The difference of complications and overall survival according to the types of vascular access in hemodialysis

Kim, Hyun Jee; Kim, Sang Hyun; Park, Won Do

Abstract

BACKGROUND: The vascular access in hemodialysis is the most important procedure, so has been developed to many methods. In other countries, some centers were reported for vascular access in hemodialysis, but few studies in Korea. This review has researched the difference of complications and overall survival according to the type of vascular asccess in hemodialysis, and compared with other reports.
METHODS
A total 157 patients (M:F=88:69) who newly underwent hemodialysis with vascular catheter insertion in Sanggye Paik hospital were enrolled into this study by review of hemodialysis database. We analyzed indication, site and numbers of catheter insertion, reason for removal of catheter, hemodialysis duration with catheter and complications based on the route of vascular access. We performed the survival analysis for the disease, gender and the methods of access according to type of catheter.
RESULTS
The mean patient age was 58.3 +/- 10.5 years and 83.4% of patients received the catheter insertion for renal replacement therapy in end stage renal disease (ESRD). The site and duration of catheter insertion for internal jugular vein were 76.9% and 26.3 +/- 7.3 days, for subclavian vein were 8.9% and 38.0 +/- 12.6 days and for femoral vein were 6.1% and 8.7 +/- 3.2 days. The duration of tunneled cuffed catheter was 237.0 +/- 103.2 days. The most common indication of removal was obtaining permanent vascular access route such as arteriovenous fistula or vascular graft anastomosis (70.8%). Complications related to catheter insertion included infection, catheter occlusion and hemorrhage. The infection occurred in 30 of 213 catheter insertion (14.1%). The infection occurred in 84.6% of patients with femoral catheter, 42.1% of subclavian catheter and 6.7% of internal jugular catheter. The most common site of catheter occlusion was subclavian vein in 15.8%, femoral vein in 7.7% and jugular vein in 2.4%. The most common organism was MRSA, cultured 30.0% in tip and blood. And reinsetion for reinfected cases, MRSA was also most common cause of infection growed 42.8% in tip culture. The survival analysis according to access revealed the jugular access was excellent method for complications and overall survival. No significant difference between diabetes and non-diabetes patients in internal jugular catheter (p=0.042). The subclavian catheter significantly higher survival rate of non-diabetes patients (p=0.036). In femoral catheter, diabetes patients showed higher survival rate (p=0.029). In internal jugular and femoral catheter, survival rate between gender was not significantly different (p=0.200). The survival rate of female was significantly higher than male in subclavian catheter (p=0.037).
CONCLUSION
This study revealed internal jugular approach is safe and popular access in according to complications and overall survival. No difference of survival rate was demonstrated between diabetics and non-diabetics in internal jugular catheter. In subclavian catheter, the survival rate was higher in non-diabetics than diabetics and female than male. Incidence of complication was associated with duration of indwelling and the type of vacular access.