Abstract: SA-PO0453
Fatal Dialysis Access Hemorrhage in Out-of-Hospital Deaths: A Korean Forensic Analysis, 2023-2024
Session Information
- Dialysis: Vascular Access
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Hyun, Yunjung, Forensic Science Division Gyeonggi Nambu Provincial Police, Suwon-si, Korea (the Republic of)
- Kee, Younkyung, Kangdong Sacred Heart Hospital, Gangdong-gu, Seoul, Korea (the Republic of)
- Kim, Do Hyoung, Hallym University Kangnam Sacred Heart Hospital, Yeongdeungpo-gu, Seoul, Korea (the Republic of)
Background
Hemorrhage from dialysis access sites, including arteriovenous fistulas (AVFs), arteriovenous grafts (AVGs), and dialysis catheters, is a rare but potentially fatal complication in hemodialysis patients. These deaths are often underreported, especially when autopsies are not performed. We aimed to evaluate cases of fatal dialysis access hemorrhage among out-of-hospital deaths using forensic data.
Methods
We retrospectively analyzed 18,165 medicolegal death records from Korea's Scientific Crime Analysis System between January 2023 and December 2024. Hemodialysis patients (n=48) were identified via keyword search (“hemodialysis” or “dialysis access”). Cases were classified as vascular access hemorrhage if wall bloodstains, external bleeding evidence, or autopsy-confirmed hemorrhage were documented. Statistical analyses included Fisher’s exact test and chi-square tests.
Results
Among 48 dialysis patients, 8 cases (16.7%) were classified as fatal vascular access hemorrhage. Among these, 5 underwent autopsy, confirming access hemorrhage in 2 cases. Compared to non-hemorrhage patients, the hemorrhage group exhibited significantly higher rates of vascular access infection (25.0% vs 0.0%, p=0.036) and vascular access wound (57.1% vs 15.8%, p=0.034). There were no significant differences in vascular access type (AVF, AVG, catheter), presence of aneurysm, or living situation (living alone vs with others).
Conclusion
Fatal dialysis access hemorrhage is often overlooked in out-of-hospital deaths. Increased clinician awareness and systematic autopsy performance are crucial to accurately determine cause of death, improve surveillance, and prevent future fatalities related to vascular access complications.