Permanent dialysis access placement in pre-ESRD patients: The relation to patient characteristics

Despite intense efforts, the morbidity and mortality of dialysis patients r emain high. One important factor in improving patient outcome is having per manent dialysis access placed pre-end-stage renal disease (pre-ESRD). The p urpose of this study was to determine whether there are characteristics ass ociated with pre-ESRD permanent access placement. Also, short- and long-ter m outcomes based on pre-ESRD permanent access placement were analyzed. A re trospective study of adult patients with chronic renal failure who began ch ronic maintenance dialysis (i.e., hemodialysis or peritoneal dialysis) at t he University of Rochester Medical Center in 1997 was performed. These 51 p atients were divided into two groups. those who had an attempt at or placem ent of a pre-dialysis permanent access, and those who did not have an attem pt at pre-dialysis permanent access placement Individual patient demographi cs, clinical characteristics, clinic visits, and short- and long-term outco mes were analyzed. The significant findings between the two groups of patie nts were: Il late referral (i.e., referral within 1 month of dialysis initi ation (p<0.05); 2) number of clinic visits attended (p<0.01); and 3) need f or inpatient dialysis (p<0.01). At least in this patient population, there does not appear to be any specific patient characteristic associated with a lower likelihood of pre-ESRD permanent access placement. Also, long-term o utcomes (renal replacement modality and survival) did not differ between th e two groups.