Background
Methods
Statistical methods
Results
Demographics
Total N | VAQ Score | ||||
---|---|---|---|---|---|
N (%) |
Mean
|
Median (IQR)
|
p-Value
| ||
Age (Years) | 749 |
<0.001*
| |||
<55 | 175 (23.4%) | 7.7 | 6 (2–11) | ||
55–64 | 183 (24.4%) | 6.2 | 4 (1–8) | ||
65–74 | 178 (23.8%) | 4.9 | 3 (1–7) | ||
75+ | 213 (28.4%) | 3.8 | 3 (1–6) | ||
Gender | 749 |
<0.001
| |||
Female | 316 (42.2%) | 6.7 | 5 (2–10) | ||
Male | 433 (57.8%) | 4.7 | 3 (1–7) | ||
Ethnicity | 748 |
<0.001
| |||
White | 369 (49.3%) | 5.5 | 4 (2–8) | ||
Asian | 252 (33.7%) | 5.2 | 3 (0–7) | ||
Black | 124 (16.6%) | 6.4 | 5 (2–10) | ||
Mixed | 3 (0.4%) | 4.7 | 3 (3–8) | ||
Peripheral Vascular Disease | 749 |
0.011
| |||
No | 641 (85.6%) | 5.3 | 3 (1–8) | ||
Yes | 108 (14.4%) | 7.2 | 5 (2–10) | ||
Cardiac disease | 749 | 0.055 | |||
No | 503 (67.2%) | 5.2 | 3 (1–7) | ||
Yes | 246 (32.8%) | 6.2 | 4 (1–9) | ||
Diabetes | 749 | 0.195 | |||
No | 450 (60.1%) | 5.8 | 4 (1–9) | ||
Diet Controlled | 66 (8.8%) | 4.2 | 3 (1–6) | ||
Tablet Controlled | 42 (5.6%) | 4.0 | 3 (0–7) | ||
Insulin | 191 (25.5%) | 5.8 | 4 (1–8) | ||
Unit | 749 |
<0.001
| |||
Unit 1 | 43 (5.7%) | 3.6 | 2 (0–4) | ||
Unit 2 | 90 (12.0%) | 4.5 | 3 (1–7) | ||
Unit 3 | 116 (15.5%) | 4.6 | 3 (0–7) | ||
Unit 4 | 68 (9.1%) | 5.1 | 4 (2–8) | ||
Unit 5 | 79 (10.5%) | 5.3 | 3 (1–7) | ||
Unit 6 | 72 (9.6%) | 5.3 | 3 (1–7) | ||
Unit 7 | 96 (12.8%) | 6.1 | 5 (2–8) | ||
Unit 8 | 75 (10.0%) | 6.3 | 4 (1–9) | ||
Unit 9 | 56 (7.5%) | 7.8 | 7 (2–12) | ||
Unit 10 | 54 (7.2%) | 7.6 | 7 (4–12) | ||
Years of Haemodiaysis | 748 | 0.235* | |||
<2 | 188 (25.1%) | 5.1 | 3 (1–8) | ||
2–3 | 197 (26.3%) | 5.2 | 3 (1–7) | ||
4–7 | 188 (25.1%) | 6.0 | 4 (2–9) | ||
8+ | 175 (23.4%) | 5.7 | 4 (1–8) |
Total | VAQ Score | ||||
---|---|---|---|---|---|
N | N (%) |
Mean
|
Median (IQR)
| p-Value | |
Current Mode of Vascular Access | 749 |
0.004
| |||
AVF | 539 (72.0%) | 5.1 | 3 (1–7) | ||
AV graft | 34 (4.5%) | 7.2 | 5 (3–10) | ||
CVC | 174 (23.2%) | 6.6 | 5 (1–9) | ||
CVC and Fistula | 2 (0.3%) | 10.0 | 10 (10–10) | ||
Duration of Current Access? | 748 |
0.003*
| |||
<1 month | 19 (2.5%) | 8.9 | 8 (4–12) | ||
1 month - 6 months | 101 (13.5%) | 6.2 | 4 (2–9) | ||
6 months − 12 months | 98 (13.1%) | 7.1 | 5 (1–11) | ||
