Open AccessDifferential Impact of Central Venous Catheters versus Arteriovenous Fistulae on Quality of Life among Irish Haemodialysis Patients
Author(s) -
Caoimhe Maguire,
Leonard D. Browne,
Mina Dawood,
Fiona Leahy,
Maria C. Ryan,
Eoin White,
Aidan O'Suillivan,
Leonard O’Sullivan,
Austin G. Stack
Publication year - 2022
Publication title -
kidney360
Language(s) - English
Resource type - Journals
ISSN - 2641-7650
DOI - 10.34067/kid.0006622021
Subject(s) - medicine , hemodialysis , arteriovenous fistula , dialysis , central venous catheter , quality of life (healthcare) , cohort , logistic regression , odds ratio , surgery , catheter , nursing
Background: Arteriovenous fistulae (AVF) have superior clinical outcomes compared to central venous catheters (CVC) among haemodialysis (HD) patients. Yet, there is increasing recognition that health-related quality of life (HRQoL) may be more important to patients than survival and that differences may exist between AVF and CVCs in this regard. This study compared HRQoL between AVF and CVC in an Irish cohort. Methods: We conducted a cross-sectional survey among prevalent haemodialysis patients (n=119) dialysing with either an AVF or CVC at a regional programme. The Short Form 36 (SF-36) and a validated Vascular Access Questionnaire (SF-VAQ) compared QoL between AVF and CVC in domains of physical functioning, social functioning and dialysis complications. Multivariable logistic regression compared differences between groups for outcomes of physical functioning, social functioning and dialysis complications expressed as adjusted odds ratios and 95% CI.Results: Mean age was 66.1 years, 52.1% were using an AVF while 47.9% had a CVC. Patients dialysing with an AVF were more satisfied with their access when asked directly (6.2 vs 5.0, P<0.01). Physical functioning scores for bleeding, swelling and bruising were significantly higher for AVF than CVC (P<0.005 for all). In contrast, patients with CVC reported greater difficulties in bathing and showering than those using an AVF (4.4 vs 2.0, P <0.001) whereas patients with AVF expressed greater concerns with physical appearances. Compared to AVF, CVC users were less likely to report difficulties in physical functioning (OR 0.35, 95% 0.12-0.94), P=0.04) but more likely to report dialysis complications (OR 1.94 (0.69-5.87), P=0.22). Conclusion: Vascular access contributes to HRQoL in haemodialysis. CVCs are associated with fewer difficulties from bleeding and bruising but greater negative impact on social activities including bathing and showering. Overall, patients with a CVC had lower dissatisfaction scores than patients with AVF when all 3 domains were added. Innovation in vascular access design and engineering may confer benefits and improve patient comfort on HD.