MO785CAUSES OF THE DELAY IN CREATING PERMANENT VASCULAR ACCESS IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Abdulla Al-Sayyari
Keyword(s):  
Vascular Access ◽  
Venous Catheter ◽  
Cross Sectional ◽  
Factors Associated ◽  
Practical Concern ◽  
Significant Difference ◽  
Patient Noncompliance ◽  
Hospital Factors ◽  
Patient Factor ◽  
Main Factor

Abstract Background and Aims Many patients start HD with central venous catheter (CVC) which has multiple complications This study aims at identifying the physicians’ perspectives regarding the reasons of delayed AVF creation Method This is a cross-sectional questionnaires-based survey designed at discovering the physicians' opinions and perception about the reasons for the delay in the creation of permanent vascular access and patient’s factors, physicians factors, and hospital factors leading to this delay, Results There was a total of 212 participants, of whom 131 (61.8%) were of consultant level. The three most important factors associated with delay in AVF creation were “denial of kidney disease or the need of AVF” (76.4%), “dialysis fears and practical concern” (75.9%) and “the patient refusing to undergo AVF surgery” (73.1%). Significantly fewer consultants (42.7%) than below consultants (45.7%) pointed out that “patient noncompliance with nephrology appointments” was a significant factor (p=0.046). The most important physicians & hospital factors was “insufficient conduction of pre-dialysis care and education about AVF initiation to the patient (63.7%) The respondents were asked to choose one of four possible factors that they felt was the main factor in delaying AVF creation. Over two thirds (68.4%) chose the patient factor as the main factor There was no significant difference in this response whether the respondents were consultants or below consultants (p=0.8)) Conclusion The most agreed on factors associated with AVF creation delay are the denial of the need for dialysis, fear of dialysis and practical concern, insufficient conduction of pre-dialysis care and education about AVF initiation to the patient, and late referral to a nephrologist. a validated approach to patients' selection and referral to vascular access creation that could be applied on different types of patient in different regions is required .

scholarly journals Factors associated with physical inactivity among female and male rural adolescents in Borneo – a cross-sectional study

2014 ◽  
Vol 26 (3) ◽  
pp. 447-453 ◽  
Author(s):  
Whye Lian Cheah ◽  
Hazmi Helmy ◽  
Ching Thon Chang
Keyword(s):  
Self Efficacy ◽  
Physical Inactivity ◽  
Cross Sectional Study ◽  
Perceived Barriers ◽  
Anthropometric Measurement ◽  
Rural Adolescents ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Significant Difference

Abstract Rural communities have shown marked increase in metabolic syndrome among young people, with physical inactivity as one of the main contributing factors. This study aimed to determine factors associated with physical inactivity among male and female rural adolescents in a sample of schools in Malaysia. A cross-sectional study was conducted among 145 students aged 13–15 years. Data on socio-demographic, health-related, and psychosocial factors (perceived barriers, self-efficacy, social influences) were collected using a self-administered questionnaire. Anthropometric measurement was taken to generate body mass index (BMI)-for-age, while physical activity (PA) level was assessed using pedometers. The mean steps per day was 6251.37 (SD=3085.31) with males reported as being more active. About 27% of the respondents were either overweight or obese, with more females in this group. There was no significant difference in steps among males and females (p=0.212), and nutritional status (BMI-for-age) (p=0.439). Females consistently scored higher in most items under perceived barriers, but had significantly lower scores in self-efficacy’s items. Males were more influenced by peers in terms of PA (p<0.001) and were more satisfied with their body parts (p=0.047). A significantly higher body size discrepancy score was found among females (p=0.034, CI –0.639, –0.026). PA level was low and almost one-third of the respondents were overweight and obese. Female students faced more barriers and had lower self-efficacy with regards PA. Based on the findings, it is recommended that interventions focus on reducing barriers while increasing support for PA. This is particularly important in improving the health status of the youth, especially among the females.