over 1 year | 530 (70.9%) | 5.0 | 3 (1–7) | ||
Current Fistula** | 538 | 0.229 | |||
Brachiobasilic | 53 (9.9%) | 5.6 | 3 (2–8) | ||
Brachiocephalic | 273 (50.7%) | 5.2 | 3 (1–7) | ||
Radiocephalic | 212 (39.4%) | 4.7 | 3 (1–7) | ||
Current Graft** | 34 | 0.090 | |||
Lower arm | 2 (5.9%) | 1.5 | 2 (0–3) | ||
Upper arm | 27 (79.4%) | 7.0 | 5 (2–9) | ||
Upper leg | 5 (14.7%) | 10.4 | 12 (10–13) | ||
Current CVC** | 174 | 0.120 | |||
Femoral | 15 (8.6%) | 10.9 | 10 (2–19) | ||
Jugular | 154 (88.5%) | 6.3 | 5 (2–9) | ||
Other | 5 (2.9%) | 6.4 | 7 (1–8) | ||
Fistula/Graft on Dominant Arm*** | 570 | 0.341 | |||
No | 445 (78.1%) | 5.2 | 3 (1–7) | ||
Yes | 125 (21.9%) | 5.2 | 3 (2–7) | ||
Does This Cause Issues?**** | 125 |
0.002
| |||
No | 88 (70.4%) | 4.3 | 3 (1–7) | ||
Yes | 37 (29.6%) | 7.4 | 6 (3–8) |
Total | VAQ Score |
p-Value
| |||
---|---|---|---|---|---|
N | N (%) |
Mean
|
Median (IQR)
| ||
Any Previous Access** | 749 |
<0.001
| |||
No | 601 (80.2%) | 5.0 | 3 (1–7) | ||
Yes | 148 (19.8%) | 7.8 | 6 (2–12) | ||
Previous CVC** | 749 |
<0.001
| |||
No | 644 (86.0%) | 5.2 | 3 (1–7) | ||
Yes | 105 (14.0%) | 7.9 | 6 (3–12) | ||
Previous Fistula** | 749 | 0.903 | |||
No | 712 (95.1%) | 5.5 | 4 (1–8) | ||
Yes | 37 (4.9%) | 6.9 | 4 (1–7) | ||
Previous Graft** | 749 | 0.194 | |||
No | 737 (98.4%) | 5.5 | 4 (1–8) | ||
Yes | 12 (1.6%) | 8.3 | 7 (2–13) | ||
Number of Previous CVC | 748 |
<0.001*
| |||
0 | 244 (32.6%) | 4.7 | 3 (1–7) | ||
1 to 5 | 437 (58.4%) | 5.4 | 4 (1–8) | ||
6 to 10 | 47 (6.3%) | 9.6 | 7 (3–14) | ||
>10 | 20 (2.7%) | 9.8 | 8 (3–18) | ||
Radiological Intervention | |||||
On Graft/Fistula*** | 575 |
<0.001
| |||
No | 428 (74.4%) | 4.6 | 3 (1–7) | ||
Yes | 147 (25.6%) | 7.0 | 5 (2–10) | ||
On CVC*** | 175 | 0.760 | |||
No | 139 (79.4%) | 6.5 | 5 (2–9) | ||
Yes | 36 (20.6%) | 7.6 | 6 (1–11) |
Total | VAQ Score |
p-Value
| |||
---|---|---|---|---|---|
N | N (%) |
Mean
|
Median (IQR)
| ||
Satisfaction with Current Access | 748 |
<0.001*
| |||
Very Dissatisfied | 4 (0.5%) | 8.0 | 8 (5–11) | ||
Somewhat Dissatisfied | 17 (2.3%) | 11.1 | 9 (6–15) | ||
Somewhat Satisfied | 83 (11.1%) | 10.3 | 8 (5–15) | ||
Very Satisfied | 644 (86.1%) | 4.8 | 3 (1–7) | ||
Recommend Current Access | 748 |
<0.001*
| |||
No | 37 (4.9%) | 8.6 | 6 (4–12) | ||
