Outcomes of Temporary Vascular Access and Factors Influencing Delayed Arteriovenous Fistula Creation

Abstract

Introduction: Haemodialysis is Malaysia's main modality of kidney replacement therapy (KRT) for end-stage kidney disease patients. However, most of the patients needed for long-term KRT are initiated with intermittent haemodialysis via a central venous catheter before placement of an arteriovenous fistula (AVF) or arteriovenous graft (AVG). Objectives: This study aimed to identify types of vascular access among incident end-stage kidney disease patients on intermittent haemodialysis and to determine the proportion of vascular access-related complications. We also aimed to study the factors that contributed to the delay in AVF creation at our institution. Methods: This is a single-centre, retrospective study of CKD stage 5 patients who were initiated on intermittent haemodialysis between 1st January 2021 and 31st December 2021. Data were collected from the medical record unit of Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan. Demographic data, comorbidities, catheter-related complications, factors associated with mortality, and delayed AVF creation were analyzed using SPSS version 27. The association between types of a catheter with complication were analyzed by chi-square test. A P-value of less than 0.05 was considered statistically significant.Results: A total of 74 patients started on intermittent haemodialysis were identified. Of these, males were 52.7 %, and females were 47.3 %. Most patients were of Malay ethnicity, with a mean age of 55 years old. Most of them have comorbidities of hypertension 95.9%, diabetes 79.7% and ischemic heart diseases 23%. Majority of them were initiated on haemodialysis with an uncuffed femoral catheter, 93.2% and later, changed to the uncuffed internal jugular catheter, 71.6%. The highest complication seen was central line-associated bloodstream infections (CLABSI) (17.6%), followed by hematoma (8.5%). There was no significant association between the types of haemodialysis catheters used with their complications. The delay in AVF creation was due to patient’s fear (36.2%) and small venous access (34%). A total of 18 patients died during this study period of which 6 were due to catheter-related complications.Conclusion: This study highlights complications associated with intermittent haemodialysis via CVC, mostly with bleeding and infections. The leading cause of mortality in this study is CLABSI. Practical concerns and fear contribute to delays in AVF creation. Early creation of arteriovenous fistula in pre-dialysis patients is vital in improving the outcomes of the patients.