Type of vascular access and location in end-stage renal disease patients under online-hemodiafiltration and its association with patient's perception of health-related quality of life

Introduction and Aims: A functional vascular access is required for a successful dialysis procedure. The lack of major advances in the field of vascular access for dialysis explains that vascular access dysfunction is still one of the most important causes of morbidity in dialysis population. Arteriovenous fistula (AVF) is the recommended form of vascular access; by this reason, most of dialysis patients use AVF as vascular access. There is, however, a lack of information about the impact of the type of vascular access and about AVF localization on patient's perception of health-related quality of life (HRQoL), particularly in end-stage renal disease (ESRD) patients under online-hemodiafiltration. The aim of this work was to evaluate the patient-reported HRQoL, according to the type and location of vascular access used. Methods: In this transversal study were enrolled 322 ESRD patients under online-hemodiafiltration. AVF was used by 252 patients (78%), whereas 70 patients (22.8%) had a central venous catheter (CVC). Besides AVF location, data about comorbidities, hemoglobin concentration, dialysis adequacy and inflammatory markers, we performed a patient's reported health status and quality of life score, by using the Kidney Disease Quality of Life-Short Form (KDQOL-SF). Results: No differences were found between the two groups of ESRD patients (AVF vsCVC) for hemoglobin concentration, C-reactive protein, dialysis adequacy and in the prevalence of diabetes. However, patients with AVF showed a significant improvement, not only in physical but also mental aspects of HRQoL, namely in cognitive function (p=0.046), quality of social interactions (p=0.044), physical functioning (p<0.001), emotional well-being (p=0.029), role-emotional (p=0.008) and energy/fatigue (p=0.014). When comparing patient's reported health status and quality of life scores by AVF location, we found a significant increase in general health perception in ESRD patients using AVF in the right upper-arm, when compared with those using AVF in the left upper-arm. Conclusions: Our results showed that the ESRD patients under online-hemodiafiltration using AVF as vascular access had higher HRQoL in several domains when compared to patients with CVC. Additionally, we also found that dialysis patients using AVF in right upper-arm presented lower HRQoL perception in general health.