Temporary vascular access for first dialysis is common, undesirable and usually avoidable

Backround: When technically feasible, patients with end-stage renal failure should commence regular dialysis treatment with permanent access to the ci rculation (by arteriovenous fistula) or peritoneum (by soft peritoneal cath eter) in situ, thus avoiding the need for initial hemodialysis employing te mporary vascular access, We have examined thr frequency, consequences and a voidability of temporary access in such patients, Methods: 178 patients com mencing regular dialysis between August 1993 and April 1995 were analysed r etrospectively using case notes. Patients were divided into those who had p ermanent dialysis access in situ when they commenced dialysis and those who required temporary access. If temporary access was required, the patients were further analysed into those who had been first seen by a nephrologist at least 12 weeks before the first dialysis. and those who had been referre d "late". It was assumed that 12 weeks was sufficient time for permanent ac cess to be instituted, Mortality within the first 90 days of commencing dia lysis was recorded. Results: Seventy-four of 82 patients opting for regular hemodialysis and 53 of 96 opting for peritoneal dialysis required temporar y vascular access, Late referral accounted for 47 and delays within the ren al service for 35 of such patients, Late presentation to the medical profes sion or indecisiveness on the part of the patient accounted for the remaind er. Twenty-five of 127 patients requiring temporary access but only one or 51 patients not requiring it died within 90 days of commencement of treatme nt, Conclusion: Late presentation to a renal unit prior to first dialysis i s associated with increased mortality. Late referral or late presentation a re associated with an increased need for temporary vascular access for firs t dialysis. Many patients who require temporary access for first dialysis c ould have been better managed.