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Course of Vascular Access and Relationship with Treatment of Anemia

José Portolés^*, Juan Manuel López-Gómez, Enrique Gruss^*, Pedro Aljama; for the MAR Study Group

^* Nephrology Service, Fundación Hospital Alcorcón, and Nephrology Service, Hospital Universitario Gregorio Marañón, Madrid, and Nephrology Service, Hospital Universitario Reina Sofía, Córdoba, Spain

Address correspondence to: Dr. José Portolés, Nephrology Service, Fundación Hospital Alcorcón, Avda. Villaviciosa 1, Alcorcón 28922, Madrid, Spain. Phone: +34-91-6219513; Fax: +34-91-66419368; E-mail: jmportoles{at}fhalcorcon.es

Background and objectives: Maintenance of the vascular access is a crucial factor in hemodialysis, but large studies of factors that are predictive of thrombosis are lacking.

Design, setting, participants, & measurements: This prospective, multicenter study investigated a cohort to describe the management of vascular access and establish the influence of anemia as a risk factor. The cohort included 1710 patients (aged 64.4 yr; 60% men) who were followed every 3 mo at 119 centers during 12 mo. On inclusion, 9.6% had a catheter, 80.3% had a native arteriovenous fistula, and 10.1% had a polytetrafluoroethylene graft.

Results: Low baseline hemoglobin increased the risk for vascular access events. The risk was higher with a polytetrafluoroethylene graft and a catheter versus arteriovenous fistula. The multivariate model included type of vascular access, previous cardiovascular events, and noncorrected anemia. The likelihood of remaining free of vascular access events 12 mo later was 0.727 (baseline hemoglobin <10.0 g/dl), 0.801 (10.01 to 11.0 g/dl), 0.814 (11.01 to 12.0 g/dl), and 0.833 (>12.0 g/dl), figures similar to those obtained with hemoglobin from the trimester before the event. The Cox model included type of vascular access.

Conclusions: Correcting anemia did not increase the risk for vascular access–related events, and anemia that was resistant to treatment identified a subgroup of patients with higher comorbidity and higher likelihood of a vascular access event.