Abstract 78: Factors Associated with Thrombotic Events During Pregnancy in the United States: NIS 2000-2010

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ali Razmara ◽  
Steven Cen ◽  
Diana L Jin ◽  
Nerses Sanossian ◽  
Amytis Towfighi
Keyword(s):  
Risk Factors ◽  
The United States ◽  
The South ◽  
Targeted Interventions ◽  
Factors Associated ◽  
Thrombosis Risk ◽  
Significant Difference ◽  
Acute Mi ◽  
Hospital Factors ◽  
Peripartum Period

Intro: Thrombosis risk is increased during pregnancy and puerperium. There are no recent data on nationwide trends in thrombotic events during the delivery period. Objective: To determine risk factors for thrombotic events in women hospitalized for deliveries. Methods: Data from the Nationwide Inpatient Sample (2000-2010) were used to identify deliveries. Weighted proportion of pregnancy hospitalizations with comorbid thrombotic events, including TIA, ischemic stroke, hemorrhagic stroke, acute MI, and venous thromboembolism, was determined. Poisson regression was used to identify risk factors for thrombotic events. The first multivariable model adjusted for sociodemographic and hospital factors. The second model in addition adjusted for comorbid conditions. Results: There were 4,305,561 women hospitalized for delivery (21.5 million US deliveries), of which 7,242 (0.17%) had thrombotic events in the peripartum period. From 2000-2010, there was an increase in deliveries with associated thrombotic events observed from 7.46/10K to 34.8/10K. Compared to 2000, deliveries with thromboses was 8-fold more likely in 2010 (RR 7.94, 95% CI 1.98-31.93). There was no significant difference in rates from 2000 to 2010 after adjustment for sociodemographic and hospital factors. From 2000-2010, pregnant women with thrombotic events were older, more likely to be White, to smoke, to lack insurance, to be admitted to rural hospitals, and to be admitted in the South or Midwest. After multivariable adjustment for sociodemographics, hospital factors, and comorbidities, admissions in the South (RR 1.26, 95% CI 1.02-1.55) or Midwest (1.33, 95% CI 1.05-1.68), atrial fibrillation (1.28, 95% CI 1.01-1.62), pre-/eclampsia (5.78, 95% CI 4.37-7.66), dyslipidemia (1.72, 95% CI 1.42-2.09), atrial septal defect (14.38, 95% CI 6.76-30.58), and valvular heart disease (1.67, 95% CI 1.25-2.24) were independently associated with higher risk of thrombotic events. Conclusions: From 2000-2010, there was a sizeable increase in deliveries with associated thrombosis. Identification of factors associated with thrombotic events for women hospitalized for normal pregnancies will aid in targeted interventions to screen for, prevent and treat thrombosis related to pregnancy.

scholarly journals Non-Proteinuric Preeclampsia: Prevalence, Factors Associated and End-Organ Dysfunction at Mbarara Regional Referral Hospital in Southwestern Uganda  

2021 ◽  
Author(s):  
Asiphas Owaraganise ◽  
Wasswa GM Ssalongo ◽  
Leevan Tibaijuka ◽  
Musa Kayondo ◽  
Godfrey Twesigomwe ◽  
...  
Keyword(s):  
Organ Dysfunction ◽  
Complete Blood Count ◽  
Referral Hospital ◽  
Chronic Hypertension ◽  
Care Providers ◽  
Cross Sectional ◽  
Regional Referral Hospital ◽  
Pregnancy Hypertension ◽  
Factors Associated ◽  
Significant Difference

