Abstract: SA-PO946
Vascular Access Practices in Japan
Session Information
- Dialysis: Vascular Access - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Uehara, Genta, Okinawa Chubu Hospital, Uruma, OKINAWA, Japan
- Tsukahara, Tomoki, Tsukuba Central Hospital, Ushiku, Ibaraki, Japan
- Hammes, Mary S., University of Chicago Medicine, Chicago, Illinois, United States
- McGill, Rita L., University of Chicago Medicine, Chicago, Illinois, United States
Background
Increasing fistulas (AVF) and grafts (AVG) and decreasing catheters (CVC) is a priority for all hemodialysis (HD) patients. DOPPS data indicate that Japanese patients have superior vascular access outcomes, so we examined vascular access practices for new HD patients in Japan.
Methods
Chart review identified patients presenting to two Japanese hospitals (an academic medical center in Okinawa and a private referral hospital in Ibaraki prefecture) for new kidney failure with no vascular access, from 2013-2017. Demographic and clinical data were collected, as well as the timing of vascular access surgery, hospital discharge/transfer, and cannulation of any new AVF or AVG. Time data are shown as median (interquartile range). Patients were censored upon transfer from facility or death.
Results
Among 222 patients (103 from Okinawa and 119 from Ibaraki), 36.9% were female, age was 70 (60, 79) years, and weight 54.6 (46.7, 61.3) kg. AVF/G were successful during 164/222 (73.9%) of hospitalizations. 58 patients left hospital with CVC, of whom 4 had unsuccessful surgery. Time from admit to surgery was 14 (7,26) days. There were 9 AVG, 9 upper arm AVF, and the remainder were Cimino or snuffbox AVF. AVF/G were cannulated with 17 gauge needles at a median of 13 (8,16) days after surgery. Hospital length of stay was 30 (20, 49) days, so cannulation usually occurred prior to hospital discharge. A Kaplan-Meier curve shows time to conversion from CVC to AVF or AVG in days. Treatments were 240 (240,240) min; blood pump rates were 150 (120,180) mL/min at first use and increased to 200 mL/min over time.
Conclusion
Initial hospitalization of a new Japanese HD patient frequently includes creation and first use of AVF/AVG; hospital length of stay is longer than in many other countries. Early construction and early use of native fistulas in the forearm and wrist is associated with very low usage of CVC in Japan, which may be facilitated by low blood pump speeds and longer treatments.