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 Northern Thailand (EPNT) was formulated. EPNT 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 EPNT and non-EPNT patients in the first 15 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 EPNT patients and 101 non EPNT patients. EPNT group had lower cumulative rate of AVA infection (EPNT: 0% vs non EPNT 2.52%, p = 0.087), than those in non EPNT. Also 11.9% in non EPNT patients had history of CVC sepsis. EPNT group had lower rates of central vein stenosis (EPNT: 1.23% vs non EPNT 5.11%, p = 0.146), than those in non EPNT group. However, these trends did not reach a statistically significance. The rates of maturation, AVA complications, and MACE were not different between two groups. The score in the general mental health in EPNT group was significantly better than those in non EPNT group. Conclusion: EPNT patients had a trend toward lower rates of sepsis and central vein stenosis, and better general mental health scores than those non EPNT patients. However, this 15-month result does not make any solid conclusions to determine the difference between EPNT and Non-EPNT. Further results will shed more light on this field.
