Initial vascular access type and associated factors among incident haemodialysis patients: a multicentre retrospective observational study.

چکیده اصلی

OBJECTIVES: To describe initial vascular access among incident haemodialysis patients, identify patient-level factors associated with starting haemodialysis with an arteriovenous fistula (AVF) rather than a central venous catheter (CVC), and explore clinical and biochemical status after 3 months. DESIGN: Multicentre retrospective observational study. SETTING: Dialysis centres in six tertiary hospitals in Taizhou, southeastern Zhejiang, China, from 1 January 2019 to 31 December 2023. PARTICIPANTS: Of 1227 database records assessed, 6 were excluded (5 initial arteriovenous graft records and 1 record outside the prespecified study period), leaving 1221 incident haemodialysis patients. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was initial AVF rather than CVC use. Secondary exploratory outcomes were mean arterial pressure and biochemical measurements after 3 months; dialysis adequacy, access patency, access infection and mortality were unavailable. RESULTS: Initial access was an AVF in 446/1,221 patients (36.5%) and a CVC in 775/1221 (63.5%); CVCs comprised 413 tunnelled cuffed and 362 non-tunnelled catheters. Initial AVF use varied across hospitals from 18.9% to 49.0%. In a centre-adjusted model using 20 multiply imputed datasets, higher baseline haemoglobin (adjusted OR per 10 g/L 1.144, 95% CI 1.060 to 1.234), albumin (per 5 g/L 1.411, 95% CI 1.242 to 1.603) and calcium (per 0.1 mmol/L 1.112, 95% CI 1.052 to 1.176) and lower C-reactive protein (per doubling 0.845, 95% CI 0.797 to 0.896) were associated with initial AVF use. At 3 months, no AVF-CVC difference remained robust after baseline and centre adjustment and false-discovery-rate control. CONCLUSIONS: Initial AVF use was uncommon and was associated with baseline clinical status and centre. These observational findings support timely predialysis assessment and individualised vascular-access planning, but they do not show that access type caused subsequent biochemical differences.

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