Abstract: FR-PO513
"Optimal" vs. "Suboptimal" Haemodialysis Start with a Line
Session Information
- Dialysis Vascular Access
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Corr, Michael, Queen's University Belfast, Belfast, United Kingdom
- Masengu, Agnes, Belfast City Hospital, Belfast, United Kingdom
- Hanko, Jennifer B., Belfast City Hospital, Belfast, United Kingdom
Background
Monitoring whether patients commence haemodialysis with a central venous catheter (CVC), or an arteriovenous fistula (AVF) is commonly used to audit the quality of a vascular access service. However, this crude metric of measurement can miss the increasing nuance and complexity of vascular access planning. At times, commencement of haemodialysis with a CVC may be the most appropriate access choice for an individual patient or be due to unpredictable events rather than representing a failure in access service delivery. We aimed to understand whether commencing haemodialysis with a CVC represented an ‘optimal’ or ‘suboptimal’ outcome and how this could influence assessment of a vascular access service.
Methods
From a prospective clinical database, patients known to nephrology >90 days before initiating haemodialysis as first ever renal replacement therapy (2011-2020) from a single centre were included. Descriptive statistical analyses were completed using SPSS Statistics.
Results
158/254 patients started haemodialysis with a CVC, 96 with an arteriovenous fistula. For 91 patients the CVC was deemed ‘optimal’ care- due to unpredictable deterioration in renal function (n=41) and inadequate veins for AVF creation (n=24). For 67 patients the CVC was ‘suboptimal’- no/late referral to access assessment (n=25) and delays in the AVF creation pathway (n=13).
Two-year mortality was 53% ‘optimal’ CVC, 37% ‘suboptimal’ CVC and 30% AVF start. There was no difference in mean survival between AVF and ‘suboptimal’ groups (2.53 vs. 2.21 years p= 0.31). There was a survival difference between AVF versus CVC (2.53 vs 1.97 years p=0.002) and ‘suboptimal’ versus ‘optimal’ CVC cohorts (2.21 vs 1.40 years p=0.16).
Conclusion
Understanding whether CVC is ‘optimal’ or ‘suboptimal’ allows more nuanced analysis of service provision. High mortality in the ‘optimal’ group suggests a frailer cohort where CVC is potentially best care. Meanwhile, appreciating many ‘optimal’ CVC patients had unsuitable veins for AVF creation prompted review of our vein preservation strategy. Finally, studying ‘suboptimal’ CVC starts helps identify practice and system issues preventing ‘optimal’ care.