVF and AVG patency times with adjusted odds ratios of 0.748 (95% confidence interval [CI]: 0.703–0.796, p < 0.0001) and 0.810 (95% CI: 0.728–0.901, p = 0.0001), respectively. A significant decrease in the VA failure risk was observed with an increase in the cumulative defined daily dose of antiplatelet agents.

Conclusion

This nationwide study demonstrated that some risk factors were associated with early VA failure and that the use of antiplatelet agents prevented the loss of VA patency in a dose–response manner. Thus, antiplatelet drugs should be routinely administered to high-risk patients receiving dialysis.