VASCULAR ACCESS OPTIONS AT HEMODIALYSIS THERAPY INITIATION: COMPLICATIONS AND SURVIVAL OF PATIENTS WITH CHRONIC KIDNEY DISEAS STAGE 5 D

Abstract

The annual increasing of dialysis population results tofocus world attention on the problems associated with improving of survival among patients with chronic kidney disease stage VD (CKD VD st.)., decreasing iatrogenic complicationfrequency. HD is the most common method ofrenal replacement therapy (RRT). Several studies haveproven the link between the type ofinitial vascular access, and an morbidity and survival of patients with CKD VD st.. Aim. The aim of this study was to explore the effects of an initial vascular access on morbidity and survival inpatients with CKD VD st., which are treated with hemodialysis. Materials and methods. In the study 79HDpatients were included. Patients were randomized into twogroups, depending on the type of vascular access at the start of HD treatment: the first group (n = 47) included patients, who started HD treatment through theformed AVF, patients among which central venous catheter (CVC) was usedfor the HD initiation composed the second (n= 32) group. The endpoints were: the total number of deaths, hospitalizations due to bacterial infections, sepsis, unstable angina and myocardial infarction. All cases that took place from 01.01.2013 to 01.12.2015 year were analyzed. Evaluation of survival wasperformed using the Kaplan-Meier method. Results. The analysis allowed to state that during analyzed period in total were 24 deaths: in the first group ofpatients - 10 (21.28%), and in the second - 14 (43.75%) cases; p = 0.03299. The survival rate ofpatients was significantly lower with the CVC. The 10-years cumulative proportion surviving was 73% and 40% when using of AMT and CVC, respectively. The relative risks and odds ratio for all-cause hospitalization in the second group ofpatients (26 episodes) were significantly higher compared to thefirstgroup (16 cases): RR = 2,387, (95% Cl: 1,550-3,674) and OR = 8,396 (95% Cl: 2,870-24,559). It was established a significant increasing of the hospitalization incidences both due infectious comorbidity (9/21,43% versus 15/46,9%;p = 0,0085), and cardiovascular diseases (7/16.7% vs. 11/34,37%;p = 0,0427) inpatients with a history ofthe CVC use at the HD initiation, compared withpatients who started treatment through theformed AVF. Conclusion. Thus, the obtainedfindings suggest that the use of the CVC at the HD initiation has a significant negative effect onprognosis in thepatientpopulation with CKD stage VD.

Keywords

• vascular access, hemodialysis, arteriovenous fistula, central venous catheter, complications, survival,patients.