The effects of vascular access types on the survival and quality of life and depression in the incident hemodialysis patients

Figures & data

Table 1. Baseline characteristics according to the types of initial vascular access.

	AVF n= 314 (21.5%) Mean ± SD or n (%)	AVG n= 76 (5.2%) Mean ± SD or n (%)	CVC n= 1,071 (73.3%) Mean ± SD or n (%)	p
Age (years)	57.3 ± 12.7	61.7 ± 12.5	58.3 ± 14.7	.051
Sex, male	207 (66.1%)	43 (56.6%)	652 (60.9%)	.153
Time referral (months)	58.2 ± 123.5	38.0 ± 47.3	40.4 ± 86.5	.015
Type of referral
Early referral	214 (72.3%)	48 (66.7%)	572 (56.6%)	<.001
Late referral	82 (27.7%)	24 (33.3%)	439 (43.4%)
Cause of ESRD
DM	184 (58.8%)	53 (69.7%)	643 (60.0%)	.003
Hypertension	47 (15.0%)	8 (10.5%)	144 (13.4%)
Glomerulonephritis	44 (14.1%)	6 (7.9%)	131 (12.2%)
Others	36 (11.5%)	5 (6.6%)	145 (13.5%)
Unknown	24 (0.6%)	4 (5.3%)	8 (0.7%)
Score of MCCI	5.4 ± 2.1	6.6 ± 2.6	5.3 ± 2.3	<.001
Comorbidity
DM	198 (63.5%)	61 (80.3%)	693 (64.8%)	.018
CAD	48 (15.5%)	11 (14.5%)	132 (12.4%)	.342
CHF	31 (10.0%)	12 (15.8%)	113 (10.6%)	.331
CVD	23 (7.5%)	15 (19.7%)	102 (9.6%)	.005
PVD	34 (11.0%)	17 (22.4%)	63 (5.9%)	<.001
Malignancy	24 (7.8%)	16 (21.1%)	67 (6.3%)	<.001
SBP (mmHg)	142.5 ± 21.2	137.7 ± 20.6	145.7 ± 23.9	.003
DBP (mmHg)	77.9 ± 13.3	72.7 ± 12.5	78.3 ± 14.6	.006
BMI (kg/m^2)	23.5 ± 3.7	23.1 ± 3.4	23.2 ± 3.5	.334
Hemoglobin (g/dL)	9.1 ± 1.5	9.0 ± 1.4	8.7 ± 1.6	<.001
Calcium (mg/dL)	7.9 ± 1.0	8.0 ± 0.9	7.7 ± 1.1	.001
Phosphorus (mg/dL)	5.4 ± 1.7	4.8 ± 1.6	5.6 ± 2.1	.001
Uric acid (mg/dL)	7.9 ± 2.3	7.6 ± 2.5	8.1 ± 2.7	.107
Total cholesterol (mg/dL)	154.0 ± 45.4	137.1 ± 38.4	157.0 ± 50.1	.004
hs-CRP at 0 m	2.4 ± 12.1	6.2 ± 30.1	5.4 ± 18.3	.028

AVF: arteriovenous fistula; SD: standard deviation; AVG: arteriovenous graft; CVC: central venous catheter; ESRD: end stage renal disease; DM: diabetes mellitus; MCCI: modified Charlson comorbidity index; CAD: coronary artery disease; CHF: congestive heart failure; CVD: cerebrovascular disease; PVD: peripheral vascular disease; SBP: systolic blood pressure; DBP: diastolic blood pressure; BMI: body mass index; hs-CRP: highly sensitive C-reactive protein.

Table 2. Comparisons of baseline characteristics between TCVC and NTCVC.