Abstract Background: Formerly, preeclampsia was only diagnosed if high blood pressure and proteinuria were present in a gravid woman at or past 20 gestation weeks. Although it is possible to have preeclampsia yet never have proteinuria, the literature on how common and factors associated with non-proteinuric preeclampsia as well as whether the frequency of end-organ dysfunction among women with non-proteinuric differs from those with proteinuric pre-eclampsia is scant.Objectives: To determine the prevalence of, factors associated with non-proteinuric preeclampsia, and compare the frequency of end-organ dysfunction between women with non-proteinuric and proteinuric preeclampsia.Methods: Between November 2019 and May 2020, women with pre-eclampsia were consecutively enrolled in a cross-sectional study at Mbarara Regional Referral Hospital. We interviewed all pregnant women ≥20 gestation weeks presenting with hypertension ≥140/90mmHg and recorded their socio-demographic, medical, and obstetric characteristics. We excluded women with chronic hypertension and pregnancy hypertension. We measured bedside proteinuria on clean-catch urine, complete blood count, and renal function and liver enzyme tests. Pre-eclampsia was defined as hypertension plus any feature of severity including <100,000 platelets/ul, creatinine >1.1g/dl, and liver transaminases ≥ twice upper normal limit with or without proteinuria. We computed the proportion of total participants with non-proteinuric pre-eclampsia at ≤+2 urine dipstick cut-off, determined the factors associated with non-proteinuric preeclampsia using logistic regression; and used Chi-square test to compare the frequency of end-organ dysfunction between non-proteinuric preeclampsia and proteinuric groups.Results: We enrolled 134 of the screened 136 participants. Their mean age was 26.9 (SD±7.1) years and 51.5% were primigravid. The prevalence of non-proteinuric preeclampsia was 24.6% (95% CI: 17.9-32.7). Primigravidity (aOR 2.70 95%CI:1.09-6.72, p=0.032) was the factor independently associated with non-proteinuric pre-eclampsia. There was a non-significant difference in the frequency of end-organ dysfunction in women with non-proteinuric and proteinuric pre-eclampsia, p=0.309.Conclusion: Non-proteinuric preeclampsia is common, especially among primigravidae. End-organ dysfunction occurs similarly in women with non-proteinuric and proteinuric preeclampsia. Obstetrics care providers should emphasize laboratory testing, beyond proteinuria, among all women with hypertensive disorders of pregnancy to optimally diagnose and manage non-proteinuric preeclampsia.

scholarly journals The Relationship between Mental Health with the Level of Empathy Among Medical Students in Southern Thailand: A University-Based Cross- Sectional Study

2021 ◽  
Vol 73 (12) ◽  
pp. 832-840
Author(s):  
Katti Sathaporn ◽  
Jarurin Pitanupong
Keyword(s):  
Mental Health ◽  
Medical Students ◽  
Protective Factor ◽  
Cross Sectional Study ◽  
Clinical Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Significant Difference ◽  
High Level

Objective: To determine the level of and factors associated with empathy among medical students.Materials and Methods: This cross-sectional study surveyed all first- to sixth-year medical students at the Facultyof Medicines, Prince of Songkla University, at the end of the 2020 academic year. The questionnaires consisted of:1) The personal and demographic information questionnaire, 2) The Toronto Empathy Questionnaire, and 3) ThaiMental Health Indicator-15. Data were analyzed using descriptive statistics, and factors associated with empathylevel were assessed via chi-square and logistic regression analyses.Results: There were 1010 participants with response rate of 94%. Most of them were female (59%). More than half(54.9%) reported a high level of empathy. There was a statistically significant difference in empathy levels betweenpre-clinical and clinical medical students; in regards to empathy subgroups (P-value < 0.001). The assessment ofemotional states in others by demonstrating appropriate sensitivity behavior, altruism, and empathic respondingscores among the pre-clinical group were higher than those of the clinical group. Multivariate analysis indicatedthat female gender, pre-clinical training level, and minor specialty preference were factors associated with empathylevel. The protective factor that significantly improved the level of empathy was having fair to good mental health.Conclusion: More than half of the surveyed medical students reported a high level of empathy. The protective factorthat improved the level of empathy was good mental health. However, future qualitative methods, longitudinalsurveillance, or long-term follow-up designs are required to ensure the trustworthiness of these findings.

scholarly journals Comparison of sensorineural hearing loss characteristics in different hemodialysis vascular accesses

