Kidney Week

Abstract: FR-PO723

Timing of Vascular Access Creation in Hemodialysis Patients

Session Information

• Dialysis: Vascular Access - I
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 704 Dialysis: Vascular Access

Authors

• Borsje, Annemiek, Northwest Clinics Alkmaar, Alkmaar, Netherlands

Annemiek Borsje,

• Van velzen, Daan M., Northwest Clinics Alkmaar, Alkmaar, Netherlands

Daan M. Van velzen,

• Bax, Willem A., Northwest Clinics Alkmaar, Alkmaar, Netherlands

Willem A. Bax,

• de Groot, Karina, Northwest Clinics Alkmaar, Alkmaar, Netherlands

Karina de Groot,

• Penne, Erik Lars, Northwest Clinics Alkmaar, Alkmaar, Netherlands

Erik Lars Penne,

Background

Late referral for vascular access creation in Chronic Kidney Disease (CKD) patients who opted for hemodialysis (HD) may lead to high central venous catheter (CVC) rates. In contrary, too early referral potentially leads to unnecessary vascular access interventions. The aim of the present study was to analyze timing of vascular access creation in patients starting HD.

Methods

We conducted a retrospective, observational study in stage 4 and 5 CKD patients from a single center in the Netherlands, referred for first vascular access creation between 2009 until 2011. Patients were divided in three groups: (too) early, optimal or (too) late vascular access creation. Early was defined as vascular access surgery ≥6 months prior to start HD. Optimal was defined as starting HD with an adequate vascular access and surgery was within 6 months prior to start. Late was defined as starting HD with a CVC. Patient characteristics as well as vascular access interventions were recorded.

Results

Forty-two patients were included (age 68±11y; 50% male; eGFR 11±3ml/min/1.73m²). Mean time from vascular access surgery to initiation of HD was 338±470 days. Vascular access creation was early in 60% (n=25), optimal in 29% (n=12) and late in 12% (n=5).
Forty-four percent of the patients in the early group (n=11; 26% of all included patients) never started HD after a mean follow-up of 8 ±0.7 years (7 patients died, 2 had stabilized kidney function, 1 underwent pre-emptive kidney transplantation, and 1 was lost to follow up). Overall, in 45% (n=19) of patients a surgical and/or endovascular intervention was performed before initiation of HD. Of the 11 patients that never started HD an intervention was performed in 36% (n=4). All patient in the early and optimal group had an adequate vascular access at start of HD. Higher age and high eGFR were associated with late vascular access creation.

Conclusion

In this study, the majority of patients started HD with an adequate vascular access. However, in a substantial proportion of patients interventions were needed prior to start HD, also in the subgroup of patients that never started HD during follow up. More studies are warranted to investigate the optimal timing of vascular access creation aiming at adequate vascular access at time of start HD on the one hand and avoiding too early referral resulting in unnecessary interventions on the other hand.