Pattern of Initial Permanent Vascular Access in New Hemodialysis Patients in Songklanagarind hospital

Abstract

Background: Arteriovenous fistula (AVF) provides the best access for longevity and the lowest association with morbidity and mortality. The 2006 National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guidelines for vascular access strongly recommended AVF use, aims the AVF prevalence to be more than 65 percent and the use of permanent cuff catheters less than 10 percents, which impacts the surgeons' practice pattern on the type of vascular access created. The present practice should initiate AVF as much as possible and lower the use of central venous catheters. Objective: To compare the types of vascular access initiated on hemodialysis patients in Songklanagarind Hospital, the practice pattern characteristics that may influence vascular access use and survival. Materials and methods: This retrospective descriptive study enrolled 470 new hemodialysis patients receiving an AVF and AVG in Vascular unit of PSU Hospital. Vascular access data were collected for each patient at study entry from 2008 to 2011. Practice pattern data were also analyzed.

Results: Total 846 operations for vascular access created from 2008 to 2011, 470 patients were created the initial vascular access. AVF and AVG were planned for 336 (71.5%) and 134 (28.5%) patients, and at the operation time, AVF and AVG were performed for 337 (71.7%) and 133 (28.3%) patients, respectively. 205 (43.6%) patients had the catheter at first visit and increase to 231(49.1%) on the operation time. The primary failure rate were 27.4 and 7.3(P<0.01), complication rate were 40.6 and 62.2 (P<0.01) in AVF and AVG, respectively.

Conclusion:  The AVF is the first initiated vascular access for suitable patient in PSU hospital which compatible with the KDOQI guideline 2006, but still high rate of catheter used. However, the primary failure rate of AVF is higher than AVG while the complication rate is lower significantly.