Vascular access route venture of the chronic hemodialysis patient: A prospective cohort study

Abstract

Objectives This study aimed to collect evidence to improve the arteriovenous fistula practice by investigating vascular access routes and by identifying the factors influencing the preferred types of vascular access routes for the first-time hemodialysis in our center. Methods We performed an epidemiological, prospective, cohort study. The study included 308 patients, who underwent hemodialysis for the first time between March 2023 and August 2023 in our hemodialysis center. We evaluated biochemical parameters, preferred vascular access routes for the first-time hemodialysis, planned/emergency hemodialysis status, the qualifications of the healthcare provider, who inserted the central venous catheter, if applicable, the presence of hypervolemia, anticoagulant use, nephrology follow-up findings, and in-hospital mortality in all patients and in those, who continued with chronic hemodialysis. Results The number of patients, who continued with chronic hemodialysis, was 167 (54.2%) and a temporary internal jugular central venous catheter was the most commonly preferred vascular access route for the first-time hemodialysis (47.3%). A central venous catheter was most commonly inserted by a nephrologist (53.7%) in chronic hemodialysis patients. Of the patients continuing with chronic hemodialysis, 45.5% were followed up in the nephrology outpatient clinic, 9.6% initiated hemodialysis on a planned basis, and 8.4% initiated hemodialysis with an arteriovenous fistula. A temporary internal jugular central venous catheter was commonly preferred when patients were followed up in the nephrology clinic and when the insertion was performed by a nephrologist; a transient femoral central venous catheter was commonly preferred in case of hypervolemia ( p < .001, p < .001, and p = .028, respectively). Age, gender, etiology, anticoagulant use, or biochemical test results did not act on the selection of the access site for the insertion of central venous catheter at the time of the first hemodialysis treatment. The access site for central venous catheter was not associated with in-hospital mortality ( p = .644). In the overall patient group, the in-hospital mortality was significantly low in patients followed up in the nephrology clinic ( p = .014). Conclusion The use of pre-emptive arteriovenous fistula for the first hemodialysis treatment occurs much less commonly than expected. Hemodialysis initiation rates with pre-emptive arteriovenous fistula lag behind nephrology outpatient follow-up rates.