[Types of hemodialysis vascular access in patients on renal replacement therapy and its complications during a one year observation period].
ABSTRACT The type of vascular access is an important determinant of complications in the dialysis population. The aim of the study was to evaluate types of hemodialysis vascular access at hemodialysis start, in the course of treatment and complications during a one year observation period. The study group consisted of 213 patients [126 (59%) males; 87 (41%) females] treated for 54 months (range from 2 to 384 months) by maintenance hemodialysis at the Nephrology Department of the University Hospital. Mean age of the patients equaled 57.4 years and ranged from 21 to 91 years. The observation period began on June 1st, 2009 and finished on May 31st, 2010. At the start of the dialysis therapy - 99 (46.5%) patients had arterio-venous fistula (AVF), 81 (38.0%) temporary catheters (TC), and 33 (15.5%) permanent catheters (PC). At the beginning of the one-year observation period, 161 (75.6%) of the patients were treated using an AVF, 37 (17.4%) using a CP, 11 (5.1%) CT, and 4 (1.9%) using an artificial graft (AVG). At the end of the one year observation period - 179 (84%) patients were dialyzed using AVF, while 30 (14.1%) patients on PC, and 4 (1.9%) using a AVG. Statistically significant differences in possessing AVF were noted between start of renal replacement therapy and the start and finish of the one year observation period (p < 0.0001), as well as beginning and finish of the observation period (p < 0.002). During the observation period - 37 (20.7%) patients with an AVF required intervention due to complications associated with vascular access; where 4 from 11 (36.4%) patients in this group had AVF located on the arm and 33 from 150 (22.0%) on the forearm. The most common complications associated with AVF were thrombosis (23 = 14.3%), narrowing of the fistula (9 = 5.6%), too high output flow (HOF) 2 = 1.2% and the steal syndrome (SS) 3 (1.9%). Infectious complications were noted in 4 from 37 patients with PC (10.8%), and significantly less with AVF-4 from 161 (2.5%) (p < 0.0001). AVG infection occurred in 2 (50%) individuals of this group. Conclusions: AVF created using patients' own vessels of the forearm is characterized with decreased risk of complications in comparison to fistulas made of artificial materials or permanent catheters. However, fistula thrombosis of the AVF is still the most common complication requiring surgical intervention.