Vascular Access Preferences in Patients Undergoing Emergency Hemodialysis: A Single Center Experience

Öz

Objective: Hemodialysis (HD) is a life-saving treatment modality in uremic patients. In many countries, including Turkey, a central venous catheter is preferred at the beginning of hemodialysis. A suitable vascular access method for an effective and adequate HD is one of the most important components in the treatment of hemodialysis patients. In this study, a single center's experience of vascular access for HD has been examined.
Materials and Methods: Patients who underwent hemodialysis for various indications between January 2016 and June 2018 in the center chosen as the location of the study were retrospectively scanned. Demographic characteristics of the patients, indications for HD admission, vascular access method, and the specialty of the clinician who applied the vascular access method have been recorded.
Results: HD treatment was applied to a total of 429 (female/male:178/251) cases over a 30-month period. The mean age of the patients was 66.8±32.3. It was determined that 27.04% of the cases were taken to HD due to acute kidney injury and poisoning, 72.96% of them due to chronic kidney disease and related complications. Arteriovenous fistula (AVF) in 3.96% of the patients and it was observed HD procedure was performed with a catheter in 96.04% of them. Temporary vascular access preferences were 66.9% femoral catheter, 25.6% jugular catheter, and 3.49% subclavian catheter. It was observed that the jugular catheter preference increased gradually compared to the first months of the study and was mostly preferred by the nephrology specialist (n:67 cases 60.90%).
Conclusion: The results obtained in this study were found to be different from the vascular access methods recommended in the literature. It was seen that the nephrology specialist played an important role in the decision of the preferred methods. Providing the necessary awareness for the correct selection of the vital vascular access route in hemodialysis patients will be one of the most important measures.

Anahtar Kelimeler

• Hemodialysis
• vascular access
• catheterization
• arteriovenous fistula

Acil Hemodiyaliz Uygulanan Hastalarda Vasküler Erişim Tercihleri: Tek Merkez Deneyimi / Vascular Access Preferences in Patients Undergoing Emergency Hemodialysis: A Single Center Experience

Öz

Amaç: Hemodiyaliz (HD) üremik hastalarda yaşam kurtarıcı bir tedavi modelidir. Türkiye dahil birçok ülkede hastalar hemodiyalize başlangıçta santral venöz kateter tercih edilir. Etkin ve

yeterli bir HD için uygun bir vasküler erişim yöntemi hemodiyaliz hastalarının tedavisinde en önemli bileşenlerinden biridir. Bu çalışmada tek bir merkezin HD için vasküler erişim
deneyimi incelenmiştir.
Gereç ve Yöntem: Araştırmanın yeri olarak seçilen merkezde Ocak 2016-Haziran 2018 tarihleri arasında çeşitli endikasyonlarla hemodiyalize alınan hastalar retrospektif olarak tarandı.
Hastaların demografik özellikleri, HD’ye alınma endikasyonları,vasküler erişim yöntemi ve vasküler erişim yöntemini uygulayan klinisyenin uzmanlık alanı kaydedildi.
Bulgular: 30 aylık sürede toplam 429 (kadın/erkek:178/251) olguya HD tedavisi uygulandı. Hastaların yaş ortalaması 66,8±32,3 idi. Olguların %27,04’ünün akut böbrek hasarı ve
zehirlenmeler nedeniyle, %72,96’sının kronik böbrek hastalığı ve ilişkili komplikasyonlar nedeniyle HD’e alındıkları saptandı.Hastaların %3,96’sında arteriyovenöz fistül (AVF),
%96,04’ünde kateter ile HD işlemi gerçekleştiği görüldü. Geçici vasküler erişim tercihleri %66,9 femoral kateter, %25,6 juguler kateter ve %3,49 subklaviyen kateter oranlarında idi. Juguler
kateter tercihinin çalışmanın ilk aylarına göre tedricen artış gösterdiği ve çoğunlukla (n:67 olgu %60,90) nefroloji uzmanı tarafından tercih edildiği görüldü.
Sonuç: Bu çalışmada elde edilen sonuçların; literatürde önerilen vasküler erişim yöntemlerinden farklı olduğu saptanmıştır. Tercih edilen yöntemlerin kararının verilmesinde nefroloji
uzmanının önemli rol oynadığı görüldü. Hemodiyaliz hastalarında yaşamsal önem taşıyan vasküler erişim yolunun doğru seçilmesi için gerekli farkındalığın sağlanması en önemli
önlemlerden olacaktır.