Maybe Not | 29 (3.9%) | 7.9 | 9 (3–11) | ||
Maybe | 59 (7.9%) | 7.5 | 6 (2–12) | ||
Yes | 623 (83.3%) | 5.1 | 3 (1–7) | ||
Access Easy to Use? | 747 |
<0.001*
| |||
Very Difficult | 3 (0.4%) | 22.0 | 19 (7–40) | ||
Somewhat Difficult | 23 (3.1%) | 11.2 | 9 (6–15) | ||
Somewhat Easy | 112 (15.0%) | 7.1 | 6 (2–9) | ||
Very Easy | 609 (81.5%) | 5.0 | 3 (1–7) | ||
Which do Nurses Prefer? | 744 | 0.352 | |||
AVF | 270 (36.3%) | 5.5 | 3 (1–7) | ||
Equally Happy | 177 (23.8%) | 5.7 | 4 (1–8) | ||
CVC | 71 (9.5%) | 5.8 | 5 (2–9) | ||
Not Sure | 226 (30.4%) | 5.4 | 4 (1–8) | ||
Which is Better for Your Health? | 748 | 0.414 | |||
AVF | 553 (73.9%) | 5.7 | 4 (1–8) | ||
No Difference | 39 (5.2%) | 4.7 | 4 (0–7) | ||
CVC | 52 (7.0%) | 4.4 | 3 (1–6) | ||
Not Sure | 104 (13.9%) | 5.3 | 4 (2–7) |
Factors associated with the VAQ score
OR (95% CI) | p-Value | |
---|---|---|
Age (per Decade) | 0.70 (0.61–0.79) |
<0.001
|
Gender (Female) | 2.23 (1.55–3.22) |
<0.001
|
Ethnicity | 0.168 | |
White | – | – |
Asian | 0.74 (0.44–1.25) | 0.262 |
Black | 1.39 (0.80–2.42) | 0.246 |
Mixed | 1.29 (0.09–18.16) | 0.849 |
Peripheral Vascular Disease | 1.44 (0.87–2.39) | 0.158 |
Cardiac disease | 1.69 (1.13–2.52) |
0.010
|
Diabetes | 0.482 | |
No | – | – |
Diet Controlled | 0.59 (0.28–1.24) | 0.162 |
Tablet Controlled | 0.68 (0.27–1.70) | 0.408 |
Insulin | 0.95 (0.61–1.49) | 0.829 |
Unit |
0.026
| |
Unit 1 | – | – |
Unit 2 | 1.82 (0.57–5.81) | 0.313 |
Unit 3 | 2.08 (0.65–6.69) | 0.218 |
Unit 4 | 2.95 (0.92–9.50) | 0.069 |
Unit 5 | 2.92 (0.92–9.25) | 0.069 |
Unit 6 | 1.97 (0.57–6.83) | 0.285 |
Unit 7 | 2.31 (0.73–7.33) | 0.154 |
Unit 8 | 3.60 (1.15–11.28) |
0.028
|
Unit 9 | 4.96 (1.53–16.11) |
0.008
|
Unit 10 | 6.12 (1.91–19.62) |
0.002
|
Duration of Haemodialysis (per Year) | 1.02 (0.98–1.06) | 0.390 |
Current Access | 0.767 | |
AVF | – | – |
AV graft | 1.38 (0.58–3.25) | 0.467 |
Tunnelled CVC | 1.03 (0.62–1.71) | 0.901 |
Duration of Current Access | 0.124 | |
<1 month | 2.71 (0.93–7.88) | 0.067 |
1 month - 6 months | 1.25 (0.70–2.26) | 0.450 |
6 months − 12 months | 1.66 (0.97–2.87) | 0.066 |
over 1 year | – | – |
Radiology Intervention in the Last Year | 1.75 (1.16–2.63) |
0.007
|
Number of Previous CVC | 0.474 | |
0 | – | – |
1 to 5 | 0.93 (0.60–1.42) | 0.725 |
