| Hemodialysis vascular access infections: epidemiology and risk factors for treatment failure |
Shi Nae Yu1, Eunjung Lee2
, Se Yoon Park3, Oh-Hyun Choi1, Sangchul Yun4, Tark Kim5, Min Seo Kang2, Yae Jee Baek2, Jongtak Jung2, and Tae Hyong Kim2 |
1Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
2Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
3Division of Infectious Diseases, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
4Department of Transplantation & Vascular Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
5Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea |
Corresponding Author:
Eunjung Lee , Tel: +82-2-709-9034, Fax: +82-2-709-9554, Email: shegets@schmc.ac.kr
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Received: June 13, 2025; Revised: August 19, 2025; Accepted: November 14, 2025. |
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| Abstract |
Background/Aims: Infection remains the second leading cause of mortality in patients with end-stage renal disease (ESRD). Despite the direct relationship between hemodialysis vascular access-related infections (HD-VARI) and both prognosis and mortality in ESRD patients, there is a paucity of research in this area.
Methods: This retrospective study was performed at a tertiary care hospital in Seoul, Korea, from 2009 to 2020. Medical records of adult patients diagnosed with HD-VARI were assessed. We analyzed the distribution of microorganisms, clinical characteristics according to vascular access type, and evaluated risk factors for treatment failure.
Results: Data from a total of 367 patients were included over the 12-year study period. Based on vascular access type, 293 (79.8%) had arteriovenous graft infections, 29 (7.9%) had arteriovenous fistula infections, and 45 (12.3%) had tunneled cuffed catheter infections. Thirty-one (8.4%) patients experienced treatment failure within 90 days. Multivariate analysis identified male sex (odds ratio [OR], 2.343; 95% confidence interval [CI], 1.041–5.274) and metastatic infection (OR, 4.297; 95% CI, 1.516–12.178) as independent predictors of 90-day infection-related treatment failure. Subtotal or total excision (removal) of the infected vascular access significantly decreased the risk of 90-day infection-related treatment failure (OR, 0.337; 95% CI, 0.129–0.876).
Conclusions: Removal of infected vascular access played a crucial role in reducing infection-related deaths or relapses within 90 days. Management of vascular access infection should be individualized based on patient-specific factors. |
| Keywords:
Hemodialysis ; Renal insufficiency, chronic ; Catheter-related infections ; Arteriovenous fistula ; Vascular access |
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