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.
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?