Hemodialysis vascular access infection and mortality in maintenance hemodialysis patients.

Unlabelled: Infectious complications associated with vascular access are a well known cause of increased morbidity and mortality in hemodialysis patients. The aim of the study was to evaluate the incidence of hemodialysis vascular access infections and patients survival in the group of maintenance hemodialysis patients during a one year observation period. The study group consisted of 213 patients (126 male, 87 female; aged 57.4 +/- 14.9 years being on renal replacement therapy for 54 months; range: 2 to 384 months) treated by maintenance hemodialysis at the Nephrology Department of the University Hospital. From the study group 181 patients (84.9%) had created arterio-venous fistulas (AVF); 28 (13.2%) permanent central venous catheters (CVC) implanted and 4 (1.9%) arterio-venous grafts (AVG). Vascular access infectious complications were monitored during a one year observation period. Infections of CVC were observed in 4 (14.3%) of the patients with CVC; 4 (2.2%) of patients with AVF and 2 (50%) of AVG. In the group of patients with signs of AVF infection the following pathogens were found: S. epidermidis 50%, S. aureus 25% and negative culture in 25%. The common pathogens in the group of patients with AVG were as follows: S. aureus and S. hemoliticus. Patients that had infections of implanted CVCin 75% were found to have Gram-positive bacteria (50% S. aureus, 25% S. coagulazo-negative), while 25% had Gram-negative infections (E. coli). In the analyzed period 30 deaths (14.1%) were noted; 23 (12.7%) in patients with AVF and 7 (25%) with CVC. Mortality due to cardio-vascular events in dialyzed patients using permanent catheters came to 43%; death due to catheter infections 14%. In the group of patients with AVF from 23 deaths 83% were of cardio-vascular origin, and 4% due to infections. No deaths were occurred during the observation period in the group of patients with AVG. One should note that only 4 patients with AVG during the study period were evaluated.
Conclusions: 1. Types of vascular access has some influence on infectious complications and survival in the group of hemodialized patients. 2. High rate of CVC infections and associated increased mortality and better patients outcome with AVF, indicate that fistula should be constructed in all cases where it is possible.