Abstract
Background: Based on national and international guidelines (Kidney Disease Outcomes Quality Initiative-K DOQI) in patients with end staged renal disease, arteriovenous access (AVA) creation without history of central venous catheter (CVC) insertion is the recommended approach, but in Thailand, most hemodialysis patients had experiences of CVC insertion beforehand. Underestimation of consequences of such approach in our patients and medical personnel, might be a cause. Therefore, we aimed to develop the protocol that can improve the outcomes. Methods: Expressed Protocol in Thailand (EPT) was formulated. EPT was composed of: 1) patients who did not have any experience of CVC insertion before AVA creation, 2) patients almost used vein for AVA creation, 3) AVA was under good surveillance after operation. This study plan followed up in 24 months, but this report compared and illustrated the outcome between EPT and non-EPT patients in the 24 months. The outcome included the rate of maturation, AVA complications, central vein stenosis, sepsis, major adverse cardiovascular event (MACE), and the score of Quality of life by SF-36. Results: There were 100 EPT patients and 101 non EPT patients. EPT group had lower cumulative rate of AVA infection (EPT: 0% vs non EPT 7.53%, p = 0.038) than those in non EPT. Also 11.9% in non EPT patients had history of CVC sepsis. Also EPT group had lower rates of central vein stenosis (EPT: 4.34% vs non EPT 11.11%, p = 0.047), than those in non EPT group. However there was no significant difference in the rates of maturation, AVA complications, and cardiovascular morbidity/mortality including MACE between two groups. The score in the Physical Functioning and General Mental Health in EPT group was significantly better than those in non EPT group during 6-18 month. Conclusion: EPT patients had a trend toward lower rates of AVA infection and central vein stenosis, and better quality of life score in terms of Physical Function and General Mental Health than those non EPT patients. Therefore the EPT approach should be recommended more and more in Thailand.
