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Outcomes of temporary vascular access and factors influencing delayed arteriovenous fistula creation among intermittent hemodialysis patients: a study in hospital Universiti Sains Malaysia, Kelantan

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Date
2023
Authors
Abdullah @ Mohd Baharudin, Abdul Hanan
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Introduction: Haemodialysis is the main modality of Renal Replacement Therapy (RRT) in Malaysia. However, most of the patients are initiated with intermittent haemodialysis via a central venous catheter as their main vascular access before placement of arteriovenous fistula (AVF) or graft (AVG). Objectives: This study aimed to identify types of vascular access among intermittent haemodialysis patients, and to determine the proportion of vascular access-related complications. We also aimed to study the factor that contributed to the delay of AVF creation at our institution. Methods: This is a single-centre retrospective, cross-sectional analysis of CKD stage 5 patients who were initiated on intermittent haemodialysis between 1 January 2021 and 31 December 2021. Data were collected from the medical record unit of Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan. Demographic data, comorbidities, catheterrelated complications, associated mortality, and factors of delayed AVF creation were analyzed using SPSS version 27. The association between types of a catheter with complication were analyzed by chi-square test. A P-value of less than 0.05 was considered statistically significant. Results: A total of 74 patients with intermittent haemodialysis were identified. Of these, males were 52.7 % and females were 47.3 %. Most patients were of Malay ethnicity with a mean age of 55 years old. Most of them have comorbidities of hypertension 95.9%, diabetes 79.7 % and ischemic heart diseases 23%. Most of them initiate haemodialysis with an Introduction: Haemodialysis is the main modality of Renal Replacement Therapy (RRT) in Malaysia. However, most of the patients are initiated with intermittent haemodialysis via a central venous catheter as their main vascular access before placement of arteriovenous fistula (AVF) or graft (AVG). Objectives: This study aimed to identify types of vascular access among intermittent haemodialysis patients, and to determine the proportion of vascular access-related complications. We also aimed to study the factor that contributed to the delay of AVF creation at our institution. Methods: This is a single-centre retrospective, cross-sectional analysis of CKD stage 5 patients who were initiated on intermittent haemodialysis between 1 January 2021 and 31 December 2021. Data were collected from the medical record unit of Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan. Demographic data, comorbidities, catheterrelated complications, associated mortality, and factors of delayed AVF creation were analyzed using SPSS version 27. The association between types of a catheter with complication were analyzed by chi-square test. A P-value of less than 0.05 was considered statistically significant. Results: A total of 74 patients with intermittent haemodialysis were identified. Of these, males were 52.7 % and females were 47.3 %. Most patients were of Malay ethnicity with a mean age of 55 years old. Most of them have comorbidities of hypertension 95.9%, diabetes 79.7 % and ischemic heart diseases 23%. Most of them initiate haemodialysis with an uncuffed femoral catheter, 93.2% and later, they change to the uncuffed internal jugular catheter 71.6%. The highest complication seen was central line-associated bloodstream infections (CLABSI) which were in 17.6% of patients, followed by hematoma in 8.5% of patients. We found no significant association between the types of haemodialysis catheters used with their complications. With regards to the delay in AVF creation, the majority of patients (36.2%) mention dialysis fear as their main concern, followed by small venous access, 34%. A total of 18 patients died during this study period. The major causes of death are due to CLABSI (5 patients) and sepsis-not related to catheter insertion (5 patients). Conclusion: In conclusion, the use of a haemodialysis central venous catheter among intermittent haemodialysis patients carries a significant risk for catheter-related complications, particularly infections and bleeding, with a risk of mortality. Early creation of arteriovenous fistula in pre-dialysis patients is vital in improving the outcomes of the patients.
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