Determinants of haemodialysis access survival

Background: Vascular access patency is of vital importance for patients requiring haemodialysis. This analysis validates potential risk factors and benefits in patients undergoing vascular access procedures. Patients and methods: Vascular access procedures performed over a two-year period were retrospectively analysed. Clinical data and concomitant medication were retrieved from files as were surgical data following a standardized data capture sheet. Outcome parameters were primary (PP) and secondary patency (SP) as well as freedom from repeated revascularization. Minimal follow-up with functioning access was 679 days. Results: During the observation period, 244 patients (mean age 62.2 +/- 0.9 years, 60.7% male patients, 36.1% pre-emptive, 31.1% late referral) underwent vascular accesses procedures. PP and SP were 35.6% and 45.6%, respectively, at 540 days. Presence of diabetes mellitus was associated with decreased PP (OR: 0.6, 95 %-CI: 0.3-1.0) and SP (OR: 0.4, 95%-CI: 0.2-0.7), whereas female gender was associated with lower SP (OR: 0.6, 95%-CI: 0.3-0.9) and freedom from repeated revascularization rates (OR: 0.6, 95%-CI: 0.3-1.0). In contrast, presence of hyperparathyreoidism was associated with higher SP (OR: 1.7, 95%-CI: 1.0-3.0) and freedom from repeated revascularization (OR: 1.7, 95 %-CI: 1.0-3.0) rates. Conclusions: Haemodialysis access performs worst in patients with diabetes mellitus and in women. The benefit of hyperparathyroidism should be interpreted as hypothesis generating.