6 to 10 | 1.63 (0.72–3.67) | 0.239 |
>10 | 0.89 (0.28–2.87) | 0.847 |
Components of the VAQ score
Mean Score for the VAQ Question Relating to: | ||||||||
---|---|---|---|---|---|---|---|---|
Bleeding
|
Pain
|
Bruising
|
Swelling
|
Redness
|
Infection
|
Clotting
|
Appearance
| |
Age (Years) |
p = 0.071
|
p = 0.283
|
p = 0.232
|
p = 0.921
|
p = 0.328
|
p = 0.050
|
p < 0.001
|
p < 0.001
|
<55 | 0.17 | 0.24 | 0.19 | 0.14 | 0.12 | 0.10 | 0.27 | 0.63 |
55–64 | 0.21 | 0.31 | 0.26 | 0.17 | 0.07 | 0.04 | 0.24 | 0.40 |
65–74 | 0.19 | 0.16 | 0.22 | 0.13 | 0.04 | 0.03 | 0.16 | 0.40 |
75+ | 0.27 | 0.20 | 0.24 | 0.14 | 0.06 | 0.02 | 0.06 | 0.23 |
Gender |
p = 0.575
|
p = 0.006
|
p = 0.005
|
p = 0.907
|
p = 0.692
|
p = 0.874
|
p < 0.001
|
p < 0.001
|
Female | 0.23 | 0.30 | 0.28 | 0.15 | 0.07 | 0.05 | 0.27 | 0.60 |
Male | 0.20 | 0.17 | 0.19 | 0.14 | 0.07 | 0.04 | 0.11 | 0.26 |
Number of Previous CVC |
p = 0.655
|
p = 0.129
|
p = 0.510
|
p = 0.949
|
p = 0.078
|
p = 0.122
|
p < 0.001
|
p = 0.868
|
0–5 | 0.22 | 0.21 | 0.23 | 0.14 | 0.06 | 0.03 | 0.15 | 0.40 |
6+ | 0.19 | 0.39 | 0.19 | 0.18 | 0.24 | 0.16 | 0.45 | 0.42 |
Current Mode of Vascular Access* |
p < 0.001
|
p = 0.068
|
p < 0.001
|
p < 0.001
|
p < 0.001
|
p < 0.001
|
p = 0.008
|
p = 0.392
|
AVF | 0.26 | 0.27 | 0.30 | 0.17 | 0.03 | 0.01 | 0.14 | 0.39 |
AV graft | 0.24 | 0.18 | 0.21 | 0.29 | 0.00 | 0.06 | 0.32 | 0.21 |
Tunnelled CVC | 0.06 | 0.12 | 0.02 | 0.06 | 0.21 | 0.17 | 0.26 | 0.46 |
Current Fistula** |
p = 0.257
|
p = 0.080
|
p = 0.831
|
p = 0.975
|
p = 0.921
|
p = 0.593
|
p = 0.172
|
p = 0.288
|
Brachiobasilic | 0.36 | 0.19 | 0.23 | 0.13 | 0.04 | 0.00 | 0.06 | 0.49 |
Brachiocephalic | 0.32 | 0.33 | 0.33 | 0.18 | 0.03 | 0.00 | 0.17 | 0.44 |
Radiocephalic | 0.17 | 0.19 | 0.29 | 0.15 | 0.03 | 0.01 | 0.14 | 0.33 |
Fistula/Graft on Dominant Arm** |
p = 0.136
|
p = 0.410
|
p = 0.638
|
p = 0.730
|
p = 0.850
|
p = 0.358
|
p = 0.567
|
p = 0.634
|
No | 0.25 | 0.27 | 0.28 | 0.17 | 0.03 | 0.01 | 0.16 | 0.41 |
Yes | 0.28 | 0.23 | 0.34 | 0.15 | 0.02 | 0.00 | 0.14 | 0.33 |
Does Fistula/Graft on Dominant Arm Cause Issues**
|
p = 0.516
|
p = 0.045
|
p = 0.016
|
p = 0.599
|
p = 0.258
|
p = 1.000
|
p = 0.254
|
p = 0.001
|
No | 0.28 | 0.14 | 0.22 | 0.16 | 0.03 | 0.00 | 0.10 | 0.20 |
Yes | 0.27 | 0.46 | 0.65 | 0.14 | 0.00 | 0.00 | 0.22 | 0.62 |
