The Prognosis of Maintenance Hemodialysis Patients With Various Types of Vascular Access in Hemodialysis Centers in Wuhan: A Retrospective Cohort Study.

Abstract

Objective: The relationship between different types of vascular access in maintenance hemodialysis (MHD) patients and patient prognosis is controversial. The vascular access of patients from various dialysis centers in Wuhan was summarized, and its relationship with prognosis was analyzed. Methods: The characteristics of MHD patients treated at 70 dialysis centers in the Wuhan Hemodialysis Quality Control System from 2017 to 2023 were collected. The demographic characteristics, laboratory indicators, compliance rates with laboratory indicators, annual mortality changes, survival time, and risk of death were compared in patients with various types of vascular access. Results: A total of 45,830 MHD patients were included in the study. Overall, arteriovenous fistulas (AVFs) and tunneled and cuffed catheters (TCCs) remain the most common types of vascular access. Non-tunneled and cuffed catheters (NCC) use decreases annually, whereas arteriovenous graft (AVG) use increases annually. Male patients mostly had AVFs. The vascular access types of patients with diabetic nephropathy were mainly TCCs (28.6%) and AVGs (29.4%). AVG patients had the highest average hemoglobin level. NCC patients had the lowest average hemoglobin, albumin, and potassium levels. AVF patients had the highest average albumin, potassium, calcium, phosphorus, and parathyroid hormone levels. TCC patients had the lowest calcium and phosphorus levels. From 2017 to 2023, the mortality rates of AVF, TCC, and AVG patients were significantly higher in 2022 (11%, 19.9%, and 11.7%, respectively). The median survival time of AVF patients was 4.92 (2.75, 7.75) years, which was significantly longer than that of TCC patients (2.83 [1.42, 4.92]) and NCC patients (1.00 [0.25, 2.25]). After multivariate adjustment, the risk of death in patients with internal fistulas was 50.6% lower than that in patients with catheters, according to the Cox regression analysis model (hazard ratio = 0.494, 95% CI: 0.439-0.556, p < 0.001). Conclusions: Among MHD patients with different vascular access types who were treated in Wuhan from 2017 to 2023, the numbers of AVF, AVG, and TCC patients increased with increasing overall number of MHD patients, whereas the number of NCC patients decreased. The overall condition and survival time of AVF patients were significantly better than those of MHD patients with other vascular access types, and the risk of death was lower.