#2598 Risk of vascular access complications in haemodialysis patients initiating dialysis with arteriovenous fistula or arteriovenous graft
Authors: Willetts Joanna , Usvyat Len , Chaudhuri Sheetal , Niklason Laura , Maddux Franklin 
Published: May 2024

Abstract

Background and Aims
Patients (pts) with end-stage kidney disease (ESKD) rely on successful vascular access (VA) for continual hemodialysis (HD) treatments. Possible VA complications are numerous and complex, which makes them difficult to study. We developed a comprehensive VA complication metric to evaluate VA complications holistically. The goal of this analysis was to describe the risk of having high VA complications in in-center hemodialysis (ICHD) pts whose initial VA included arteriovenous fistula (AVF) or arteriovenous graft (AVG), and who have been successfully receiving regular dialysis care for at least 2 years.

Method
Adult ICHD pts, with Charlson Comorbidity Index &lt;8, who initiated treatment at one of the clinics of a large dialysis organization between Jan 2016 and Dec 2021, received continuous treatment for ≥2 years, remained on ICHD until censored, and whose initial VA included an AVF or an AVG were investigated. Pts could be censored by death, transplant, discharge from FKC, or study end. Initial VA was determined by use of either AVF or AVG during ICHD treatments in the 90-120 days after initiation of ICHD.
Individual-level vascular access complication rates (VACR) were defined as the sum of a patient's VA complication events divided by their duration of follow-up until censor date. VA complication events include: hospitalization due to VA problems or VA infection, VA infections not requiring hospitalization, VA removal due to infection, symptoms of VA infection, symptoms of thrombosis/stenosis, documented stenosis, documented thrombosis, cannulation issues, bacteremia, sepsis. The threshold for high VACR was the highest quintile values. Logistic regression was used to determine the risk of having a high VACR by demographic and comorbid conditions.

Results
Analyses included 94,208 pts who met our inclusion criteria. The mean VACR for the population was 2.7 VA complications per patient per year (PPY). Pts whose VACR was in the highest quintile, ≥4.34 PPY, were categorized as having high VACR. Table 1 shows the risk of having high VACR by demographic characteristics and comorbid conditions present at ICHD initiation. In general, we observed lower or neutral risk of having high VACR in the demographic characteristics we examined. However, older patients as well as patients with higher BMI had an increase in risk of having high VACR.
We observed significant increased risk of having high VACR in diabetic pts (20%), pts with cerebrovascular disease (35%), pts with COPD (10%), pts with Congestive Heart Failure (21%), patients with dementia (22%), and patients with history of myocardial infarction (26%).

Conclusion
We observed that being older, having increased BMI, or having several comorbid conditions are associated with increased risk of having high VACR in successful ICHD patients who initiated dialysis with an AVF or AVG. Multivariate analyses to further explore these associations are warranted.