Effects Of Vascular Access On Early Death In ESRD Hemodialysis Patients

Objective Through the retrospective analysis of the patient’s demographic characteristics,epidemiological characteristics,deaths,vascular access types and its associated risk factors to provide scientific basis for selecting the best vascular access,preventing and controlling the risk factors of early death associated with vascular access and reducing the early mortality of MHD patients.Method The study retrospectively analysis reviewed the data of end-stage renal disease(ESRD)maintenance hemodialysis patients registered in the dialysis in Zhejiang Dialysis Quality Control Center from January 1,2012 to December 31,2017.RSULTS 1.A total of 31,494 patients with end-stage renal disease(ESRD)who started hemodialysis between January 1,2012 and December 31,2017 in Zhejiang were selected,among which 4912(15.6%)cases were died.The mortality rate of the four survival periods(0~3 months,4~6 months,7~9 months,>12months)were 15.8per 100 patient-years,5.6 per 100 patient-years,4.5 per 100 patient-years,and 4.7 per100 patient-years.The demographic and epidemiological characteristics of MHD patients with different vascular accesses in different survival periods are as follows:(1)The gender composition generally shows a trend that males are significantly higher than females;(2)The study give priority aged 45 and above,with a highest proportion of 45-64 age group;(3)The top primary disease was diabetic nephropathy,followed by chronic glomerulonephritis,hypertensive nephropathy and polycystic Kidney,but the proportion of other and unknown was considerable;(4)The top complication was cardiovascular disease,followed by diabetes,cerebrovascular disease and tumor.2.The gender,age,primary disease,and comorbidities of MHD early death patients in different vascular pathways were different.Compared with AVF access group,the gender and age of TCC access group were significantly different(P<0.01)and the age and proportion of cardiovascular disease of UTC were also different(P<0.01).The NTC access group were significantly different from AVF access group in age and the proportion of cardiovascular disease(P<0.01).In the proportion of cardiovascular disease,the UTC access group was statistically different from the TTC group(P<0.01).3.The top three causes of death in early death MHD patients were cardiovascular disease(211,25.39%),systemic failure(202,24.31%),and cerebrovascular disease.(115,3.84%).The top three causes of death in the AVF access group were cerebrovascular events(24.8%),systemic failure(19.8%),and cardiovascular events(17.8%).The top three causes of death in the TCC access group were cardiovascular events(27.0%),systemic failure(23.6%),and cerebrovascular events(15.4%).The top three causes of death in the UTC access group were cardiovascular events(26.7%),systemic failure(24.5%),and tumors(10.2%).The top three causes of death in the other and unexplained groups were systemic failure(35.3%),cardiovascular disease(21.6%),and cerebrovascular disease(17.6%).The chi-square test showed a statistically significant difference in the cause of death in the access groups(X ~2=39.443,P<0.01).The first month survival rate for AVF(autologous arteriovenous fistula),TCC(Tunneled cuffed catheter)and NTC(non-tunneled cuffed catheter)access group were(92.8±0.3)%,(83.9±0.4)%and(44.7±0.6)%.The second month survival rate for AVF,TCC and NTC access group were(90.3±0.3)%,(78.5±0.5)%and (38.0±0.6)%.The third month survival rate for AVF,TCC and NTC access group were(88.3±0.3)%,(74.1±0.5)%and(33.9±0.6)%.The difference in cumulative survival rates between the access groups was statistically significant(Log-rank test X ~2=5989.667,P﹤0.01).4.There were differences in serum albumin,hemoglobin,total white blood cell count,serum phosphorus,PTH,CRP and fasting blood glucose levels among different vascular pathways,among which the CRP in the AVF access group was lower than that in UTC group(P<0.01);the serum albumin,hemoglobin of AVF access group were higher than the UTC access group.In contrast,the white blood cells and CRP in the AVF group were significantly lower than those in the UTC access group(P<0.01).Compared to the TCC access group,the white blood cells and CRP was lower in the UTC access group(P<0.01).The blood glucose level in the UTC access group was higher than in the access group of other and unknown(P<0.01).5.We compared survival period(0~3months)with the period(>12 months),finding that the comorbidity of cardiovascular disease was a risk factor(OR=1.37,95%CI=1.136~1.652,P<0.01);with AVF access group as reference,TCC access(OR=2.900,95%CI=2.262~3.717,P=0.000),UTC access(OR=24.537,95%CI=18.906~31.844,P<0.01)and the access of other and unknown(OR=2.437,95)%CI=1.69~3.514,P<0.01)are risk factors.Conclusion The mortality rate of the four survival periods(0~3 months,4~6 months,7~9 months,>12months)were 15.8 per 100 patient-years,5.6 per 100 patient-years,4.5 per 100 patient-years,and 4.7 per 100 patient-years,among which the mortality of 0~3 months was the highest.The proportion of vascular access in MHD early death patients was sequential UTC,TCC and AVF,suggesting that the use of UTC is associated with early mortality of MHD patients.The complication of cardiovascular disease,TCC and UTC are independent risk factors for MHD early death patients.The risk of early death in the UTC is associated with higher infection than AVF access group,suggesting that the prevention of infection can reduce early mortality in MHD patients,especially the catheter-related infection.