Impact of Vascular Access Type on Inflammatory Biomarkers and Clinical Outcomes in Haemodialysis Patients

Abstract

Introduction: The majority of dialysis patients have chronic low-grade inflammation linked to protein energy waste, early CVD,   steoporosis, and overall weakness. To minimize the risk of infections and complications, guidelines advocate for the use of  arteriovenous fistulas (AVFs) whenever possible, as central venous catheters (CVCs) pose a greater risk for these issues.

Objective: This  study aimed to assess the impact of various hemodialysis vascular access types on the occurrence and characteristics of infections  experienced by hemodialysis patients.

Patients and Methods: This prospective cohort study was conducted in Ain Shams University  Hospitals, Hemodialysis Units over 6 months duration.

Results: We found that the average age of the patients was 49.5 ± 8.4 years and  the average duration of hemodialysis (HD) was 3.2 ± 1.9 years. The proportion of males and females was nearly equal (46.0% and 54.0%  respectively). Patients from El-Demerdash and ASHUSH accounted for 60.3% and 39.7% of the cases, respectively. Catheter types included  temporary catheters (49.2%), AVFs (31.7%), and AVGs (19.0%). We noticed that less than one-fifth of cases had leucocytosis and  elevated procalcitonin in months 2 and 3. Leucocytosis and elevated procalcitonin in months 2 and 3 were most frequent in temporary  catheters, followed by AVGs, and least frequent in AVFs.

Conclusion: The use of temporary catheters was linked to a higher incidence of  infections. Infection episodes were accompanied by elevated inflammatory markers, a higher likelihood of catheter removal, an increased  risk of thrombosis, and more frequent hospital admissions.