LEE J1,2, KNAGGE D1, PUTTASWAMY V1,3, O’LONE E1,2
1Royal North Shore Hospital, St Leonards, Australia, 2University of Sydney, Camperdown, Australia, 3Prince of Wales Hospital, Randwick, Australia
Aim: To assess the time to first intervention in haemodialysis vascular access following initial access insertion.
Background: Vascular access is a lifeline to patients requiring haemodialysis. Functioning vascular access allows administration of an appropriate dialysis prescription. Complications arising in vascular access can compromise dialysis adequacy. Time to event of any vascular access intervention is a surrogate measure for inability to perform adequate dialysis.
Methods: Single centre prospective longitudinal study including consecutive patients requiring haemodialysis from 2005-2020. Primary outcome was time to first of any intervention including: fistulogram, angioplasty, thrombectomy, stenting, ligation, central access insertion. Kaplan-Meier survival analysis was performed and stratified for age and sex using the χ2 log-rank test. Subgroup analysis was performed assessing thrombosis as an individual event. Patients missing procedural data were excluded. Median survival time with 95% confidence intervals reported. Data were censored for death or loss to follow-up.
Results: The cohort included 1308 patients requiring haemodialysis: 36.3% women, mean age 63. 416 patients underwent 1211 access interventions, median 2 interventions per patient (IQR: 1-3 interventions). Median follow-up time 3.3 years (IQR: 1.8-6.4 years). Unadjusted median time to first event 0.9 years (95%CI: 0.7-1.1 years). Univariate analysis suggested age and sex were not significant predictors of intervention. 117 (8.9%) patients had access thrombosis. Unadjusted median time to first thrombosis was 1.6 years (95%CI: 1.2-2.2 years); age was the only significant predictor of thrombosis (p=0.04).
Conclusions: The majority of patients requiring haemodialysis undergo numerous interventions to allow for adequate dialysis. Time to first intervention is often short. This information is essential for education of patients and appropriate timing of fistula formation. Further research is required to elucidate factors affecting vascular access outcomes.
Joshua Lee is a final year Basic Physician Trainee based at Royal North Shore Hospital in Sydney, NSW. He is a Clinical Associate Lecturer at the University of Sydney. He completed his Bachelor of Commerce, Doctor of Medicine, and Master of Medicine (Clinical Epidemiology) at the University of Sydney. He plans to pursue Nephrology advanced training, and has a keen interest in applying his statistical foundations to translational research.