	TCVC n= 896 (83.7%) Mean ± SD or n (%)	NTCVC n= 175 (16.3%) Mean ± SD or n (%)	p
Age (years)	58.7 ± 14.7	56.3 ± 15.0	.042
Sex, male	536 (59.8%)	116 (66.3%)	.109
Time referral (months)	41.8 ± 93.2	33.4 ± 39.0	.244
Type of referral
Early referral	472 (56.2%)	100 (58.5%)	.582
Late referral	368 (43.8%)	71 (41.5%)
Cause of ESRD
DM	534 (59.6%)	109 (62.3%)	.005
Hypertension	122 (13.6%)	22 (12.6%)
Glomerulonephritis	99 (11.0%)	32 (18.3%)
Others	134 (15.0%)	11 (6.3%)
Unknown	7 (0.8%)	1 (0.6%)
Score of MCCI	5.3 ± 2.3	5.5 ± 2.4	.312
Comorbidity
DM	580 (64.9%)	113 (64.6%)	.938
CAD	102 (11.5%)	30 (17.2%)	.035
CHF	68 (7.6%)	45 (25.9%)	<.001
CVD	76 (8.5%)	26 (14.9%)	.009
PVD	49 (5.5%)	14 (8.0%)	.194
Malignancy	56 (6.3%)	11 (6.3%)	.991
SBP (mmHg)	146.1 ± 23.7	143.6 ± 24.7	.214
DBP (mmHg)	78.5 ± 14.8	76.9 ± 14.0	.194
BMI (kg/m^2)	23.2 ± 3.6	23.1 ± 3.4	.952
Hemoglobin (g/dL)	8.8 ± 1.6	8.0 ± 1.6	<.001
Calcium (mmHg)	7.7 ± 1.0	7.4 ± 1.2	.001
Phosphorus (mmHg)	5.5 ± 2.0	6.4 ± 2.2	<.001
Uric acid (mmHg)	8.1 ± 2.8	8.6 ± 2.6	.010
Total cholesterol (mmHg)	157.2 ± 50.7	156.1 ± 46.7	.801
hs-CRP at 0 m	5.6 ± 08.8	4.3 ± 15.5	.383
hs-CRP at 3 m	2.7 ± 12.9	1.5 ± 5.9	.056

TCVC: tunneled central venous catheter; SD: standard deviation; NTCVC: non-tunneled central venous catheter; ESRD: end stage renal disease; DM: diabetes mellitus; MCCI: modified Charlson comorbidity index; CAD: coronary artery disease; CHF: congestive heart failure; CVD: cerebrovascular disease; PVD: peripheral vascular disease; SBP: systolic blood pressure; DBP: diastolic blood pressure; BMI: body mass index; hs-CRP: highly sensitive C-reactive protein.

Table 3. Baseline characteristics according to types of permanent vascular access.

	AVF n= 914 (82.1%) Mean ± SD or n (%)	AVG n= 199 (17.9%) Mean ± SD or n (%)	p
Age (years)	56.8 ± 13.5	61.7 ± 12.5	<.001
Sex, male	455 (64.7%)	87 (56.9%)	.068
Time referral (months)	48.7 ± 91.8	35.6 ± 45.6	.097
Type of referral
Early referral	430 (64.7%)	84 (59.2%)	.215
Late referral	235 (35.3%)	58 (40.8%)
Cause of ESRD
DM	421 (59.9%)	109 (71.2%)	.075
Hypertension	91 (12.9%)	15 (9.8%)
Glomerulonephritis	108 (15.4%)	15 (9.8%)
Others	75 (10.7%)	11 (7.2%)
Unknown	8 (1.1%)	3 (2.0%)
Score of MCCI	5.2 ± 2.2	6.3 ± 2.4	<.001
Comorbidity
DM	458 (65.3%)	118 (77.1%)	.005
CAD	90 (12.9%)	23 (15.0%)	.492
CHF	71 (10.2%)	23 (15.0%)	.086
CVD	57 (8.2%)	22 (14.4%)	.018
PVD	55 (7.9%)	20 (13.1%)	.041
Malignancy	50 (7.2%)	18 (11.8%)	.059
SBP (mmHg)	144.4 ± 22.9	144.0 ± 21.3	.839
DBP (mmHg)	78.2 ± 14.2	73.5 ± 12.8	<.001
BMI (kg/m^2)	23.3 ± 3.6	23.2 ± 3.6	.714
Hemoglobin (g/dL)	8.8 ± 1.7	8.9 ± 1.5	.704
Calcium (mg/dL)	7.7 ± 1.1	7.8 ± 0.91	.343
Phosphorus (mg/dL)	5.7 ± 2.0	5.4 ± 1.8	.129
Uric acid (mg/dL)	8.2 ± 2.5	7.9 ± 2.5	.195
Total cholesterol (mg/dL)	156.0 ± 47.9	155.4 ± 53.4	.896
hs-CRP 0 m	2.7 ± 11.8	3.9 ± 20.1	.331

AVF: arteriovenous fistula; SD: standard deviation; AVG: arteriovenous graft; ESRD: end stage renal disease; DM: diabetes mellitus; MCCI: modified Charlson comorbidity index; CAD: coronary artery disease; CHF: congestive heart failure; CVD: cerebrovascular disease; PVD: peripheral vascular disease; SBP: systolic blood pressure; DBP: diastolic blood pressure; BMI: body mass index; hs-CRP: highly sensitive C-reactive protein.

