Determining the surveys of long term intravenous access that are formed for hemodialysis at the chronic renal failure patients and searching factorcs that affect these surveys

Aim: The purpose of this study; in patients who have been planned hemodialysis with a diagnosis of chronic renal failure and have been generated a permanent vascular access at Farabi Hospital, Faculty of Medicine, Karadeniz Technical University, is to identify the surveys of permanent vascular access routes (AVF, AVG, and a permanent catheter) and by determining the factors affecting this survey, in this way, to contribute to the extension of permanent vascular access surveys which will be created after this time.Material and Method: Our study have included 18 years aged and older 420 patients who were followed with a diagnosis of Chronic Renal Failure in Nephrology Clinic, Farabi Hospital, Faculty of Medicine, Karadeniz Technical University, who were applied arteriovenous fistula, arteriovenous grafts and permanent catheters between 01 January 2000 - 31 December 2010 in order to generate a permanent hemodialysis access by surgeons of Thoracic and Cardiovascular Surgery clinic, Farabi Hospital, Faculty of Medicine, KTU, in the operating room of Farabi Hospital, Faculty of Medicine, KTU, and whose archive files could be reached. The names and file numbers of the 18 years aged and older patients, who were scheduled hemodialysis with the diagnosis of CRF and applied permanent vascular access (arteriovenous fistula, arteriovenous grafts and permanent catheters) procedures, have been obtained and recorded. Patients, whose file numbers and names were recorded, have been listed according to the date of surgery and their files have been obtained from the archive of Farabi Hospital, Faculty of Medicine, Karadeniz Technical University. The files of the patients have been retrospectively reviewed and patient?s age, gender, body mass index, cause of CRF, a history of central venous catheter, whether upper extremity arterial and venous Doppler ultrasonography were applied or not before the procedure, whether s/he was in the follow-up of nephrologists or not, preoperative hematocrit, platelets, albumin, calcium, phosphorus, parathyroid hormone, glucose, total cholesterol, triglycerides, LDL cholesterol, C-reactive protein, prothrombin time (PT) and partial thromboplastin time (PTT) values, which were stated in the AVF follow-up form, have been recorded before the operation for permanent vascular access. Determining the date which AVF, AVG, and permanent catheter lost their functions or the exitus date of patients, the patency duration of the permanent access road, have been identified by calculating in months. The necessary information have been obtained and recorded by accessing by telephone to the patients, who had no or incomplete information in the file relating to the date that permanent hemodialysis access route lost its function, or to their relatives.Findings: It has been determined in our study that 86% AVF, 10.5% AVG, 9.8% permanent catheter was applied in of 420 CRF patients who were created a permanent vascular access. In patients in the study, the average AVF patency duration has been determined as 34.73 months, the average AVG patency duration as 27.59 months, and the average permanent catheter patency duration as 8.53 months. The causes of CRF have been respectively determined as 30.7% diabetic nephropathy, 22.6% hypertensive nefrosclerosis, 15.7% unknown etiology, 12.9% due to polycystic kidney disease, 8.3% due to obstructive uropathy, 4.5% due to glomerulonephritis, 2,6% drug nephropathy, 1.7% amyloidosis, 1% due to multiple myeloma. Fistula patency duration has been determined as the longest in AVF-generated patients under 45, as shorter than 45 years in patients between 45 to 65 ages but longer than patients over 65 years, and as the shortest in patients over age 65 (p< 0,0001). It has been determined that the fistula patency was the longest in patients who were not been applied central venous catheters before generating fistula in AVF-generated patients and that the duration of fistula patency was significantly shortened as the number of central venous catheter increased (p = 0.007). Fistula patency duration in patients undergoing dialysis generated within the first 29 days after generation of AVF has been determined as shorter than those of patients who undergo dialysis from this fistula on 30th day and after than the fistula was generated (p= 0,0001).Conclusion: It should be reached to a vein large enough to provide adequately and repeated dialysis blood flow in patients in which chronic hemodialysis is scheduled. For this purpose, although the patient can be implemented AVF, AVG, and a permanent catheter, this need is ideally met with AVFs. Due to lower costs and having a more long-term patency rates, AVFs are the firstly type of permanent vascular access to be chosen. Patient?s age, history of central venous catheter and waiting the maturation process of the fistula and the graft are extremely important in extending the lifetime of the permanent vascular access. In patient who is scheduled permanent vascular access for hemodialysis, the application for central venous catheter should be avoided and the maturation process of AVF-AVG should be awaited before cannulation.