Risk of vascular access complications with frequent hemodialysis.

Suri RS, Larive B, Sherer S, Eggers P, Gassman J, James SH, Lindsay RM, Lockridge RS, Ornt DB, Rocco M , !ing GO, "#iger $S% &re'uent Hemodia#ysis (et)ork !ria# Grou*+

Source
"idney ,#inica# Research -nit, -niversity o. /estern Ontario, Room $01234, ictoria Hos*ita#, 566 ,ommissioners Road East, London, Ontario (4$ 3G7, ,anada+ rita+suri8#hsc+on+ca

Abstract
&re'uent hemodia#ysis re'uires using the vascu#ar access more o.ten than )ith conventiona# hemodia#ysis, 9ut )hether this increases the risk .or access1re#ated com*#ications is unkno)n+ :n t)o se*arate tria#s, )e random#y assigned 037 *atients to receive in1center dai#y hemodia#ysis ;4 days *er )eek< or conventiona# hemodia#ysis ;2 days *er )eek< and 5= *atients to receive home nocturna# hemodia#ysis ;4 nights *er )eek< or conventiona# hemodia#ysis, .or >0 months+ !he *rimary vascu#ar access outcome )as time to .irst access event ;re*air, #oss, or access1re#ated hos*ita#i?ation<+ Secondary outcomes )ere time to a## re*airs and time to a## #osses+ :n the Dai#y !ria#, == ;2>@< o. 037 *atients had a *rimary outcome eventA 22 re*airs and >7 #osses in the dai#y grou* and >= re*airs, >> #osses, and > hos*ita#i?ation in the conventiona# grou*+ Overa##, the risk .or a .irst access event )as =4@ higher )ith dai#y hemodia#ysis than )ith conventiona# hemodia#ysis ;ha?ard ratio BHRC, >+=4% D7@ con.idence interva# B,:C, >+>>10+=D% PE6+6>=<% among the >D5 *atients )ith an arteriovenous ;$ < access at randomi?ation, the risk )as D6@ higher )ith dai#y hemodia#ysis ;HR, >+D6% D7@ ,:, >+>>1 2+07% PE6+60<+ Dai#y hemodia#ysis *atients had signi.icant#y more tota# $ access re*airs than conventiona# hemodia#ysis *atients ;PE6+6>><, )ith 77@ o. a## re*airs invo#ving throm9ectomy or surgica# revision+ Losses o. $ access did not di..er 9et)een grou*s ;PE6+75<+ /e o9served simi#ar trends in the (octurna# !ria#, a#though the resu#ts )ere not statistica##y signi.icant+ :n conc#usion, .re'uent hemodia#ysis increases the risk o. vascu#ar access com*#ications+ !he nature o. the $ access re*airs suggests that this risk #ike#y resu#ts .rom increased hemodia#ysis .re'uency rather than heightened survei##ance+