#2431 Vascular access outcomes among patients on maintenance hemodialysis in Perpetual Succour Hospital: a 3-year cross-sectional analysis
Authors: Mejos Joel John , Darunday Grecia , Polito Eratosthenes , Maguad Ruben 
Published: May 2024

Abstract

Background and Aims
Hemodialysis (HD) is the most widely used treatment modality worldwide in the care of patients with end stage renal disease (ESRD). The success of the therapy depends largely on the quality of the VA and its proper functioning, which has a bearing on the patient's quality of life. Vascular access dysfunction remains one of the leading causes of excessive morbidity, mortality, and healthcare costs in this group.
A functional vascular access is mandatory to achieve good levels of dialytic efficiency, and it is considered the lifeline of patients on maintenance HD. The ideal vascular access should have specific characteristics among which the most important are the following: ease of placement; delivery of adequate blood flow for effective dialysis; good primary patency rates; low rates of complications and side effects; long-lasting life; and low economic costs. There are 3 types of vascular accesses (VAs): the internal arteriovenous fistula (IAVF); the central venous catheter, which can be tunneled (CVC-T) or not (CVC-nT); and the synthetic vascular graft. Internal arteriovenous fistula is considered the best option because it is safer, more durable, and less expensive. The catheter is essential for emergency onset in HD but is associated with a higher number of infections, higher mortality, and greater costs.
Arteriovenous fistulae (AVF) have advantages over arteriovenous grafts (AVG) and central venous catheters (CVC), but whether AVF are associated independently with better survival is unclear. The aim of this study is to determine the vascular access outcomes of ESRD patients on maintenance hemodialysis.
Specifically, this study (1) described the clinicodemographic profile of the patients in terms of age, sex, primary etiology of ESRD, employment status, comorbidities, hepatitis status and family history of the disease; (2) determined the vascular access used on the HD patients (AVF/AVG, CVC or IJ; (3) identified interventions performed to maintain vascular access for hemodialysis; (4) determined the categories of the vascular access site; (5) assessed the vascular access outcome; (6) determined the reason and number for vascular access change and the (7) clinical outcome of the HD patients.

Method
This is a single center, cross-sectional study of ESRD patients on maintenance hemodialysis enrolled in Perpetual Succour Hospital Hemodialysis Unit from April 1, 2021, to November 30, 2023.

Results
There were 260 hemodialysis patients included, with successful vascular access outcome (73.13%) and were younger (57.2 ± 14.1). Those who had failed vascular access were females (54.2%), unemployed (61.4%) and had diabetes mellitus (50.6%) as the primary etiology of their ESRD. Those with failed vascular access were hypertensive (86.7%), with history of CAD and MI (57.8%) and were having diabetes mellitus (56.6%). Proportion of those with failed and successful vascular access significantly differ among hypertensives $(p = .012)$, diabetics $(p = .039)$, with chronic glomerulonephritis $(p = .011)$, and among those with malignancy $(p = .003)$. Most of those who were alive had successful vascular access (76.8%), however, among those who had failed vascular access died (57.6%). And the association of clinical outcomes (death or not) and failure or success of vascular access is statistically significant, $(p = .001)$.

Conclusion
Our study showed that failed vascular access were more associated with female gender, diabetes mellitus as the primary etiology of ESRD and with other co-morbid conditions such as hypertension and CAD or MI. Successful vascular outcome were among those of younger age group compared to those whose vascular access failed, probably due to better vascular condition and fewer co-morbidities.
As shown in Table 2, type of access, interventions performed, and vascular access site significantly differ among HD patients with failed vascular access outcome and with those who were successful $(p = .001)$Those with failure on the vascular access were changed to CVC (44.6%) while others had changed to IJ (22.9%).
Eighty of those with failed vascular (96.4%) access has changed site due to no bruit (65.0%) and thrombosis (33.8%).