Changes in vascular access in a dialysis unit in recent years: planning problems, change in preferences, or demographic change?

Evidence on the reasons for the general and discouraging overutilization of catheters in DOPPS countries is lacking. We analysed the changes in distribution of the different types of vascular access in all 398 patients ongoing hemodialysis at our unit, from January 2000 until December 2005, as well as patients' characteristics. Secondly, risk factors associated with the use of permanent catheters were evaluated in all 95 patients who used that kind of vascular access from January 1997 until April 2006. The percentage of fistulas in prevalent patients diminished from year 2000 until year 2005 (from 95% to 77.9%); concurrently there was an increase in the use of permanent catheters (from 4.2% to 21.5%). The percentage of incident patients having a usable fistula or graft at the beginning of hemodialysis diminished progressively (83.4% in 2000; 69.3% in 2005), and there was a significant increase in the percentage of incident patients using a permanent catheter (from 0 to 23%). Coincidentally, there was a change in patients characteristics: increasing age (71.3 vs. 60.5 years); greater diabetes percentage (7.1% vs. 18.5%) and less time on dialysis (93.2 vs 37 months; p < 0.03). Causes of permanent catheter insertion varied, exhaustion of all other arteriovenous options being the most frequent in the first period of the study and the presence of an unsuitable vascular anatomy in the second. Despite our policy favoring arteriovenous angioaccess, our results with regards to vascular access worsened in both prevalent and incident patients, coinciding with a change in patients' characteristics. We believe that reversing this trend may become more complicated as the population on dialysis grows older and becomes more prone to diabetes.