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Association of Initial Hemodialysis Vascular Access with Patient-Reported Health Status and Quality of Life

Haimanot Wasse^*, Nancy Kutner, Rebecca Zhang, and Yijian Huang

^* Department of Medicine, Renal Division, and Rehabilitation/Quality of Life Special Studies Center, United States Renal Data System, Emory University, Atlanta, Georgia

Address correspondence to: Dr. Haimanot Wasse, Renal Division, Emory University, WMB Room 338, 1639 Pierce Drive, Atlanta, GA 30322. Phone: 404-727-1598; Fax: 404-727-3425; E-mail: hwasse{at}emory.edu

Background: Although the arteriovenous fistula (AVF) is the recommended form of vascular access for patients with ESRD, its impact on patient perception of health status, quality of life (QOL), or satisfaction is unknown.

Design, setting, participants, and measurements: This study compared patient-reported health status and QOL scores and vascular access type among a national random sample of 1563 patients at dialysis initiation and day 60 of ESRD during 1996 to 1997. Patients were stratified into five categories: AVF at first dialysis and day 60 of ESRD, arteriovenous graft (AVG) at first dialysis and day 60, central venous catheter (CVC) at first dialysis and AVF at day 60, CVC at first dialysis and AVG at day 60, and CVC at first dialysis and day 60.

Results: Ten percent (n = 154) of patients had an AVF, 21% (n = 326) had an AVG, and 69% (n = 1083) had a CVC at dialysis initiation; those who were most likely to use an AVF were white and male. After statistical adjustment, patients with persistent AVF use reported greater physical activity and energy, better emotional and social well-being, fewer symptoms, less effect of dialysis and burden of kidney disease, and better sleep compared with patients with persistent CVC use, whereas measures such as cognitive and sexual function did not differ by access type.

Conclusions: Compared with persistent CVC use, early persistent AVF use is associated with the perception of improved health status and QOL among patients with ESRD. Future longitudinal studies may help to clarify further the association between QOL and vascular access.