Mean Score for the VAQ Question Relating to: | |||||||||
---|---|---|---|---|---|---|---|---|---|
Worries Working Well
|
Attending Dialysis Early
|
Leaving Dialysis Late
|
Problems Sleeping
|
Protecting Access
|
Interfering ADL’s
|
Interfering Leisure Activities
|
Worries About Hospitalisation
|
How Long Access Will Last
| |
Age (Years) |
p < 0.001
|
p = 0.149
|
p = 0.556
|
p < 0.001
|
p < 0.001
|
p < 0.001
|
p < 0.001
|
p = 0.003
|
p < 0.001
|
<55 | 0.71 | 0.28 | 0.51 | 0.90 | 0.94 | 0.55 | 0.57 | 0.50 | 0.85 |
55–64 | 0.60 | 0.26 | 0.42 | 0.74 | 0.63 | 0.29 | 0.26 | 0.53 | 0.80 |
65–74 | 0.44 | 0.28 | 0.43 | 0.60 | 0.40 | 0.25 | 0.20 | 0.41 | 0.56 |
75+ | 0.29 | 0.16 | 0.43 | 0.44 | 0.31 | 0.12 | 0.10 | 0.27 | 0.41 |
Gender |
p = 0.116
|
p = 0.047
|
p = 0.037
|
p < 0.001
|
p = 0.214
|
p = 0.190
|
p = 0.520
|
p < 0.001
|
p = 0.004
|
Female | 0.56 | 0.28 | 0.52 | 0.80 | 0.63 | 0.36 | 0.30 | 0.54 | 0.77 |
Male | 0.45 | 0.21 | 0.39 | 0.56 | 0.50 | 0.25 | 0.25 | 0.33 | 0.56 |
Number of Previous CVC |
p < 0.001
|
p = 0.413
|
p = 0.042
|
p = 0.035
|
p = 0.046
|
p = 0.089
|
p = 0.023
|
p < 0.001
|
p < 0.001
|
0–5 | 0.45 | 0.23 | 0.42 | 0.63 | 0.53 | 0.28 | 0.25 | 0.35 | 0.56 |
6+ | 1.03 | 0.34 | 0.72 | 0.93 | 0.87 | 0.46 | 0.48 | 1.10 | 1.48 |
Current Mode of Vascular Access* |
p = 0.025
|
p = 0.370
|
p = 0.308
|
p = 0.635
|
p = 0.020
|
p < 0.001
|
p = 0.024
|
p < 0.001
|
p = 0.001
|
AVF | 0.43 | 0.21 | 0.41 | 0.64 | 0.50 | 0.22 | 0.23 | 0.33 | 0.54 |
AV graft | 0.82 | 0.29 | 0.76 | 0.88 | 0.65 | 0.24 | 0.21 | 0.74 | 1.12 |
Tunnelled CVC | 0.62 | 0.33 | 0.50 | 0.66 | 0.73 | 0.53 | 0.41 | 0.64 | 0.85 |
Current Fistula** |
p = 0.044
|
p = 0.988
|
p = 0.683
|
p = 0.032
|
p = 0.145
|
p = 0.217
|
p = 0.388
|
p = 0.467
|
p = 0.021
|
Brachiobasilic | 0.58 | 0.17 | 0.36 | 0.98 | 0.48 | 0.13 | 0.15 | 0.46 | 0.87 |
Brachiocephalic | 0.37 | 0.21 | 0.45 | 0.67 | 0.43 | 0.22 | 0.22 | 0.34 | 0.53 |
Radiocephalic | 0.48 | 0.23 | 0.36 | 0.54 | 0.58 | 0.24 | 0.26 | 0.27 | 0.48 |
Fistula/Graft on Dominant Arm** |
p = 0.936
|
p = 0.683
|
p = 0.957
|
p = 0.305
|
p = 0.621
|
p = 0.936
|
p = 0.303
|
p = 0.516
|
p = 0.556
|
No | 0.44 | 0.22 | 0.42 | 0.64 | 0.51 | 0.23 | 0.22 | 0.35 | 0.55 |
Yes | 0.48 | 0.19 | 0.43 | 0.78 | 0.44 | 0.20 | 0.27 | 0.31 | 0.64 |
