Vascular Access in Patients Treated With Chronic Hemodialysis for 30 Years or More

The aim of our study was to evaluate vascular access in patients treated with chronic hemodialysis for 30 years or more. Patients who had started dialysis in 1978 or earlier were identified from the Slovenian Renal Replacement Therapy Registry. The data on vascular access on April 2008 are presented. Sixteen patients were still alive, seven men and nine women aged 62 +/- 12 years (46-84), and they had been treated for 32 +/- 1.7 years (30-35), mainly with chronic HD. They had started HD at the age of 30 +/- 12 years (13-50), and none had diabetes. The vascular access in nine was a native arteriovenous (AV) fistula, on the forearm in eight patients, and a brachiobasilic fistula in one patient. Four patients had their primary AV fistulas still in use (maximum 35 years). In the remaining five patients, multiple salvage procedures had been performed or new AV fistulas created. The vascular access in four patients was the polytetrafluoroethylene (PTFE) graft, functioning for 1-8 years. In three patients, a non-cuffed, single-lumen hemodialysis catheter (a precurved jugular in two patients and a subclavian in one) locked with 30% citrate, with mupirocin at the exit site, was used for 5-12 years. The catheters were exchanged approximately once every two years over a guide-wire because of mechanical damage. None of these three patients had had catheter-related sepsis or exit-site infection. Before catheters, these patients had had multiple AV fistulas and PTFE grafts. Although native AV fistula is the predominant type of vascular access, a greater than 30-year survival on hemodialysis is possible with the combined use of AV fistula, PTFE graft, and a non-cuffed hemodialysis catheter locked with citrate.