Survival of vascular access in daily dialysis (DHD)

One of the most feared problems in DHD is the risk of vascular access failure, so that it often limits the diffusion of this technique. Available data are limited; moreover, in most cases data regard home hemodialysis (HHD) patients, with the problem of the risk of a selection bias. The aim of the study was to evaluate the number of fistula complications (occlusion, infections, necessity of surgical treatment, angioplasty or urokinasi) in two groups of patients either on a DHD or on other dialysis schedules, in patients at home or in Limited Care Center. In the period considered (total period about 1500 patient-months; HHD: non DHD 463, DHD 278 months; Limited Care Center: non DHD 613, DHD 140 months) we registered 37 events (12 with vascular access occlusion, 11 with necessity of surgical treatment, 14 with necessity of other intervention, angioplasty or urokinasi). In particular, we registered 23 events in HHD (18 non DHD, 6 with vascular access occlusion and 5 DHD, 3 with vascular access occlusion, respectively 4/100 and 2/100 patient-months), 14 events in Limited Care Center (8 non DHD, none with vascular access failure and 6 DHD, 3 with vascular access failure, respectively 1/100 and 4/100 patient-months). Survival curves according to Kaplan-Meier didn’t show significant differences for DHD group; a worse survival was shown for HHD patients. In a Cox-proportional hazard model history of previous vascular episodes and HHD were independent risk factors (RR 2.01, 95% CI 1.06–3.83 and RR 1.98, 95% CI 1.15–3.39 respectively; overall score 0.04), while a protective role for male sex was present (RR 0.54, 95% CI 0.30–0.96). In conclusion: The increased number of punctures in DHD didn’t cause, in our study, an increase in the risk of vascular access occlusion. The surprise was the disadvantage of HHD compared to dialysis in Limited Care Center, contrary to all expectations. Results from this observational study will be study in depth (relationship with previous vascular problems, hypotension, body weight loss, biochemical risk factors, dialysis efficiency) and for a more prolonged period.