The associations of hemodialysis access type and access satisfaction with health-related quality of life

Abstract

Objective: In addition to age and comorbidities, health-related quality of life (HRQOL) is known to predict mortality in hemodialysis (HD) patients. Understanding the association of vascular access type with HRQOL can help surgeons to provide patient-centered dialysis access recommendations. We sought to understand the impact of HD access type on HRQOL.

Methods: We conducted a cross-sectional prospective study of community-dwelling prevalent HD patients in Pittsburgh, Pennsylvania. We assessed patient satisfaction with their access using the Vascular Access Questionnaire (VAQ) and HRQOL with the Short Form Health Survey. We compared access satisfaction and HRQOL across access types. We used logistic regression modeling to evaluate the association of access type with satisfaction and multivariate analysis of variance to evaluate the association of both of these variables on HRQOL.

Results: We surveyed 77 patients. The mean age was 61.8 ± 15.9 years. Arteriovenous fistula (AVF) was used by 62.3%, tunneled dialysis catheter (TDC) by 23.4%, and arteriovenous graft (AVG) by 14.3%. There was a significant difference in satisfaction by access type with lowest median VAQ score (indicating highest satisfaction) in patients with AVF followed by TDC and AVG (4.5 vs 6.5 vs 7.0; P = .013). Defining a VAQ score of <7 to denote satisfaction, AVF patients were more likely to be satisfied with their access, compared with TDC or AVG (77% vs 56% vs 55%; P = NS). Multivariate regression analysis yielded a model that predicted 46% of the variance of VAQ score; important predictors of dissatisfaction included <1 year on dialysis (β = 3.36; P < .001), increasing number of access-related hospital admissions in the last year (β = 1.69; P < .001), and AVG (β = 1.72; P = .04) or TDC (β = 1.67; P = .02) access. Mean physical and mental QOL scores (the composite scores of Short Form Health Survey) were not different by access type (P = .49; P = .41). In an additive multivariate analysis of variance with the two composite QOL scores as dependent variables, 25.8% of the generalized variance in HRQOL (effect size) was accounted for by access satisfaction with only an additional 3% accounted for by access type.

Conclusions: HD patients experience greatest satisfaction with fistula, and access satisfaction is significantly associated with better HRQOL. Controlling for access satisfaction, there is no significant independent association of access type on HRQOL. Future research should investigate the relationship between access satisfaction, adherence to dialysis regimens, mortality, and the consequent implications for patient-centered care.

Conflict of interest statement

Author conflict of interest: none.

The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.

Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Figures

Fig 1.

There was a significant difference in satisfaction by access type with lowest median Vascular Access Questionnaire (VAQ) score (indicating highest satisfaction) in patients with arteriovenous fistula (AVF). Significant differences are indicated by asterisks. By domain, patients with catheters were least bothered by physical symptoms, including pain, bleeding, swelling, and bruising. Patients with catheters were most dissatisfied with dialysis-related complications, such as their vascular access not working, their access being difficult to care for, or being worried about requiring hospitalization or replacement of the access. Arteriovenous graft (AVG) access type was associated with most dissatisfaction with access interference with social functioning.

Fig 2.

When dividing patients into binary groups, arteriovenous fistula (AVF) patients were overall much more likely to be satisfied with their access, compared with tunneled dialysis catheter (TDC) or arteriovenous graft (AVG).

Fig 3.

There was no difference in either quality of life (QOL) summary score by access type (P = nonsignificant). SF-36, Short Form-36.

Fig 4.

Directional arrows represent hypothesized causal pathways. Coefficients of significant relationships are displayed. Other pathways were found to be nonsignificant. Access type was found to have a nonsignificant direct relationship with health-related quality of life (HRQOL). Access satisfaction mediated the effect of access type on HRQOL. HD, hemodialysis.