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Impact Of Nutrition And Immunocompetence On The Outcomes Of Primary Dialysis Access
Mark G. Davies, MD PhD MBA1, Joseph P. Hart, MD MHL2.
1Ascension Health, Waco, TX, USA, 2MCW, Milwaukee, WI, USA.

Background: Establishing long-term arteriovenous access is important in long-term care for patients with End-Stage Renal Disease (ESRD). The aim of this study was to analyze the impact of varying degrees of nutrition and immunocompetence on the outcomes of primary dialysis access placement.
Methods: Between 2018 and 2022, all patients undergoing a primary access placement were analyzed. Nutritional and immunocompetency status was measured by the prognostic nutritional index (PNI 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (per mm3). Patients were stratified as Low-risk PNI >40 and High-risk PNI <40. Outcomes of maturation (successful progression to HD), re-intervention, functional dialysis (continuous HD for three consecutive months), and patency were examined.
Results: 674 patients (64% female, mean age of 61ą15yrs; meanąSD) underwent placement of arteriovenous fistula (AVF, 86%), peritoneal dialysis catheter (PD, 6%), arteriovenous graft (AVG, 4%) and long-term hemodialysis catheter (HC, 3%). At the time of access placement, 38% were considered high risk, and the remainder low risk. High-risk PNI was associated with ineligibility for PD placement and care and a greater likelihood for AVG and HC placement. The presence of a high-risk PNI impacted 30-day MACE, early thrombosis and time to maturation (Table 1). Furthermore, the maintenance of access and the duration of functional dialysis were worse (Table 1).
Conclusions: The identification of a high nutritional and Immunocompetence risk, as measured by the PNI, impacts the choice of access and is associated with poor short-term and long-term outcomes after placement of dialysis access. Predetermination and mitigation of nutritional and Immunocompetence risk should be considered in the establishment of long-term dialysis access care.
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