O10
THE EFFECTS OF INITIAL ACCESS ON THE SURVIVAL OF PATIENTS
REQUIRING CHRONIC HAEMODIALYSIS (HD) FOR END STAGE RENAL
FAILURE: A 6 YEAR RETROSPECTIVE STUDY
Sharp, A, Somalanka, S, Steele, M, D Makanjuola, D, DeSilva, V
South West Thames Renal and Transplant Unit, St Helier Hospital, Carshalton
BACKGROUND: Evidence suggests that patients who receive dialysis through a central
venous catheter (CVC) have an increased morbidity and mortality compared to those using an
arteriovenous fistula (AVF).
PURPOSE OF STUDY: To measure the impact of initial dialysis access on survival of
patients receiving long term HD for
ESRF.
1st Access for Dialysis
120%
100%
80%
Patients alive/Percent
METHODS: A total of 184 patients
on HD were followed up over a 6
year period. All patients were
categorised into groups based on
their initial access for HD.
Categories were split into those that
received their initial HD via an
arteriovenous fistula (AVF) (n=61),
a permanent tunnelled CVC (n=63)
or a temporary CVC (n=61).
AVF
RESULTS: The three study groups
Permanant CVC
60%
had similar demographics and coTemporary CVC
morbidities. The only differences
being that the AVF group had a
slightly lower blood pressure at the
40%
start of dialysis when compared
with the permanent CVC group (P
<0.05) In this study, when
20%
comparing AVF, permanent
tunnelled CVC and temporary CVC,
patients receiving initial
haemodialysis via a AVF have a
0%
0
500
1000
1500
2000
2500
significant survival advantage over
Time/Days
those receiving haemodialysis via a
temporary CVC (p=0.040). There is
no significant survival advantage when comparing AVF with permanent CVC (p=0.126), and
when comparing permanent CVC with temporary CVC (p=0.578) for initial access in patients
with ESRF receiving chronic HD.
CONCLUSION: The type of dialysis access used at the point of initial HD in this study had
a significant affect on patient survival. It is important to recognise, that this is a selected
group of patients that had been on HD for greater than 90 days (not acute). In addition, it does
not take into account any change in the type of venous access over the study period. However,
it does suggest that once established on dialysis, the type of access at initiation of HD can still
affect patient prognosis. These data suggest that receiving initial HD via an AVF conferred a
survival advantage over those receiving HD via a temporary CVC. Interestingly, there was no
significant survival advantage when comparing permanent CVC with both AVF and
temporary CVC. Conversely, as described in the literature, in the acute setting this may be
very different. Further studies that compare patient survival from first dialysis, who receive
dialysis exclusively through an AVF or CVC, would provide further evidence for this
hypothesis.