2020 ◽  
Author(s):  
Behieh Kohansall ◽  
Nasser Saeedi ◽  
Moeinoddin Hossein Beigi ◽  
Azam Moslemi ◽  
Akram Valizadeh
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Vascular Access ◽  
Demographic Data ◽  
Life Quality ◽  
Cross Sectional Study ◽  
Sensorineural Hearing ◽  
Moderate Degree ◽  
Cross Sectional ◽  
Significant Difference

Background and Aim: Sensorineural hearing loss (SNHL) is one of the complications in hemodialysis patients. Vascular access (VA) represents a lifeline for these patients affecting their life quality and clinical outcomes. Arterio­venous fistula is the gold standard of VAs with minor complications and better hemodialysis adequacy. There is no study investigating hearing differences in hemodialysis VAs. Hence, this study aimed to compare SNHL characteristics amongst hemodialysis VAs. Methods: This cross-sectional study conducted on 64 patients aged 18−60 years received regular hemodialysis in 2019. Demographic data and comorbid conditions were recorded based on patients’ case records and electronic databases. After a physical examination, otoscopy, tympa­nometry, and conventional audiometry, patients were divided into fistula (n = 26), permanent catheter (n = 36), and temporary catheter (n = 2) groups according to vascular access type. Results: Prevalence rate of SNHL was 63.89%, 50% and 50% in the permanent catheter, fistula and temporary catheter groups, respectively. Most patients had mild sloping-SNHL in the per­manent catheter and fistula groups as against moderate degree in the other group. There was no significant difference in hearing thresholds, deg­ree and audiogram shape among VA groups. No significant relation was found between age, sex, hemodialysis duration and disease duration with hearing loss in all groups (p > 0.05). Conclusion: More patients had SNHL in per­manent catheter group. Vascular access types, longer duration of hemodialysis and disease dur­ation do not seem to be associated with SNHL. However, further investigation is needed to cla­rify the relationship. Keywords: Sensorineural hearing loss; vascular access; chronic renal failure; hemodialysis

scholarly journals FLEBITIS EN NEONATOS EN UN HOSPITAL DE LA PROVINCIA DE EL ORO. MACHALA-ECUADOR

2021 ◽  
Vol 6 (4) ◽  
pp. 30
Author(s):  
Elida Yesica Reyes Rueda ◽  
Melvis Arteaga de Vizcaino ◽  
Jorge Armando García Maldonado ◽  
Tania Diciana Arévalo-Córdova ◽  
Diego Orlando Lanchi Zúñiga
Keyword(s):  
General Hospital ◽  
Venous Catheter ◽  
Chi Square ◽  
Cross Sectional ◽  
Peripheral Venous Catheter ◽  
Prolonged Hospitalization ◽  
Hospitalization Time ◽  
Co Morbidity ◽  
Significant Difference ◽  
Hospital General

