Severe anaemia compromises haemodialysis vascular access, survival

  • Locham S & al.
  • Ann Vasc Surg
  • 23 Aug 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Severe anaemia is associated with reduced durability of haemodialysis (HD) vascular access and poorer survival among patients with stage IV-V chronic kidney disease.

Why this matters

  • According to the authors, this is the largest study to date reporting outcomes stratified by anaemia severity.
  • Presurgical correction of anaemia may help reduce mortality and improve durability of vascular access.

Study design

  • Study of 28,000 patients undergoing surgery for placement of arteriovenous fistula (AVF) or graft (AVG) from the Vascular Quality Initiative-HD database.
  • Preoperative anaemia was classified by WHO standards as no/mild (41.8%), moderate (49.2%), or severe (9.1%). 
  • Mean follow-up of primary patency was 9.60±7.86 months.
  • Funding: None.    

Key results

  • Patients with severe, moderate, and no/mild anaemia faced similar (all P>.05) rates of:
    • In-hospital bleeding (2.2% vs 2.2% and 2.1%);
    • Swelling (0.7% vs 0.5% and 0.4%); and
    • Wound infection (0.1% vs 0.3% and 0.4%).
  • The 30-day mortality rate was significantly higher with severe vs moderate and no/mild anaemia (2.1% vs 1.1% and 1.1%; P<.001>
  • In multivariate analysis, severe vs no/mild anaemia was tied to:
    • 90% increased risk for 30-day mortality (OR=1.90; P=.006).
    • 17% increase in primary patency loss at 1 year (aHR=1.17; P=.03).

Limitations

  • Retrospective, observational design cannot prove causation.
  • Few patients with severe anaemia.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit