Association of Clinic Vascular Access Monitoring Practices with Clinical Outcomes in Hemodialysis Patients

Authors:
  • BABrad Astor
    Brad Astor
  • NFNancy E. Fink
    Nancy E. Fink
  • JEJoseph A. Eustace
    Joseph A. Eustace
  • MKMichael J. Klag
    Michael J. Klag
  • NPNeil R. Powe
    Neil R. Powe
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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.

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