Best Option for Dialysis Patients Access for Hemodialysis

Critical Appraisal
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Coentrão, L., Santos-Araújo, C., Dias, C., Neto, R., & Pestana, M. (2012). Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study. BMC Nephrology, 13(1), 1-7. file:///C:/Users/user/Downloads/1471-2369-13-88.pdf
Introduction
Chronic Kidney disease (CKD) patients require urgent and critical treatment modalities to prolong their lives and improve the quality of their lives. Generally, this means that they will have improved aspects such as decreased rates of their morbidity and mortality. These patients' different approaches or treatment choices include renal replacement treatments such as hemodialysis, peritoneal dialysis (PD), and kidney transplantation (Coentrão et al., 2012). The clinical question evaluates the efficiency of different vascular access types during the initiation of long-term renal replacement treatment (RRT) in terms of survival rates and morbidity. The two vascular access types for hemodialysis are an arterio-venous fistula (AVF) and a permanent catheter. The research article for this critical appraisal seeks to explore the connection that exists between the mode of dialysis and patient mortality rates, following the role of hemodialysis vascular access (VA) type during the initiation of RRT. According to Coentrão et al. (2012), hemodialysis VA type at the start of RRT significantly modifies the connection between mortality and survival among CKD patients and the dialysis modality.
Research Summary
The research was a retrospective cohort study that was done among CKD patients. According to Coentrão et al. (2012), these patients were eighteen years and older when they started RRT. The patients had either started hemodialysis or peritoneal dialysis in the study institution. The patients were randomly selected and recruited for the study from the nephrology department of the institution. The patients had to be diagnosed with end-stage kidney/renal disease (ESRD) and had already been started on a long-term outpatient RRT. The patients who had previously been on RRT and had started again during the period of study or patients who had been referred to another institution were not eligible for the study. The choice of dialysis modality was solely based on the choice of the patient and their medical and nutrition status (Coentrão et al., 2012). The patients who first started on peritoneal dialysis were directed to the PD group. Patients whose initial dialysis modality was hemodialysis with a tunneled cuffed catheter or a venous fistula were assigned to the TCC or AVF groups.
Follow-up was consistently done from the first-day dialysis as an outpatient procedure and continued for the next year or until the patient died or switched to the specific dialysis modality. One hundred and ninety-one patients with CKD started RRT during the study; one hundred and thirty-three patients started on hemodialysis, while fifty-eight patients started on peritoneal dialysis (Coentrão et al., 2012). A total of thirty-nine patients were cut off from the study, generally because they had a previous RRT procedure or follow-up was cut short due to referral and transfer to other districts. Among these patients, twenty-three had been recruited to the HD groups, while sixteen had been recruited to the PD group (Coentrão et al., 2012). The final analysis compounded one hundred and fifty-two CKD patients. Three study cohorts were established; HD-AVF (fifty-nine patients), HD-CVC (fifty-one patients), and PD (Forty-two patients).
Clinical data were obtained from the health institution’s database and outpatient records for patients with CKD. Co-morbidity was assessed by a physician who thoroughly reviewed every patient's health records on the enrolment date. Several methods were used to compare, analyze, and calculate patient variables. The SPSS software was used to conduct all statistical analyses. The main findings revealed that HD-TCC patients had an elevated probability, compared to HD-AVF and PD patients, of more clinical visits, emergencies, and hospital admission due to the high rate of VA complications. Coentrão et al. (2012) record that after one year, the survival rates for HD-TCC were 74.5%, HD-AVF was 96.6%, and PD was 97.6%. The author concluded that HD VA type at the start of RRT is a critical factor in the relationship between CKD patients' survival and dialysis modality. The major limitation noted by the authors was a probability of selection bias, mainly propagated by the patient's preference for treatment and referral point to a nephrologist.
Critical Analysis
Introduction
Even though the study was not published in the last five years, it is significantly seminal. It has widely influenced later and recent developments in health research pertaining to CKD patients. Additionally, it is peer reviewed and serves credible evidence. The study looked into the effects of HD-AVF and HD-CVC compared with PD. Its purpose was to explore a...