Factors influencing first vascular access placement in patients starting hemodialysis.

Background: The aim of the study was to assess whether age, gender and the primary renal disease are associated with differences in the type of first vascular access placement.

Methods: We reviewed the records of 145 patients on hemodialysis (HD) 44 females and 101 males with a mean age of 64±14.5 years, on HD for 46.9±41.2 months (range 1-252).

Results: The primary renal diseases were diabetes (23.4%), hypertension (17.2%), glomerulonephritis (25.7%), cardiac failure (6.9%) and others (26.8%). Double lumen catheter and arteriovenous fistula was the first vascular access in 109 (75%) and 35 patients (24%) patients, respectively. Graft was the first vascular access in 1 patient (0.5%). Arteriovenous fistula was the first choice for 29.7% of the male patients and 9% of the female. Double lumen catheter was the first choice for 70.3% of the male (subclavian 50.5%, femoral 4.95%, and jugular 14.85%) and 86.4% of the female (subclavian 75%, femoral 2.3%, and jugular 9.1%) (P=0.04). Double lumen catheter was the first choice for 79.7% of the patients older than 65 years and 70.4% for the patients younger than 65 years (P=0.19). Double lumen catheter was the first choice for all the patients with cardiac failure as the primary cause of renal disease.

Conclusion: Double lumen catheter was the first vascular access for the majority of our patients, probably due to late Nephrologist's referral. Cardiac failure being the primary cause of renal disease and female gender influence also this choice, but not the age of the patients.