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Quality of dialysis vastly depends on complications related to vascular access. Vascular access is one of the major factors determining the morbidity and mortality in maintenance hemodialysis patients.
This cross-sectional study was carried out on 501 patients from three dialysis centers (one urban and two rural center) across Bangladesh. Data was collected from patients on maintenance hemodialysis for at least three months during May-June, 2023. Data was analyzed by statistical analysis software (SAS) studio.
Among 501 patients, Male 251 (50.1%), Female 250 (49.9%). Mean age of the patients was 51.5 (SD±13) years. 48.3% (237) were diabetic and 51.7% (264) were non diabetic. Mean age of diabetic and non-diabetic patient was 56.5 years and 47.2 years respectively. Diabetic patients were significantly older compared to non-diabetic patients (p<0.0001). Among diabetic patients mean duration of diabetes was 14.3 years (SD ±8.1).
Out of 495 patient 84% patient started dialysis with temporary vascular access; 62.6% started with jugular venous catheter (JVC), 20.2% with femoral venous catheter (FVC), 1.2% with permanent catheter. 16% patients started dialysis with arteriovenous fistula (AVF).
In urban center out of 397 patients, 68.77% initiated dialysis with JVC, 13.60% with FVC, 0.25% with permanent catheter, 17.38% with AVF. In rural center out of 98 patients, 37.76% started dialysis with JVC, 46.94% with FVC, 5.10% with permanent catheter and 10.20% with AVF. Initiation of dialysis with AVF is significantly higher in urban center than rural center (p<0.0001).
Duration of venous catheter in situ before being switched to AVF was 6.9 weeks (SD±4.9). With temporary vascular access 37.4% (151) were complicated with infection and 2.5% (10) patient developed thrombosis.
Out of 181 diabetic patient 42.54% developed catheter related complication and out of 214 nondiabetic patient 39.25% developed catheter related complication. Between diabetic and non-diabetic patient, catheter related complication was similar (p=0.5)
AVF related complication were as follows: aneurysm and pseudoaneurysm 11%, thrombosis 9.8%, abscess 0.6% and AVF failure 11.8%.
Out of 237 diabetic patients, 8.86% had AVF failure. Out of 253 non diabetic patients, 14.62% had AVF failure (p=0.04). Apart from AVF failure rest of AVF related complications were similar in both diabetic and non-diabetic patients.
Mean duration of dialysis in diabetic patients were 19.1 months and in non-diabetic patients were 30.8 months (p<0.0001). Diabetic patients started dialysis at older age (54.9 years) compared to non-diabetic patients (44.6 years) (p<0.0001). Diabetic patients started dialysis at lower serum creatinine compared to non-diabetic patient (p<0.0001). 46(19.7%) diabetic patient, initiated dialysis by AVF compared to 33 (13.2%) non diabetic patients (p=0.04).
In our study non diabetic patients had higher AVF failure rate then diabetic patient. This higher failure rate in nondiabetic patients can be explained by longer hemodialysis duration. Catheter related complication was similar in both diabetic and non-diabetic patients. The number of patient initiating dialysis with AVF was more in diabetic patients than non-diabetic patient as they were on regular follow up.