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Improving Patient Care: Michael V. Rocco, Diane L. Frankenfield, Sari D. Hopson, and William M. McClellan Relationship between Clinical Performance Measures and Outcomes among Patients Receiving Long-Term Hemodialysis Ann Intern Med 2006; 145: 512-519 [Abstract] [Full text] [PDF]

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Type of vascular access and patients' mortality

Yujiro Kida, Kiyomi Chiba, RN, Mitsuaki Terazono, CE, and Tetsuji Sato, DMD, PhD   (18 October 2006)

Type of vascular access and patients' mortality 18 October 2006
Yujiro Kida, MD, PhD Tsurumi University, Tokyo Medical and Dental University, Kiyomi Chiba, RN, Mitsuaki Terazono, CE, and Tetsuji Sato, DMD, PhD Send rapid response to journal: Re: Type of vascular access and patients' mortality kida-y{at}tsurumi-u.ac.jp Yujiro Kida, et al.	Rocco and coworkers provided four indexes in order to evaluate the association between the quality of care of patients receiving long-term hemodialysis and the risk for death (1). Four indexes were composed of hemoglobin level, serum albumin level, Kt/V urea value, and type of vascular access (1). According to the article by Rocco et al., the use of arteriovenous fistula meets the target in the point of vascular access, whereas the use of arteriovenous graft or catheter does not meet such target (1). We disagree with such their manner. The adjusted odds ratio for death among patients dialyzed with synthetic graft was 1.1 (0.9 to 1.4) compared with arteriovenous fistula (2). On the other hand, the adjusted odds ratio for death among patients dialyzed with catheter was 1.4 (1.1 to 1.9) compared with arteriovenous fistula (2). These results indicate that the use of arteriovenous fistula or graft for vascular access is superior to catheter in the survival of patients receiving hemodialysis. Actually, in the patients dialyzed with catheter, lower blood flow rate during hemodialysis led insufficient dialyzed-state (2). Venous catheter was associated with increased rates of infection including bacteremia or endocarditis (3). These factors would increase patients' mortality. Therefore, in order to perform more precise analysis, we would like to propose that the use of arteriovenous fistula or graft meets the target in the point of vascular access and the use of catheter does not meet such target. References (1) Rocco MV, Frankenfield DL, Hopson SD, et al. Ann Intern Med 2006;145:512-9. (2) Pastin S, Soucie JM, McClellan WM. Kidney Int 2002;62:620-6. (3) Nassar GM, Ayus JC. Kidney Int 2001;60:1-13. Conflict of Interest: None declared