Investigation Of Vascular Access In Maintenance Hemodialysis And Influence Factors

Background and Objective Successful implementation of hemodialysis relies on a good function of vascular access, and hence the precondition of hemodialysis is to establish the vascular access and to maintain its function. NKF/K‐DOQI guidelines(2006) recommend that the proportion of maintenance hemodialysis patients with long‐term central venous catheter should not be more than 10% and that with arteriovenous internal fistula should be more than 65%. In 2014, the consensus of Chinese VA experts pointed that AVF >80%, AVG >10% and TCC < 10%. At present domestic MHD patients using VA generally do not meet the above requirements, and there are even no specific clinical survey data. This study investigates the epidemiological features of 210 MHD patients in hemodialysis centers of the Third Affiliated Hospital in Anhui Medical University, such as age, gender, primary disease, medical insurance, vascular access etc., and specifically discusses the advantages and influence factors of AVF in the initial hemodialysis. This work aimes to increase the employment of AVF in the initial hemodialysis, to decrease VA complication, to promote dialysis treatment standardization and continuous quality improvement, which would be critical to formulate the corresponding prevention and control strategies in future medical practice, and at the same time, can also provide data to arrange the allocation of health resources for administrative department of public health more appropriately.Methods We investigated 210 MHD patients in the hemodialysis center of the Third Affiliated Hospital in Anhui Medical University in Hefei(2013). By using questionnaire, medical records and related information from Chinese national renal data system, we collected the information including general features, primary disease, HD frequency, HD mode, weekly HD time, ecomomic status, medical insurance, the vascular access options and the incidence of complications with AVF. The patients were assigned into two groups, i.e. the AVF and the temporary catheter, and the information of gender, age, primary disease, educational level, economic status, blood flow, long‐term complications and the service life of the AVF situation data education were compared. All data in the study were obtained by researcher via face‐to‐face communications, adopting a uniform interpretation of language, guide the patients to fill out the questionnaire. In this paper, SPSS19.0 software was used to input and analyse the data, and p<0.05 is a statistical difference.Results 1) General information: 210 cases of MHD patients: including 138 males(65.7%), 72 cases were female(34.3%), male, female ratio is about 23:12; the age ranged from 22 to 90 years old, the average age of(53.5±15.2). Among 20 ~ 29 years old in 9 cases(4.3%), 30 ~ 39 years old in 32 cases(15.2%), 40 ~ 49 years old in 45 cases(21.4%), 50 ~ 59 years old in 47 cases(22.4%), 60 ~ 69 years old in 34 cases(16.2%), 70 ~ 79 years old in 35 cases(16.7%) and ?80 years 8 cases(3.8%). Frequency of dialysis 3 times a week in 167 cases(79.5%), 2.5 times a week in 30 cases(14.3%), 2 times a week in 13 cases(6.2%). 4 ~ 4.5h per time.2) Composition of primary disease: 108 cases of primary glomerulonephritis(51.4%), 39 cases of diabetic kidney disease(18.6%), 33 cases of hypertensive nephropathy(15.7%), 15 cases of interstitial nephropathy(7.1%), 13 cases of autosomal dominant polycystic kidney disease(6.2%), 1 case of allergic purpura nephritis(0.5%), and 1 case of primary aldosteronism(0.5%).3) Medical insurance: in 210 MHD patients, there are 4 cases of provicial medical insurance(1.9%), 173 cases of city medical insurance(82.4%), 6 cases of medical residents(2.9%), 24 cases of new rural cooperative medical insurance(11.4%), 2 cases of free(1%), and 1 case of self payment(0.5%).4) Vascular access and initiate HD: 105 cases of femoral vein catheterthe(50.0%), 54 cases of AVF(25.7%), 48 cases of jugular vein catheter(22.9%) and 3 cases of arteriovenous puncture(1.4%). 202(96.2%) MHD patients used AVF and 8(3.8%) ones use TCC.5) Vascular access and blood flow: in patients with AVF, there are 81.1%(164/202) with the blood flow of 200 ~ 300ml/min, including 15.8%(32/202) of 200 ~ 250ml/min and 65.4%(132/202) of 300ml/min. Besides, there are 14.9%(30/202) of ?300ml/min, 3.0%(6/202) of 150~200ml/min, and 1.0%(2/202) of ?150ml/min.6) Vascular access and complication: there are totally 78 cases of AVF, accounting for the total number of 28.6% dialysis. These include 52(66.7%) cases of occurred thrombosis, 21(26.9%) cases of fistula stenosis, 4(5.1%) cases of aneurysm, 1(1.3%) case of hematoma, with no obvious bleeding or infection cases. TCC complications: 1 case of catheter infection and 1 case of catheter thrombosis.7) Vascular access and influence factors: The first HD using autologous AVF vascular complications reduced. Early establishment of AVF and the level of education, economic conditions are positively correlated, the difference was statistically significant(p<0.05). But there was no statistically difference associated with the patient’s gender, age, primary disease and blood flow of AVF.Conclusion AVF is the main VA of MHD patients(96.2%), but the proportion of the first HD with AVF(25.7%) is still lower than the proportion of the guide. The patients with preparation of AVF in advance were positively correlated with their cultural education level and economic status, had fewer long‐term complications than others. It is still a necessary but long‐term and arduous work to complete the CKD3,4 patients in mission and to establish AVF in advance.