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Permanent vascular access has been called the “Achilles’ heel” of hemodialysis as it is used to carry out the dialysis procedure, and often a source of morbidity and mortality of the patients. The patient’s outcome and dialysis efficiency depends greatly on how well his vascular access is functioning. Major risk factors for vascular access loss should be recognized in order to limit use of costly surveillance programs to those who would significantly benefit from them, and to identify those who would need early intervention in order to possibly salvage a problematic vascular access.
General Objectives: To determine the association between the clinical profile of hemodialysis patients with vascular access loss.
Specific Objectives: 1. To determine the prevalence of vascular access loss in hemodialysis patients at The Kidney Service on permanent vascular access 2. To determine the association of demographics and clinical profile of hemodialysis patients with vascular access loss
A single center, retrospective, observational cohort study conducted in a tertiary hospital in Cebu City, involving adult Filipino hemodialysis patients. The charts of those who fulfilled the inclusion criteria were reviewed and data were collected. The prevalence data was expressed as percentage. The association between the clinical profile and vascular access loss was analyzed using odds ratio. Confidence level was assigned at 95% and a margin of error at 0.05.
Seventy six (76) or 44% had vascular access loss. Patients with older age, those who have diabetes, hyperparathyroidism, severe anemia, and had episode of hypotension have increase odds of vascular access loss in patients with arteriovenous fistula (AVF). Unfortunately data obtained from patients on AVG and tunneled catheter were not statistically significant due to low number of study population collected.
The most common causes of vascular access loss were thrombosis (50%), infection (21%), primary vascular access failure (21%), and pseudoaneurysm (8%).
Older age, diabetes mellitus, hyperparathyroidism, severe anemia, and episode of hypotension are risk factors for vascular access loss. Hence, identifying patients with these risk factors should raise awareness on our part to watch out for vascular access loss, and to better tailor the type of vascular access that best suit our patients. Also, since some of these risk factors are preventable, we should strive to avoid them from occurring in our patients.