Introducción: La flebitis es la inflamación del sistema venoso, con frecuencia ocurre por el uso de catéteres vasculares. Objetivo: Establecer la relación entre la flebitis por catéter venoso periférico y la hospitalización prolongada en los recién nacidos ingresados en el Servicio de Neonatología del Hospital General Teófilo Dávila. Métodos: Estudio observacional, descriptivo, transversal y prospectivo, realizado en el Hospital General Teófilo, Cantón Machala, Ecuador señalado, durante el 2018–2019. La muestra fue de 87 neonatos y la información recogida permitió la caracterización de neonatos y sus madres, frecuencia de flebitis y factores de riesgo para su aparición. Los datos se analizaron con estadística descriptiva e inferencial chi-cuadrado (chi2).  Resultados: de los 87 neonatos, el 60,92% eran varones, 56,32% pretérmino, 85,05% con peso adecuado para edad gestacional, 73,56% ingresados 6 días o más y 56,32% (49 neonatos) presentó flebitis, de estos últimos, los varones con diferencia significativa con respecto a las hembras (p<0,05) y el peso adecuado (37,93%) fue significativamente mayor (p<0,01). La co-morbilidad neonatal que predominó en los neonatos con flebitis fue la prematuridad con 42,86%( CI 95%, p<0,005) y el síndrome de dificultad respiratoria 18.37%. El 79,30% recibió solo una punción para la cateterización, 100% recibieron antibióticos, 75,55% presentaron flebitis grado 1 con una asociación significativa (p<0,001) entre el tiempo de hospitalización y la flebitis. Conclusiones: Existe un predominio de niños prematuros que desarrollan flebitis y una relación significativamente estadística, entre el tiempo de hospitalización de los niños recién nacidos y aparición de flebitis. Palabras clave: Flebitis, catéter, neonato, recién nacido, hospitalización prolongada  ABSTRACT Introduction: Phlebitis is the inflammation of the venous system, frequently occurs due to the use of vascular catheters. Objective: To establish the relationship between peripheral venous catheter phlebitis and prolonged hospitalization in newborns admitted to the Neonatology Service of the Teófilo Dávila General Hospital. Methods: Observational, descriptive, cross-sectional and prospective study, carried out at the Teófilo General Hospital, Cantón Machala, Ecuador indicated, during 2018-2019. The sample consisted of 87 neonates and the information collected allowed the characterization of neonates and their mothers, frequency of phlebitis and risk factors for its appearance. The data were analyzed with descriptive and inferential chi-square (chi2) statistics. Results: of the 87 neonates, 60.92% were male, 56.32% preterm, 85.05% with adequate weight for gestational age, 73.56% admitted for 6 days or more, and 56.32% (49 neonates) presented phlebitis, of the latter, males with a significant difference compared to females (p<0.05) and adequate weight (37.93%) was significantly higher (p <0.01). The neonatal co-morbidity that predominated in neonates with phlebitis was prematurity with 42.86% (CI 95%, p<0.005) and respiratory distress syndrome 18.37%. 79.30% received only one puncture for catheterization, 100% received antibiotics, 75.55% presented grade 1 phlebitis with a significant association (p <0.001) between hospitalization time and phlebitis. Conclusions: There is a predominance of premature children who develop phlebitis and a statistically significant relationship between the hospitalization time of newborn children and the appearance of phlebitis. Keywords:  Phlebitis, catheter, neonate, newborn, prolonged hospitalization

Determinants of venous catheter hemodialysis onset and subsequent switch to arteriovenous fistula: An epidemiological study in Lazio region

2020 ◽  
pp. 112972982095994
Author(s):  
Luigi Tazza ◽  
Laura Angelici ◽  
Claudia Marino ◽  
Anteo Di Napoli ◽  
Maurizio Bossola ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Regression Models ◽  
Venous Catheter ◽  
Organizational Factors ◽  
Hemodialysis Patients ◽  
Lower Probability ◽  
First Year ◽  
Lazio Region ◽  
Factors Associated

Background: The factors associated with the inability to start hemodialysis with an arteriovenous fistula (AVF) in chronic kidney disease patients are not fully understood. Aim: Evaluating factors associated with type of vascular access at the first chronic hemodialysis and at 1 year after it. Methods: The study cohort includes patients registered in the Regional Dialysis and Transplant Registry of Lazio undergoing first hemodialysis between 2008 and 2015. Logistic regression models were used to evaluate the association between socio-demographic, clinical and care/organizational factors, and vascular access at first hemodialysis. Cox regression models were used to assess the odds of switching to AVF during the first year of hemodialysis among patients starting dialysis with central venous catheter (CVC). Results: In the cohort of 6208 incident hemodialysis patients, 52.7% had an AVF and 47.3% had a CVC. Among the 2939 incident patients with CVC, 27.4% switched to FAV after 1 year. A higher probability of starting dialysis with AVF was observed among males (OR = 1.83; 95% CI 1.63–2.06), while a lower probability was observed among patients aged >85 years (OR 0.64; IC 95% 0.51–0.80). Patients with early referral to a nephrologist had a triple probability of start dialysis with AVF. We observed a higher odds of switch to AVF among males (HR = 1.62; 95% CI 1.40–1.89) and a lower odds among patients over 65 years. Conclusion: The observed high rate of AVF at the start of hemodialysis and of the switch from CVC to AVF in the first year, although declining since 2008, is a positive outcome. However, over one-third of patients maintain the CVC as vascular access for the first year because of unmodifiable factors, such as gender, age, comorbidity. The present study suggests that logistics/management and assistance/welfare problems may contribute to the delay or lack of AVF placement in incident hemodialysis patients or within the first year of dialysis.

