Factors associated with early failure of vascular access in acute-phase patients

Background: Acute-phase patients sometimes require hemodialysis therapy without vascular access (VA) present on admission. These patients require VA creation to continue hemodialysis after discharge. The risk of early VA failure in acute-phase conditions is considered high due to the unstable nature of the patients’ condition. Hence, optimal timing of VA creation is not established. Methods: This retrospective study included patients who had VA (arteriovenous fistula or graft) created between May 2010 and July 2016. Results: During this study, 913 VA creations were performed among 804 patients. Of the included, 435 were acute-phase patients (275 men, 160 women). The average age was 67.4 ± 14.7 years. The causes of admission were exacerbation of renal failure (274 patients, 63.0 %), heart disease (61 patients, 14.0 %), infectious disease (30 patients, 6.9 %), and malignancy (15 patients, 3.4 %). Early VA failure occurred in 53 patients (12.2 %). There was no difference in causes of admission between patients with and without VA failure. Serum albumin level was significantly lower (2.7 ± 0.8 g/dL vs. 3.0 ± 0.6 g/dL, P < 0.01) in the early VA failure group than in the without early failure group. Albumin level was associated with early VA failure (odds ratio 0.4723, 95 % confidence interval 0.2744–0.8130, P < 0.01). Assessing only patients with arteriovenous fistula, the serum albumin level was significantly lower (2.6 ± 0.7 g/dL vs. 3.1 ± 0.6 g/dL, P < 0.01) in the early VA failure group than in the without early failure group. Conclusions: When we perform VA creation in acute-phase patients, hypoalbuminemia is associated with the risk of early VA failure. The status of the patient is an important factor to consider when creating VA.