Vascular access complications and risk factors in hemodialysis patients: A single center study

Abstract

Background: Morbidity related to vascular access is the leading cause of hospitalization for chronic hemodialysis patients and is associated with high cost. Since data on vascular access complications are scarce, this study was designed to focus on vascular access complications in hemodialysis patients.

Methods: 119 patients with End Stage Renal Disease (ESRD) on regular hemodialysis were recruited for the study, They were subjected to the following Laboratory blood tests: Kidney function tests, CBC, KT/V, serum albumin, fasting blood sugar, swab culture and sensitivity from the skin over the vascular access and blood culture and sensitivity from both central and peripheral samples, In addition, radiological Doppler ultrasound was done for all patients to evaluate the vascular access.

Results: 27 out of 119 patients (22%) have positive blood culture, 64 (53.7%) patients have positive swab culture, 68 (57%) patients have stenosis, 25 patients (21%) have athermanous plaques and 44 (36.9%) patients have aneurysmal dilatation. There was a significant low Kt/V in patients with stenosis and aneurysmal dilatation (p< 0.001). Low Kt/V, low serum albumin level and low BMI were significant in patients with central blood infection (p< 0.008, <0.008 and <0.001 respectively). There was significant increase in the risk of infection in male patients, patients with low BMI, increased BUN and increased duration of HD session (p< 0.046, <0.008, <0.002 and <0.009 respectively). Stenosis was the most common risk factor for vascular failure as it occurred in (29%) of patients. Diabetes was the second common risk factor for vascular failure as it occurred in (17%) of patients.

Conclusion: Stenosis and infection are the most common complications of the vascular access. DM is an important risk factor for the incidence of infection. Other risk factors for dialysis CRBSI include older age, low serum albumin, high BUN and decreasing the duration of dialysis.

Keywords: Vascular access; Hemodialysis; Complications