Risk Factors of Preeclampsia among Pregnant Women in Khorramabad (West of Iran)

2020 ◽  
Vol 16 (4) ◽  
pp. 313-317
Author(s):  
Mahnaz Mardani ◽  
Farshad Teymouri ◽  
Maryam Rezapour
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Cross Sectional Study ◽  
Smoking History ◽  
Cross Sectional ◽  
Factors Associated ◽  
Significant Difference ◽  
Spss Software ◽  
Health Care Centers ◽  
Risk Of Preeclampsia

Background: Preeclampsia occurs in 2-10% of pregnancies, worldwide, and is characterized as a combination of hypertension and proteinuria. Objective: The purpose of this study is to determine the risk factors associated with the incidence of preeclampsia in the west of Iran and associated factors. Methods: This is a cross sectional study that was performed on 740 pregnant women between 2014- 2017, who were referred to different health care centers of Khorramabad. The data was collected from these centers and a questionnaire was filled for every woman that included age, height, gender of the neonate, number of pregnancies, multiparity, season of the pregnancy, birth weight, mothers’ body mass index (BMI) before delivery, smoking history and diagnosis of preeclampsia. The data obtained was statistically analyzed using SPSS software. Results: Of the 760 subjects included, 1.1% (8 cases) were reported to be presented with preeclampsia. We found a significant difference between non pre-eclamptic and pre-eclamptic patients in terms of BMI (p=0.006), number of pregnancies (p<0.05), maternal age (p<0.05) and weight (p=0.004). With an increase in BMI and the number of pregnancies, the risk of preeclampsia was elevated. Pre-eclamptic mothers had higher body weight than non-pre-eclamptic ones (75.9 kg vs. 65.6 kg) and the prevalence of preeclampsia increased with age. Conclusion: The prevalence of preeclampsia was seen to be positively associated with higher BMI, pregnancy rate, mother weight and age are associated with higher prevalence of preeclampsia.

scholarly journals Outcomes of Automated Auditory Evoked Potential Performed in Different Settings and the Factors Associated with Referred Cases

2017 ◽  
Vol 22 (04) ◽  
pp. 342-347
Author(s):  
Daniela Silva ◽  
Georgea Ribeiro ◽  
Gustavo Castilho ◽  
Jair Mantovani
Keyword(s):  
Hearing Loss ◽  
Evoked Potential ◽  
Cross Sectional Study ◽  
Auditory Evoked Potential ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Hearing Status ◽  
Significant Difference ◽  
Age Of Diagnosis

Introduction For the population with risk factors for hearing loss, the first option to assess the hearing status is the performance of the automated brainstem auditory evoked potential (BAEP) test because of its efficacy in identifying retrocochlear hearing loss. Objective To verify the outcomes of automated BAEP performed in different settings as well as the factors associated with the prevalence of hearing impairment. Methods Cross-sectional study conducted from October of 2014 to May of 2015. The sample consisted of 161 infants with at least one risk factor for hearing loss who underwent automated BAEP during the hospital stay or at the outpatient clinic. After 30 days, the altered cases were referred for BAEP diagnosis. Results One hundred and thirty-eight infants (86%) had a result of “pass” and 23 (14%) of “failure” in the automated BAEP. There was no statistically significant difference in the rate of “referred” results between examinations performed in different settings. The infants' ages did not influence the number of abnormal cases. All of the 23 infants who presented a “referred” result in the automated BAEP, unilateral or bilateral, were sent for BAEP diagnosis, and out of these, 9 (39%) remained with at least some degree of alteration. The average age of diagnosis was 2.7 months. Conclusion The results of the automated BAEP were similar when performed during hospitalization or after discharge. Neither the age at the examination nor the gender of the patient influenced the prevalence of hearing loss.

