Multicenter Investigation of the Initial Hemodialysis Vascular Access and Its Related Factors in Hangzhou of China

Abstract

Objective. To investigate the initial hemodialysis vascular access in Hangzhou and provide evidence for improving the use of autologous arteriovenous fistula by identifying factors associated with the choice of initial vascular access. Methods. We retrospectively studied the initial hemodialysis vascular access of 257 patients in five hemodialysis units in Hangzhou of China during a 21-month period (January 2018 to September 2019). A logistic regression was used to identify the risk factors of failing to use an arteriovenous fistula at the initiation of hemodialysis. Results. (1) 257 participants with mean age $67.65\pm 13.43$ years old were reviewed, including 165 males (64.2%) and 92 females (35.8%). The etiologies of end-stage renal disease included diabetic nephropathy (37.35%), chronic glomerulonephritis (31.13%), hypertensive nephropathy (14.01%), and other diseases (17.51%). Only 51 patients (19.84%) received arteriovenous fistula, whereas the remaining 206 patients (80.16%) initiated dialysis with a central venous catheter. (2) Logistic regression analysis revealed that the independent risk factors for central venous catheter at the initial hemodialysis were age >70 years old ( $\text{OR}=4.827$ , $p<0.01$ versus ≤70 years old), chronic glomerulonephritis as the primary etiology ( $\text{OR}=2.565$ , $p<0.05$ versus nonchronic glomerulonephritis) and eGFR <8.5 mL/min/1.73m2 ( $\text{OR}=2.283$ , $p<0.05$ versus eGFR ≥8.5 mL/min/1.73m2). Conclusion. The proportion of patients using arteriovenous fistula as the initial hemodialysis vascular access in Hangzhou was still low. The choice of vascular access for the first hemodialysis was related to age, eGFR, and the primary etiology of end-stage renal disease. Increasing the proportion of planned vascular access and arteriovenous fistula at the initiation of hemodialysis is still our current goal.