Morbimortalidad en hemodiálisis en función del acceso vascular. Una revisión bibliográfica

Objectives: To examine by literature review the morbidity and mortality associated with vascular access, analyze current trends in the type of access of Spanish hemodialysis units, determine the factors that influence their choice and show the importance of the arteriovenous fistula as vascular access. Methodology: We have designed a cross-sectional study by reviewing the scientific literature between 2008 and 2014. Results: The reviewed studies show that compared with arteriovenous fistula, central venous catheters have a higher relative risk of death and more severe comorbidity that increases with time. There is also an inverse relationship between the probability of starting dialysis with a permanent vascular access and the time from patient referral to assessment by the surgeon, as well as from the evaluation by the surgeon to the construction of vascular access. Conclusions: The arteriovenous fistula has proved the most reliable and durable vascular access being by this reason the vascular access for excellence. In recent years it has not been possible to achieve the goals outlined in the guidelines with regard to the prevalence and incidence of vascular access. The high morbidity associated with the initiation in hemodialysis with a central venous catheter requires the reduction of their use. The cause of current excess is multifactorial, so it is necessary to act simultaneously at various levels being crucial to refer the patient on time to allow the completion time of the arteriovenous fistula.