UL study shows kidney dialysis patients in Ireland may be at higher risk of hospitalization and infection

A study conducted by researchers at the University of Limerick has found that the treatment used for the majority of kidney failure patients in Ireland can lead to increased rates of hospitalization, infection and even death. .

The study, carried out by a team at the same medical school, found high rates of central venous catheter dependence in Irish patients undergoing hemodialysis, which researchers believe is worse than in patients in other countries. We believe that this may lead to clinical outcomes.

Patients who develop kidney failure rely heavily on the “lifeline” connection between the dialysis machine and the patient's blood vessels. This connection is usually in the form of an arteriovenous fistula (AVF), which is a surgical connection between a vein and an artery within a patient's blood vessels, or a large central venous catheter (CVC), which is an artificial plastic tube inserted into a large vein. Become. Inside the body (usually the veins in the neck).

A new study by UL researchers published in the journal Kidney360 shows that AVF adoption rates among dialysis patients are extremely low, and CVC usage rates are correspondingly high, which may put patients at higher rates of hospitalization and mortality. It turned out that there is.

The study found that Irish patients who started dialysis were more likely to use a catheter than a fistula for treatment (77% vs. 23%), and the proportion of patients with a functioning fistula was lower at the main Irish center. It was shown that there was a large difference between The proportion of patients with fistulae increased only slightly at the end of the first year of dialysis.

International studies have demonstrated that countries with fistula rather than catheter policies have better clinical outcomes for patients than those without.

“Using catheters for hemodialysis increases patient infection rates and increases the risk of clotting problems, hospitalization and even death,” said Dr. Roberts, Foundation Medical Director of UL Medicine and Consultant Nephrologist at University Hospital Limerick. Professor Austin Stack explains: Senior author of the study.

“As a result, national clinical programs and professional societies recommend the use of fistulas rather than catheters for most patients starting hemodialysis. Professor Stack added:

He said the low rates of fistula use and high rates of catheter dependence at the start of dialysis were very worrying and “need to be addressed at a national level.”

The study, funded by the Health Research Board (HRB), looked at 610 patients who started hemodialysis in Ireland between 1 January 2015 and 31 December 2016 and were followed up one year later. Ta.

Lead author Dr Wael Hussein said the study highlighted the need for detailed research into why the incidence of fistulas is so low in Ireland compared to other European countries.

“Our analysis suggests that factors related to the organization and planning of vascular access in individual centers, factors that take place outside the patient area, are responsible for the poor outcomes observed. ” he explained.

“These factors include resourcing the current national hemodialysis program with access to dedicated vascular surgical support and theater time, recruiting vascular nursing experts similar to international centers of excellence, and improving vascular access pathways and quality. This may include high-level coordination to ensure high indicators and “timely implementation,'' Dr. Hussain added.

With over 500 new patients developing kidney failure and requiring dialysis each year in Ireland and over 2,000 patients a year being treated on hemodialysis programmes, Professor Stack said: Programs need to be resourced and empowered to respond to our needs.” patient”.

Dr Máiréad O'Driscoll, CEO of the Health Research Council, added: “We aim to improve people’s health, improve patient care and support research that saves lives. We wish Professor Stack and his team continued success in their research.”