Kidney Week

Abstract: TH-PO263

Vascular Access Survival with Thrice-Weekly, In-Center, Nocturnal Haemodialysis

Session Information

• Hemodialysis, Hemodiafiltration, and Frequent Dialysis
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Hull, Katherine Leigh, University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom

Katherine Leigh Hull, MBChB

• Bugeja, Ann, Ottawa Hospital, Ottawa, Ontario, Canada

Ann Bugeja, MD

• Graham-Brown, Matthew, University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom

Matthew Graham-Brown, MBChB, PhD

• Reid, Lindsay, University of Ottawa, Ottawa, Ontario, Canada

Lindsay Reid

• Smith, Aiden J., University of Leicester Department of Population Health Sciences, Leicester, United Kingdom

Aiden J. Smith, MSc

• van Jaarsveld, Brigit C., Amsterdam Universitair Medische Centra, Amsterdam, Noord-Holland, Netherlands

Brigit C. van Jaarsveld, MD, PhD

• Burton, James, University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom

James Burton, MBChB, PhD, FASN

Background

This study explores vascular access complications in patients established on in-centre nocturnal haemodialysis (INHD) compared to conventional haemodialysis.

Methods

Retrospective cohort study with patients acting as their own control. Data were collected from: Leicester Renal Network, UK (project number 12494) and The Ottawa Hospital, Canada (project number 20230336-01H). Adults established on INHD (intervention period) preceded by usual daytime in-centre haemodialysis (control period) with an established vascular access were eligible. Data were collected between 01/01/2009-31/12/2021.

The primary outcome measure was a composite of outcomes due to vascular access complication: hospitalisation, intervention, change in vascular access modality, change in dialysis modality and death. The primary outcome was evaluated by time-to-event rate in days using Kaplan-Meier plots. Statistical significance was accepted at P<0.05.

Results

123 individuals were included (UK, n=66; Canada, n=57). The mean age was 51.2 years (±17.0), 69.1% (n=85) were male, 56.1% (n=69) were white. There was no difference in the primary outcome for the intervention period (n=33, 26.8%) and the control period (n=31, 25.2%): P=0.868.
The 12-month vascular access survival probability was 69.8% (95%CI 61.0–78.6%) for the intervention period and 70.5% (95%CI 61.5-79.5%) for the control period (Figure 1). During the intervention period, arteriovenous grafts were associated with lower vascular access survival (P<0.001), and during the control period, regular vitamin K antagonist use was associated with lower vascular access survival (P=0.002).

Conclusion

Vascular access type and use of regular anticoagulation were associated with a reduced vascular access survival probability. There does not appear to be an increased risk to vascular access survival and safety for INHD compared to conventional haemodialysis.

Figure 1 – Kaplan-Meier plot demonstrating vascular access time-to-event rate