Figure 1. Patients’ survival according to the types of initial vascular access. (A) Comparisons among the AVF, AVG and CVC patients. (B) Comparison between NTCVC and TCVC. AVF: arteriovenous fistula; AVG: arteriovenous graft; CVC: central venous catheter; NTCVC: non-tunneled CVC; TCVC: tunneled CVC.

Figure 2. Patients’ survival according to the types of permanent vascular access. AVF: arteriovenous fistula; AVG: arteriovenous graft.

Table 4. Health-related quality of life (HRQOL) and Beck’s depression inventory (BDI) scores at 3 months after dialysis beginning according to the types of initial vascular access.

	AVF (n= 215) Mean ± SD	AVG (n= 48) Mean ± SD	CVC (n= 608) Mean ± SD	p^†	p^‡
HRQOL measure
SF-36
PCS	42.1 ± 9.3	38.7 ± 8.5	39.6 ± 9.5	.021*	.024*
MCS	42.6 ± 9.3	43.9 ± 7.6	39.7 ± 9.9	.002*^,**	.005*^,**
Physical functioning	73.6 ± 22.9	62.7 ± 26.9	65.9 ± 27.4	.010*	.008*
Role-physical	49.1 ± 41.6	39.1 ± 41.1	38.1 ± 41.0	.022*	.015*
Bodily pain	71.4 ± 23.6	72.9 ± 23.0	66.2 ± 24.9	.047*	.108
General health	37.0 ± 19.4	32.2 ± 18.0	35.5 ± 18.0	.370	.114
Mental health	54.9 ± 15.6	55.1 ± 16.4	52.1 ± 18.1	.202	.124
Role-emotional	67.1 ± 42.8	74.0 ± 37.6	49.0 ± 44.9	<.001*^,**	<.001*^,**
Social functioning	68.6 ± 24.1	64.8 ± 26.1	61.7 ± 25.9	.019*	.008*
Vitality	45.5 ± 18.2	44.7 ± 16.6	42.6 ± 19.9	.292	.100
Kidney disease targeted
Symptoms/problems	82.4 ± 14.1	83.1 ± 12.6	78.1 ± 16.6	.008*^,**	.016*^,**
Effects of kidney disease	71.5 ± 16.3	69.6 ± 16.5	67.2 ± 19.5	.057	.018*
Burden of kidney disease	33.2 ± 21.6	34.6 ± 18.6	30.7 ± 22.6	.376	.413
Work status	27.1 ± 35.2	28.1 ± 28.2	23.5 ± 31.9	.429	.622
Cognitive functioning	87.1 ± 15.1	84.8 ± 14.8	81.1 ± 20.7	.005*	.002*
Quality of social interaction	69.5 ± 19.3	69.2 ± 17.7	63.4 ± 21.1	.005*	.004*
Sexual function	76.5 ± 25.9	66.7 ± 33.2	68.5 ± 34.3	.381	.145
Sleep	67.8 ± 19.8	71.0 ± 23.3	68.1 ± 19.4	.711	.97
Social support	57.3 ± 25.8	59.4 ± 23.9	62.0 ± 24.3	.144	.011*
Dialysis staff encouragement	85.3 ± 19.1	90.6 ± 13.5	84.3 ± 19.1	.187	.618
Overall health	55.6 ± 18.7	54.7 ± 16.1	51.3 ± 19.6	.061	.024*
Patient satisfaction	68.8 ± 23.1	76.6 ± 20.7	65.9 ± 22.6	.024**	.014**
Mean	60.6 ± 17.3	59.8 ± 18.2	56.1 ± 16.9
BDI	13.8 ± 9.5	13.7 ± 8.0	16.6 ± 11.0	.020*	.024*

AVF: arteriovenous fistula; SD: standard deviation; AVG: arteriovenous graft; CVC: central venous catheter; HRQOL: health-related quality of life; SF-36: short form 36; PCS: physical composite summary; MCS: mental composite summary; BDI: Beck’s depression inventory.

^† Value was obtained from unadjusted regression analysis.

^‡ Value was obtained from regression analysis adjusted for age, sex, type of referral, modified Charlson comorbidity index, and hemoglobin levels.

