J Korean Med Sci.  2009 Jan;24(Suppl 1):S102-S108. 10.3346/jkms.2009.24.S1.S102.

Status of Initiating Pattern of Hemodialysis: A Multi-center Study

• Yoon HE
• Chung S
• Chung HW
• Shin MJ
• Lee SJ
• Kim YS
• Kim HW
• Song HC
• Yang CW
• Jin DC
• Kim YS
• Kim SY
• Choi EJ
• Chang YS
• Kim YO

• KMID: 1778148
• DOI: http://doi.org/10.3346/jkms.2009.24.S1.S102

Abstract

This study was to evaluate the status of initiating pattern of hemodialysis (HD). Five hundred-three patients in 8 University Hospitals were included. Presentation mode (planned vs. unplanned), and access type (central venous catheters [CVC] vs. permanent access) at initiation of HD were evaluated, and the influence of predialysis care on determining the mode of HD and access type was also assessed. Most patients started unplanned HD (81.9%) and the most common initial access type was CVC (86.3%). The main reason for unplanned HD and high rate of CVC use was patient-related factors such as refusal of permanent access creation and failure to attend scheduled clinic appointments. Predialysis care was performed in 57.9% of patients and only 24.1% of these patients started planned HD and 18.9% used permanent accesses initially. Only a minority of patients initiated planned HD with permanent accesses in spite of predialysis care. To overcome this, efforts to improve the quality of predialysis care are needed.

Keyword

Renal Dialysis; Arteriovenous Fistula; Catheterization; Referral and Consultation

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Arteriovenous Fistula
Female
Glomerular Filtration Rate
Humans
Kidney Failure, Chronic/etiology/mortality/therapy
Male
Middle Aged
Multivariate Analysis
Nephrology/*methods
Renal Dialysis/*methods
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1 Rate of planned HD. The proportion of patients who started planned HD was higher in patients with predialysis care than in patients without predialysis care (24.1% vs. 9.9%, p<0.001).

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  Fig. 2 Type of vascular access in use at initiation of HD. Patients who received predialysis care used more permanent accesses than those who did not receive predialysis care (18.9% vs. 6.6%, p<0.001) at initiation of HD. TCC, tunneled cuffed catheter; NCC, non-cuffed catheter; AVG, arteriovenous grafts; AVF, arteriovenous fistulae.

• 

  Fig. 3 Type of vascular access in use at initiation of HD according to the duration of predialysis care. Patients who received 12 months or more of predialysis care tended to use more permanent accesses than those who received less than 12 months of predialysis care (20.6% vs. 14.7%, p=0.2). TCC, tunneled cuffed catheter; NCC, non-cuffed catheter; AVG, arteriovenous grafts; AVF, arteriovenous fistulae.

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