Anahtar Kelimeler

• Arteriyovenöz fistül
• Hemodiyaliz
• Vasküler erişim
• Kateterizasyon

Kaynakça

1. 1. Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, Allon M, Asif A, Astor BC, Glickman MH, Graham J, Moist LM, Rajan DK, Roberts C, Vachharajani TJ, Valentini RP; National Kidney Foundation. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020 Apr;75(4 Suppl 2):S1-S164.
2. 2. Allon M. Vascular Access for Hemodialysis Patients: New Data Should Guide Decision Making. Clin J Am Soc Nephrol. 2019 Jun 7;14(6):954-61.
3. 3. Hayashi R, Huang E, Nissenson AR. Vascular Access for hemodialysis. Nat Clin Pract Nephrol. 2006;2(9):504-13.
4. 4. Woo K, Lok CE. New insights into dialysis vascular access: What is the optimal vascular access type and timing of access creation in CKD and dialysis patients? Clin J Am Soc Nephrol. 2016 ;11(8):1487-94.
5. 5. Sequeira A, Naljayan M, Vachharajani TJ. Vascular access guidelines: summary, rationale, and controversies. Tech Vasc Interv Radiol. 2017;20(1):2-8.
6. 6. Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089-100.
7. 7. Süleymanlar G, Utaş C, Arınsoy T, et al. A population based survey of chronic renal disease in Turkey - The CREDIT study. Nephrol Dial Transplant 2011; 26: 1862-71.
8. 8. Süleymanlar G, Ateş K, Seyahi N. Türkiye’de Nefroloji, Diyaliz ve Transplantasyon – Registry 2019. Türk Nefroloji Derneği Yayınları, Ankara, 2020. ISBN 978-605–62465–0–0.

9. 9. Tordoir J, Canaud B, Haage P, et al: European best practice guidelines on haemodialysis (EBPG) on Vascular Access. Nephrol Dial Transplant 2007; 22 [Suppl 2]:ii88-117.
10. 10. Ravani P, Gillespie BW, Quinn RR, et al. Temporal risk profile for infectious and noninfectious complications of hemodialysis access. J Am Soc Nephrol. 2013; 24(10):1668-77.
11. 11. Aydın Z, Öztürk S. Gürsu M. Uzun S, Karadağ S, Tayfur F. Çoban T. Kazancıoğlu R. hemodiyaliz hastalarında damar giriş yolu olarak kateter kullanımı: Tek merkez deneyimi. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 2010;19(1):46-51.
12. 12. Al-Balas A, Lee T, Young CJ, Kepes JA, Barker-Finkel J, Allon M. The clinical and economic effect of vascular access selection in patients initiating hemodialysis with a catheter. J Am Soc Nephrol. 2017;28(12):3679-87.
13. 13. Rayner HC, Besarab A, Brown WW, Disney A, Saito A, Pisoni RL:Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): Performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines. Am J Kidney Dis 2004; 44: 22–6.
14. 14. Miguel SS, Chow J. Vascular dialysis Access flow measurement: early intervention through early detection. J Ren Care 2009;35(4):185-91.
15. 15. Kelly YP, Mendu ML. Vascular access for renal replacement therapy in acute kidney injury: Are nontunneled catheters the right choice? Semin Dial. 2019;32(5):406-10.
16. 16. Coryell L, Lott JP, Stavropoulos SW, et al. The case for primary placement of tunneled hemodialysis catheters in acute kidney injury. J Vasc Interv Radiol. 2009;20(12):1578-81.
17. 17. Ozmen S, Kadiroglu AK, Ozmen CA, Danis R, Sit D, Akin D, Yilmaz ME. Does the direction of arterial needle in AV fistula cannulation affect dialysis adequacy? Clin Nephrol. 2008;70(3):229-32.
18. 18. Harwood L, Wilson B, Goodman M. Cannulation outcomes of the arteriovenous fistula for hemodialysis: A Scoping review. Nephrol Nurs J. 2017;44(5):411-25.
19. 19. Wilson B, Harwood L. Outcomes for successful cannulation of the arteriovenous fistula: perspectives from patients on hemodialysis. Nephrol Nurs J. 2017;44(5):381-8.
20. 20. Allon M, Brouwer-Maier DJ, Abreo K, et al. Recommended clinical trial end points for dialysis catheters. Clin J Am Soc Nephrol. 2018;13(3):495-500.
21. 21. Almasri J, Alsawas M, Mainou M, et al. Outcomes of vascular access for hemodialysis: A systematic review and meta-analysis. J Vasc Surg. 2016;64(1):236-43.
22. 22. Ravani P, Quinn R, Oliver M, et al. Examining the association between hemodialysis access type and mortality: The role of access complications. Clin J Am Soc Nephrol. 2017;12(6):955-64.
23. 23. Murea M, Geary RL, Davis RP, Moossavi S. Vascular access for hemodialysis: A perpetual challenge. Semin Dial. 2019;32(6):527-34.