NDT Advance Access published online on June 8, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp269
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Effect of demographic characteristics and timing of vascular access maturation on patency in Chinese incident haemodialysis patients
1 Division of Nephrology, Taipei Veterans General Hospital 2 Institute of Health and Welfare Policy 3 Institute of Public Health, National Yang Ming University, Taipei 4 Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
Correspondence and offprint requests to: Yee-Yung Ng; E-mail: yyng{at}vghtpe.gov.tw
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Abstract |
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Background. Functional, long-lasting vascular access is essential for maintaining effective long-term haemodialysis. Previous studies have documented demographic factors and comorbid conditions associated with long-term vascular access. However, no studies have examined the effect of demography and timing of vascular access maturation on primary patency in Chinese incident haemodialysis patients.
Methods. We retrospectively enrolled 7028 adult incident patients who began haemodialysis between 1 January and 31 December 2002. A total of 5890 patients with mature arteriovenous fistula or arteriovenous graft, before or after beginning regular haemodialysis, were identified between 1 January 2000 and 31 December 2003. The Cox regression hazard model was used to assess the impact of sex, age, diabetes, type of access and timing of vascular access maturation on the duration of primary vascular access patency.
Results. Of the study population, 2920 patients (50%) had diabetes; 4929 patients (84%) received fistulas and 961 (16%) grafts. Grafts, female sex and advanced age were significantly associated with shorter primary vascular access patency duration (P < 0.05). Diabetes was a risk factor for shorter primary vascular access patency duration for incident patients with mature fistulas before or after initiation, but not for patients with mature graft. Arteriovenous graft placement and maturation were better when completed >6 months prior to haemodialysis initiation for the duration of primary access patency.
Conclusion. Demographic characteristics and timing of vascular access maturation affect access type and duration of primary access patency among incident patients. Individual programmes for vascular access may be necessary to establish functional long-term access.
Keywords: arteriovenous fistula; arteriovenous graft; haemodialysis; patency; vascular access
Received for publication: 16.11.08
Accepted in revised form: 12. 5.09