Vascular Access Outcomes among Patients on Maintenance Hemodialysis in Perpetual Succour Hospital: A 3-Year Cross-Sectional Analysis

Background: Vascular access is the key in successful management of chronic hemodialysis (HD) patients. Though native arteriovenous fistula (AVF) is considered the access of choice, many patients in our country initiate HD through central venous catheter (CVC). The ideal vascular access should have specific characteristics among which the most important are the following: ease of placement; delivery of adequate blood flow for effective HD; good primary patency rates; low rates of complications; long-lasting life; and low economic costs. Hence, successful HD depends on creation and maintenance of adequate vascular access. Methods: This is a single center, cross-sectional study of ESRD patients on maintenance hemodialysis enrolled in Perpetual Succour Hospital Hemodialysis Unit from April 1, 2021, to November 30, 2023. Results: There were 260 hemodialysis patients included, with successful vascular access outcome (73.13%) and were younger (57.2 ± 14.1). Those with failed vascular access were females (54.2%), unemployed (61.4%) and had diabetes mellitus (DM) (50.6%) as the primary etiology of their ESRD. Those with failed vascular access were hypertensive (86.7%), with concomitant CAD, MI (57.8%) and DM (56.6%). Proportion of those with failed and successful vascular access significantly differ among hypertensives (p=0.012), diabetics (p=0.039) , with chronic glomerulonephritis (p=0.011) , and among those with malignancy (p=0.003). And the association of clinical outcomes (death or not) and failure or success of vascular access is statistically significant, p= <0.001. Conclusion: Our study showed that failed vascular access were more associated with female gender, DM as the primary etiology of ESRD and with other co-morbid conditions such as hypertension and CAD or MI. Successful vascular outcome were among those of younger age group compared to those whose vascular access failed, probably due to better vascular condition and fewer co-morbidities. Lastly, 87% of patients on AVF were alive however, most of those who died also had AVF (59.1%) and CVC (36.4%), and proportion of those who were alive and dead with different vascular access significantly differ , p<0.001.