P1325VASCULAR ACCESS OUTCOMES IN A FRAIL HAEMODIALYSIS POPULATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Alice Radley ◽  
Wan Wong ◽  
Tara Collidge ◽  
Peter Thomson
Keyword(s):  
Vascular Access ◽  
Demographic Data ◽  
Venous Catheter ◽  
Blood Cultures ◽  
Dialysis Access ◽  
Local Data ◽  
Clinical Frailty Scale ◽  
Significant Difference ◽  
Bed Days

Abstract Background and Aims Current guidelines recommend the pursuit of arteriovenous (AV) access over central venous catheter (CVC) access in haemodialysis (HD) populations. The limitations of this approach are increasingly recognised, and are particularly relevant when considering frail patients with relatively high levels of comorbidity and limited life expectancy. In such patients AV access may incur more invasive procedures, whereas CVC access may incur heightened risks of infection. This study aimed to evaluate the association between HD access modality and access complications, hospitalisation and mortality in a cohort of HD patients with frailty. Method We performed a retrospective analysis of prospectively recorded data from the Strathclyde Electronic Renal Patient Record concerning HD patients from 01/10/2017 to 21/09/2019. HD patients with a Rockwood clinical frailty scale (CFS) ≥6 were identified with baseline demographic data being recorded from date of first CFS ≥6 to census date 21/09/19 or death. We recorded the first vascular access modality at study inception and the modality at the time of census or death. Episodes of TCVC associated sepsis were determined using both clinical diagnosis in patient case records and positive blood cultures. Episodes were regarded as separate where positive blood cultures occurred ≥14 days apart. An inpatient admission was regarded as a discharge date ≥24 hours following admission. These were then further categorised as unscheduled or elective. Results 139 patients were identified with CFS ≥6. Median age was 72 years and 51% were female. Median follow-up was 1.1 years with total 50861 observed HD days. 52.3% patients were deceased at census. Table 1 illustrates vascular access modality at initial CFS. CVC accounted for the greatest proportion of dialysis access days (50.3%) compared to AVF (40.7%) and AVG (8.9 %). There was no significant difference in mortality between vascular access modalities over the follow-up period (50.7% CVC; 55% AVF; 54.5% AVG, p=0.18). In total, 5244 HD exposed days (10.3%) were spent as an inpatient during follow-up, of which 5120 (98%) were unscheduled and 119 (2%) were elective. The AVG group had the highest rate of inpatient bed days (138/1000 HD days) when compared to CVC (107/1000 HD days) and AVF (94/1000 HD days). Both AVG and CVC were associated with more inpatient bed days than AVF (p&lt;0.0001 for each). Patients who started with CVC and transitioned to AV access had a rate of 86/1000 HD days. This was significantly lower than those who remained CVC throughout (p=0.0001). There were 24 recorded events of CVC associated sepsis during follow-up, occurring at a rate of 0.8 per 1000 HD days. Rates of CVC associated sepsis were similar between CFS 6 (0.6 per 1000 HD days) and CFS 7 (1.1 per 1000 HD days), p=0.21. The CVC associated staphylococcus aureus bacteraemia (SAB) rate for the overall population was 0.2 per 1000 HD days. AVG sepsis occurred at a rate of 0.2 per 1000 HD days and there were no incidences of AVF sepsis in those who continued with AVF throughout the follow-up period. Conclusion CVC was the most prevalent access modality in this frail HD population. Rates of CVC associated sepsis and SAB were similar to published bloodstream infection rates and existing local data (Murray et al QJM 2014). Although absolute events were low, increasing frailty from CFS 6 “moderately frail” to CFS 7 “severely frail” did not appear to influence rate of CVC associated sepsis. Patients with CVC and AVG had greater inpatient bed days than those with AVF. Transitioning from CVC to AV access reduced inpatient bed days. However, the choice of vascular access modality did not influence mortality overall.

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