Comparison Among Different Types Of Vascular Access For Maintaining Hemodialysis

Objective To compare 3 types of vascular acess for maintaining hemodialysis——central venous catheters (CVC), arteriovenous fistula(AVF) and arteriovenous fistula(AVG) on their primary patency, secondary petancy and infection incedence.Methods Data were analyzed from inpatients with end-stage renal disease. They received CVC catheterization or AVF/AVG formation in Department of Nephrology, Sir Run Run Shaw Hospital, and had long-term follow-up records. Brands of CVC included Bard and Quinton. Then compare them on primary patency, secondary petancy and infection incidence(blood infection) by statistical method such as T test, Chi-square test, life table and Kaplan-Meier estimator.Result A total of 147 cases were included:64 CVC,68 AVF,64 AVG, no significant statistical difference among their age. DM proportion were:CVC 45.3%, AVF 27.9%, AVG 42.2%. Data of secondary petancy of some patients were lost as they were out of follow-up. On primary patency, up to 6 months,12 months,24 months and 36 months, CVC were 67%,50%,19%,2%; AVF were 54%,28%,10%,3%; AVG were 36%,17%,6%,2%; AVF with DM were 42%,26%,5%,0%; AVF without DM were 59%,29%,12%,4%。On secondary patency, up to 6 months, 12 months,24 months and 36 months, CVC were 67%,50%,19%,2%; AVF were 72%,38%,14%,6%; AVG were 93%,70%,39%,14%; AVF with DM were 50%, 33%,0%,0%; AVF without DM were:89%,37%,26%,16%. On infection incidence(/patient*year), CVC were 0.0067, AVF were 0.0024, AVG were 0.0041.Conclusion In these nearly 200 cases, Primary patency:CVC were higher than AVF and AVG, AVF were higher than AVG(P<0.05). Secondary petancy:AVG were higher than AVF and CVC. Secondary petancy was higher than primary patency on either AVF or AVG. (P<0.05, Chi-square test).On infection incidence, CVC were higher than AVF amd AVG, AVG were higher than AVF. DM would obviously reduce both Primary patency and Secondary petancy in patients with AVF. IF a patient wanted to creat a chronic hemodialysis acess, we suggest that AVF should be the first choice. If vessel condition were poor, AVG should be a good choice. CVC should be avoid as far as possible.