E. S. Lee1,2, K. C. Chun1, T. Yenumula1, A. S. Schmidt1, K. M. Samadzadeh1, A. Rona1, A. Gonzalves1, M. D. Wilson3, R. E. Noll1,2, E. S. Lee1,2 1VA Northern California Health Care System,Surgery,Mather, CA, USA 2University Of California, Davis,Surgery,Sacramento, CA, USA 3University Of California, Davis,Department Of Public Health Sciences, Division Of Biostatistics,Sacramento, CA, USA
Introduction: End-stage renal disease (ESRD) patients face an unknown number of dialysis access interventions (DAI) that could occur throughout their lifetime on dialysis. The purpose of this study is to determine the frequency of DAI per year while on dialysis to better inform prospective dialysis patients.
Methods: A retrospective chart review of ESRD patients on dialysis for a minimum of 1 year was conducted at a large regional medical center. The frequency of DAI per year was the primary outcome measure. An intervention is defined as any procedure (fistulogram, catheter placement, or new access) done to regain dialysis access for the patient. Average days between interventions is determined by time between first dialysis access until date of death or end of study analysis (Dec. 31, 2015), divided by total number of interventions. The primary outcome was then evaluated with other patient factors such as initial access type (catheter, fistula, or graft), time between DAI, time on dialysis, age, hypertension, diabetes, smoking, cholesterol, triglycerides, statin use, blood thinner use, body mass index, coronary artery disease, peripheral vascular disease, chronic obstructive pulmonary disease, and stroke. A general linear model (GLM) was fit to test for associations between the measured variables and average days between interventions. The Tukey correction for multiple comparisons was used to compare across groups in variables significant from GLM.
Results: A total of 166 patients (mean ± standard deviation; 67.2 ± 10.3 years) were analyzed from 1991 to 2015 in this study. The patients are comprised of 54.2% (n=90) white, 37.4% (n=62) African American, and 8.4% other. Patients averaged 1.4 ± 1.4 DAI per year (7.2 ± 8.5 DAI total, range: 1 to 37 DAI) within an average follow up length of 5.6 ± 3.8 years while on dialysis. The average days between interventions based upon initial access type were: catheter (n=86) 475 ± 359.8 days, graft (n=16) 516.1 ± 448.5 days, and fistula (n=64) 546.8 ± 595.5 days (Table).
Conclusion: ESRD patients can expect 1 to 2 interventions per year to maintain dialysis access, regardless of initial dialysis access type. Although not statistically different, longer days between interventions can be expected with the fistula versus other access types and that the average life expectancy after starting dialysis is 5 to 6 years.
