Hi Bob,
Welcome to Home Dialysis Central. I’m glad to hear that you’re considering home hemo–you can learn a lot on this site about why you might feel better, have a less rigid diet, more control over your schedule, a better quality of life–and perhaps even live longer with home dialysis.
You asked:
I’ve heard all the stories about the problems with ports, but it seems like fistulas are not problem free. What is the general consensus here?
Rather than a general consensus, I’d prefer to share a study with you:
Kidney Int. 2001 Oct;60(4):1443-51.
Type of vascular access and mortality in U.S. hemodialysis patients.
Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK.
BACKGROUND: Vascular access (VA) complications account for 16 to 25% of hospital admissions. This study tested the hypothesis that the type of VA in use is correlated with overall mortality and cause-specific mortality. METHODS: Data were analyzed from the U.S. Renal Data System Dialysis Morbidity and Mortality Study Wave 1, a random sample of 5507 patients, prevalent on hemodialysis as of December 31, 1993. The relative mortality risk during a two-year observation was analyzed by Cox-regression methods with adjustments for demographic and comorbid conditions. Using similar methods, cause-specific analyses also were performed for death caused by infection and cardiac causes. RESULTS: In diabetic mellitus (DM) patients with end-stage renal disease, the associated relative mortality risk was higher for those with arteriovenous graft (AVG; RR = 1.41, P < 0.003) and central venous catheter (CVC; RR = 1.54, P < 0.002) as compared with arteriovenous fistula (AVF). In non-DM patients, those with CVC had a higher associated mortality (RR = 1.70, P < 0.001), as did to a lesser degree those with AVG (RR = 1.08, P = 0.35) when compared with AVF. Cause-specific analyses found higher infection-related deaths for CVC (RR = 2.30, P < 0.06) and AVG (RR = 2.47, P < 0.02) compared with AVF in DM; in non-DM, risk was higher also for CVC (RR = 1.83, P < 0.04) and AVG (RR = 1.27, P < 0.33). In contrast to our hypothesis that AV shunting increases cardiac risk, deaths caused by cardiac causes were higher in CVC than AVF for both DM (RR = 1.47, P < 0.05) and non-DM (RR = 1.34, P < 0.05) patients. CONCLUSION: This case-mix adjusted analysis suggests that CVC and AVG are correlated with increased mortality risk when compared with AVF, both overall and by major causes of death.
Simply stated, in a large study, non-diabetic people who had catheters were more than 70% more likely to die than people with fistulas.
Now, I would never try to tell you that fistulas are trouble-free. Folks here who have one will surely say otherwise. But catheters are so prone to causing infection (sepsis–life-threatening blood poisoning) that you truly are risking your life by having one any longer than you absolutely have to.
The fistula is the gold standard for dialysis access because:
– It’s entirely your own tissue, so it’s less prone to inflammation and infection
– Natural blood vessels have a smooth lining that makes them less likely to clot (grafts and catheters are more likely to clot)
– Blood flows for dialysis are typically better
– Natural blood vessels self-heal after each needle stick
– A good fistula can last for decades (grafts probably shouldn’t be used for more than 2-5 years–they become too hole-y; and catheters often need to be changed several times a year)
Does this info help?