Factors Associated with Hemodialysis Vascular Access Failure: A retrospective study in Colombia

Abstract

Introduction: Vascular access (VA) remains a major source of morbidity for hemodialysis patients (HD). Few data sources adequately capture longitudinal patency of the VA. This study aimed to evaluate VA failure and its related factors in HD patients. Methods: A retrospective cohort study of 985 incident hemodialysis patients treated in clinics of BRCS in Colombia, from January 1rst ,2016, until December 3 of the same year, was done. The cohort's enrollment was on day 1 of HD, and with follow-up for up to 15 months. Association among a group of independent variables and time to failure of the VA was performed, and adjusted by baseline variables using a Cox regression model. Results: A total of 985 patients were included in the study, requiring 1774 procedures of vascular access during follow-up. The mean age was 61 ± 15.6 years. At day 1, 15% were dialyzing with an arteriovenous fistula (AVF) or AVG; and at day 90, this proportion had increased to 70%.  The rate of vascular access procedure was 1.95 per patients-year, 95% CI 1.86-2.04. The rate of vascular access failure was 0.66 per patients-year, 95% CI 0.61–0.72. Risk factors for failure in AVF/AVG were age > 65 (p= 0.008), diabetes (p= 0.019), female sex (p= 0.002) rural housing (p<0.0001) and higher hemoglobin (p= 0.021). Conclusion: Vascular access failure and the requirement for procedures associated with it are frequent in the dialysis population. Several risk factors, some of them modifiable, are related to vascular access failure.