Risk Factors that Influence the Early Access Patency of an Arteriovenous Fistula in Hemodialysis Patients

PURPOSE: It is very important to obtain vascular access that resists repeated punctures and maintains an adequate blood flow for performing hemodialysis in patients with end stage renal disease. This study was designed to identify the risk factors that may influence the early patency rate of arteriovenous fistulas (AVFs). METHOD: We analyzed 304 cases of AVFs in 299 patients who underwent hemodialysis access surgery in our hospital from January 2000 to March 2007. The rate of early access failure and the risk factors of early access patency were evaluated retrospectively. RESULT: The rate of early access failure of an AVF was 14.5%. The early access failure group showed a higher incidence in women and in the patients with a previous history of ipsilateral central venous catheterization. Further examination by multivariate analysis demonstrated that a history of ipsilateral central venous catheterization was an independent risk factor for early access failure of AVFs. CONCLUSION: A history of ipsilateral central venous catheterization was an independent risk factor for early access failure of AVFs in this study.

Risk Factors for Early Access Failure of Arteriovenous Fistula in Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: Early failure of vascular access for hemodialysis is not uncommon. It has been known that DM, hypertension, age, sex and some abnormal laboratory findings at the surgery are the risk factors. We designed this study to analyze the risk factors for the early access failure of arteriovenous fistula (AVF). METHODS: Among 111 patients who underwent vascular access surgery and hemodialysis at KHMC from 2000 to 2004, 106 patients with AVF were enrolled. The rate of early access failure of AVF was evaluated. Histories of DM, hypertension, cardiovascular disease, and ipsilateral central venous catheterization, medication and laboratory findings were investigated through the medical records, retrospectively and statistically analyzed. RESULTS: The rate of early access failure of AVF was 21.3%, higher than that of AV grafts. The number of patients older than 50 years of age was greater in early access failure group. Early access failure group showed higher incidence of cardiovascular disease. Early access failure group showed higher incidence of ipsilateral central venous catheterization. Early access failure group also showed higher level of hemoglobin and hematocrit. Logistic regression analysis showed that higher hemoglobin and history of ipsilateral central venous catheterization are independent risk factors for early access failure of AVF. CONCLUSION: Older age at the time of surgery, history of ipsilateral central venous catheterization or cardiovascular disease and higher level of hemoglobin were associated with early access failure of AVF. History of ipsilateral central venous catheterization and higher level of hemoglobin are independent risk factors.