Association of clinic vascular access monitoring practices with clinical outcomes in hemodialysis patients

Laura C. Plantinga, Bernard G. Jaar, Brad Astor, Nancy E. Fink, Joseph A. Eustace, Michael J. Klag, Neil R. Powe

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Early identification of access dysfunctions may be associated with improved patient outcomes. We examined whether patient outcomes were associated with vascular access monitoring practices in an incident dialysis cohort. Methods: We conducted a national prospective cohort study and analyzed 363 hemodialysis patients who had a first permanent vascular access (arteriovenous fistula or graft) by 6 months after the start of dialysis. Multivariate methods were used to examine associations between monitoring practices and 6-month Kt/V (reaching Kt/V ≥1.2), access intervention, access failure, and 2-year septicemia and all-cause hospitalization and mortality. Results: Patients who received monitoring weekly or more often (49%) were more likely to have an access intervention (adjusted RH = 1.40, 95% CI, 1.07-1.84) than those who received monitoring less frequently. Additionally, patients treated at clinics that reported performing regular access monitoring (80% of patients) were less likely to be hospitalized for septicemia (IRR = 0.35, 95% CI, 0.21-0.61) or for any cause (IRR = 0.77, 95% CI, 0.60-0.99). There were no statistically significant differences between patients exposed to different vascular access monitoring practices in access failure, achievement of Kt/V, or survival. Conclusion: Frequent monitoring of dialysis access may initially increase the number of interventions but is beneficial to longer-term outcomes, including septicemia-related and all-cause hospitalization.

Original languageEnglish (US)
Pages (from-to)c151-c159
JournalNephron - Clinical Practice
Volume104
Issue number4
DOIs
StatePublished - Nov 2006

Keywords

  • Hospitalization
  • Mortality
  • Septicemia
  • Vascular access patency
  • Vascular access surveillance

ASJC Scopus subject areas

  • Nephrology

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