Does Fistula/Graft on Dominant Arm Cause Issues** |
p = 0.495
|
p = 0.063
|
p = 0.763
|
p = 0.801
|
p = 0.022
|
p < 0.001
|
p < 0.001
|
p = 0.937
|
p = 0.423
|
No | 0.44 | 0.26 | 0.44 | 0.73 | 0.32 | 0.03 | 0.09 | 0.31 | 0.56 |
Yes | 0.57 | 0.03 | 0.41 | 0.89 | 0.73 | 0.59 | 0.70 | 0.32 | 0.81 |
Views on AVF vs. CVC by unit
Free text analysis
Reason | N (%) |
---|---|
Reasons for not considering fistula if current access is a CVC (N = 67) | |
Concern about physical aspects of the fistula | |
Pain from the fistula | 12 (18%) |
Appearance of fistula | 5 (7%) |
Bleeding from the fistula | 4 (6%) |
Lifespan of a fistula | 1 (1%) |
Concerned about amount of maintenance required | 1 (1%) |
Happy on a line/ feels a line is better for health | 17 (25%) |
Concern about having surgery | 10 (15%) |
Previous bad experience with fistula | 7 (10%) |
Surgical fatigue | 7 (10%) |
Holding out for a transplant | 3 (4%) |
Problems from fistula on dominant arm (N = 37) | |
Poorer function of dominant hand overall | 26 (70%) |
Decreased function of dominant hand whilst on dialysis | 10 (27%) |
Pain | 2 (5%) |
Inability to self cannulate | 1 (3%) |
Is there anything else you wish you had known before starting? (N = 108a) | |
More information in general/medical aspects dialysis | 28 (26%) |
More information on access choices: | |
In general | 13 (12%) |
Covering CVC as an option | 3 (3%) |
More information about fistulas: | |
In general | 4 (4%) |
Bleeding risk | 2 (2%) |
Failure to mature risk | 1 (1%) |
Risk of steal | 1 (1%) |
Appearance | 8 (7%) |
More information on mechanisms of dialysis | |
Difficulty in needling | 2 (2%) |
Need for needle rotation | 2 (2%) |
Size of needles | 1 (1%) |
Pain relating to cannulation | 10 (9%) |
More information on renal replacement choices | 11 (10%) |
Information regarding impact of access on Activities daily living | 7 (6%) |
Crash landed so different info needed/discussed | 6 (6%) |
The amount of nephrology input would decrease on dialysis | 3 (3%) |
Discussion about the finite nature of vascular access options | 2 (2%) |
Need for intervention to maintain access | 1 (1%) |
Procedure for CVC removal | 1 (1%) |
More peer education | 1 (1%) |
Information on timing of access placement | 1 (1%) |