^* AVF versus CVC.

^** AVG versus CVC.

Table 5. Health-related quality of life (HRQOL) and Beck's depression inventory (BDI) scores at 12 months after dialysis beginning according to the types of initial vascular access.

	AVF (n= 186) Mean ± SD	AVG (n= 48) Mean ± SD	CVC (n= 394) Mean ± SD	p^†	p^‡
HRQOL measure
SF-36
PCS	45.2 ± 9.5	43.9 ± 10.1	41.5 ± 9.2	.006*	.008*
MCS	42.8 ± 8.7	42.1 ± 8.0	40.3 ± 9.1	.080	.145
Physical functioning	72.6 ± 21.9	70.9 ± 22.1	65.5 ± 25.9	.066	.129
Role-physical	74.4 ± 32.4	67.4 ± 31.9	57.2 ± 36.0	<.001*	.004*
Bodily pain	74.6 ± 21.0	73.2 ± 24.1	65.8 ± 22.4	.005*	.006*
General health	49.6 ± 21.6	48.9 ± 20.1	45.7 ± 21.7	.324	.233
Mental health	53.9 ± 16.8	54.6 ± 17.3	50.9 ± 17.1	.302	.567
Role-emotional	72.2 ± 40.1	73.9 ± 37.6	55.2 ± 42.1	.002*^,**	.017*^,**
Social functioning	67.8 ± 30.2	65.7 ± 31.3	58.0 ± 32.5	.045*	.065
Vitality	54.8 ± 14.2	50.9 ± 15.1	50.7 ± 17.3	.145	.258
Kidney disease targeted
Symptoms/problems	85.3 ± 12.1	86.2 ± 13.3	79.7 ± 16.3	.005*	.013*
Effects of kidney disease	70.0 ± 16.8	71.6 ± 17.8	69.6 ± 19.7	.880	.872
Burden of kidney disease	31.0 ± 20.0	34.0 ± 26.7	30.3 ± 22.9	.757	.78
Work status	42.0 ± 23.5	34.0 ± 67.7	31.3 ± 23.2	.234	.945
Cognitive functioning	69.0 ± 17.4	67.8 ± 11.3	64.8 ± 18.8	.181	.164
Quality of social interaction	70.0 ± 19.5	73.8 ± 18.5	64.5 ± 20.4	.022*	.084
Sexual function	67.1 ± 25.8	72.9 ± 30.0	68.2 ± 32.7	.914	.866
Sleep	66.0 ± 21.1	65.1 ± 25.7	59.9 ± 22.5	.080	.101
Social support	73.6 ± 16.0	71.6 ± 20.6	69.0 ± 20.6	.162	.151
Dialysis staff encouragement	76.6 ± 15.0	81.7 ± 16.4	74.9 ± 18.6	.185	.375
Overall health	57.8 ± 48.8	60.9 ± 49.9	49.4 ± 45.7	.007**	.004**
Patient satisfaction	59.1 ± 17.9	60.9 ± 19.1	53.3 ± 20.1	.025**	.031*^,**
Mean	62.5 ± 13.8	62.4 ± 14.6	56.6 ± 13.3
BDI	12.9 ± 9.4	14.0 ± 8.5	17.3 ± 10.8	.003*	.009*

AVF: arteriovenous fistula; SD: standard deviation; AVG: arteriovenous graft; CVC: central venous catheter; HRQOL: health-related quality of life; SF-36: short form 36; PCS: physical composite summary; MCS: mental composite summary; BDI: Beck’s depression inventory.

^† Value was obtained from unadjusted regression analysis.

^‡ Value was obtained from regression analysis adjusted for age, sex, type of referral, modified Charlson comorbidity index, and hemoglobin levels.

^* AVF versus CVC.

^** AVG versus CVC.

Table 6. Frequency of annual hospitalization according to the types of vascular access.

Type of vascular access	Annual hospitalization Mean ± SD	p
Initial access
AVF	0.6 ± 1.3	.092
AVG	0.7 ± 1.4
TCVC	0.6 ± 1.4
NTCVC	0.9 ± 2.0
Permanent access
AVF	0.7 ± 1.5	.024
AVG	1.1 ± 1.7

SD: standard deviation; AVF: arteriovenous fistula; AVG: arteriovenous graft; TCVC: tunneled central venous catheter; NTCVC: non-tunneled central venous catheter.