Risk of Major Vascular Events in Patients with Hemodialysis Vascular Access Dysfunction-A Retrospective Cohort Analysis

BACKGROUND: The pathogenesis in hemodialysis vascular access dysfunction was similar to various vascular diseases. However, the association between hemodialysis vascular access dysfunction and major vascular events has not been investigated. We conducted a retrospective analsis to investigate the association between hemodialysis vascular access dysfunction and major vascular events. METHODS: A 1,000,000-subject database systematically sampled from the Taiwanese National Health Insurance (NHI) Research Database was used in the present study. Of the hemodialysis patients using hemodialysis vascular access, those receiving any procedure for vascular access dysfunction during a 2-year inclusion period were defined as access dysfunction-prone. Otherwise, patients were defined as access dysfunction-unsusceptible. The study outcomes, including hospitalization due to acute myocardial infarction (AMI), acute ischemic stroke, transient ischemic attack (TIA), peripheral artery disease, events of coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) and all-cause mortality, were assessed during the entire 7-year study period. RESULTS: Among the 1,288 patients on hemodialysis via vascular access during the inclusion period, 131 of access dysfunction-prone and -unsusceptible patients were included for analysis after age- and sex-matching. The occurrence of all major vascular events of interest was similar between the two study groups. The events of CABG and PCI were not significantly different, neither. However, patient survival was significantly superior in the access dysfunction-unsusceptible patients either revealed by Cox regression model or Kaplan-Meier method. CONCLUSION: The finding of this study did not show the association between hemodialysis vascular access dysfunction and major vascular events. However, access dysfunction is associated with decreased survival in hemodialysis patients using vascular access. To investigate the nature of this association, a population-based analysis including causes of mortality is mandatory in the future.