Hemodialysis Arteriovenous Vascular Access Creation After Kidney Transplant Failure (original) (raw)
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Transplantation, 2017
Background: In incident hemodialysis (HD) patients the use of catheters is associated with a worse prognosis when compared to those with an arteriovenous fistula (AVF), but the role of vascular access (VA) type in the morbidity and mortality of patients returning to HD with a failing renal allograft is unknown. We aimed to determine the associations between the type of vascular access and mortality in this population. Methods: This was a retrospective observational cohort study of 138 patients who initiated dialysis after kidney transplant failure between 1995 and 2014. We recorded access type, laboratory values at entry, stratified patients per risk and determined the effect on mortality of programmed vascular access (PVA), (AVF or PTFE graft) and nonprogrammed vascular access (UPVA), (tunneled or nontunneled catheters) at the initiation of HD. Results: 85 (61.6 %) and 53 (38.4 %) patients initiated therapy with PVA and UPVA, respectively. Overall mortality was 14.6 % at 1 year. Patients using catheters had greater mortality than those with a PVA (Log Rank p value <0.0001). At 24 months 7 patients died in PVA group vs. 22 in UPVA group. Multivariate Cox analysis showed that initiation of HD with a catheter (hazard ratio (HR), 5.90; 95 %, confidence interval (CI) 2.83 to 12.31) was independently associated with greater mortality after adjusting for confounders. Conclusion: Nonprogrammed vascular access with a catheter predicted all cause mortality among patients with transplant failure reentering HD.
Vascular Access Perspectives in Patients After Kidney Transplantation
Frontiers in Surgery, 2021
Introduction: More attention has been paid to the influence of arteriovenous fistula (AVF) on the cardiovascular system. In renal transplant recipients, some beneficial effect of an elective vascular access (VA) ligation was observed in patients with a high AVF flow. However, this strategy is not widely accepted and is in contradiction to the rule of vasculature preservation for possible future access. The aim of our study is to elucidate the vascular access function and VA perspective in the kidney transplantation (KTx) population.Materials and Methods: KTx patients with a stable graft function were recruited to participate in this single center observational study (NCT04478968). The measurement of VA flow and vessel mapping for future vascular access was performed by a color Doppler ultrasound. The study group included 99 (63%) males and 58 (37%) females; the median age was 57 (IQR 48–64) years. The median time from the transplantation to the baseline visit was 94 (IQR 61–149) mon...
Vascular Access Creation before Hemodialysis Initiation and Use: A Population-Based Cohort Study
Clinical journal of the American Society of Nephrology : CJASN, 2015
In Canada, approximately 17% of patients use an arteriovenous access (fistula or arteriovenous graft) at commencement of hemodialysis, despite guideline recommendations promoting its timely creation and use. It is unclear if this low pattern of use is attributable to the lack of surgical creation or a high nonuse rate. Using large health care databases in Ontario, Canada, a population-based cohort of adult patients (≥18 years old) who initiated hemodialysis as their first form of RRT between 2001 and 2010 was studied. The aims were to (1) estimate the proportion of patients who had an arteriovenous access created before starting hemodialysis and the proportion who successfully used it at hemodialysis start, (2) test for secular trends in arteriovenous access creation, and (3) estimate the effect of late nephrology referral and patient characteristics on arteriovenous access creation. There were 17,183 patients on incident hemodialysis. The mean age was 65.8 years, 60% were men, and ...
BMC nephrology, 2017
Little is known about vascular access conversion and outcomes for patients starting hemodialysis with nonfunctional arteriovenous (AV) access. We assessed mortality risk associated with nonfunctional AV access at hemodialysis initiation, taking subsequent changes in vascular access into account. We studied the 53,092 incident adult hemodialysis patients included in the French REIN registry from 2005 through 2012. AV access placed predialysis was considered nonfunctional when dialysis began with a central venous catheter. Information about vascular access changes was obtained from treatment modality updates. At hemodialysis initiation, AV access was functional for 47% of patients and nonfunctional for 9%; 44% had a catheter alone. After a 3-year follow-up, 63% of patients beginning hemodialysis with a nonfunctional AV access had changed to a functional one, 4% had had a transplant, 19% had died before any vascular access change, and 13% still used a catheter. Cox proportional hazard ...
Vascular Access, Complications and Survival in Incident Hemodialysis Patients
Kidney and Dialysis
The arteriovenous fistula (AVF) has long been considered the optimal vascular access. However, the evolving characteristics of the ageing dialysis population limit the creation of an AVF in all patients. Thus, more patients start hemodialysis (HD) with a central venous catheter (CVC) rather than an AVF, and the supremacy of the AVF has recently been questioned. The aim of this study was to analyze the incidence and rate of access complications in 100 patients between 2010 and 2015. A total of 63 patients started HD with an AVF, while 37 began HD with a CVC. We found no differences in patient survival according to the vascular access in use at the beginning of dialysis, but patients were more likely to die while undergoing dialysis by means of a CVC than an AVF. Patients started on dialysis with a CVC had more cardiovascular disease, while patients who began dialysis with an AVF presented more hypertension. Fistulas presented a longer survival time despite more hospital admissions, b...
Vascular Access in Patients Treated With Chronic Hemodialysis for 30 Years or More
Therapeutic Apheresis and Dialysis, 2009
The aim of our study was to evaluate vascular access in patients treated with chronic hemodialysis for 30 years or more. Patients who had started dialysis in 1978 or earlier were identified from the Slovenian Renal Replacement Therapy Registry.The data on vascular access on April 2008 are presented. Sixteen patients were still alive, seven men and nine women aged 62 Ϯ 12 years (46-84), and they had been treated for 32 Ϯ 1.7 years (30-35), mainly with chronic HD. They had started HD at the age of 30 Ϯ 12 years (13-50), and none had diabetes. The vascular access in nine was a native arteriovenous (AV) fistula, on the forearm in eight patients, and a brachiobasilic fistula in one patient. Four patients had their primary AV fistulas still in use (maximum 35 years). In the remaining five patients, multiple salvage procedures had been performed or new AV fistulas created. The vascular access in four patients was
The Journal of Vascular Access, 2018
Introduction: After a kidney transplant, it is unknown whether the maintenance of a functioning hemodialysis arteriovenous access could have deleterious effects on renal grafts. We hypothesize that maintaining an arteriovenous access can deviate a significant proportion of the cardiac output from the renal graft. The aim of this study was to investigate whether a temporary closure of the arteriovenous access could lead to an increase in graft perfusion. Methods: We conducted a study in 17 kidney-transplanted patients with a functioning arteriovenous access. We evaluated, at baseline and 30 s after compression of the arteriovenous access (access flow occlusion), the hemodynamic parameters and the renal resistive index of the graft by Doppler ultrasound. Results: After arteriovenous access occlusion 82.4% (n = 14) of the patients had a decrease in resistive index. All patients had a decrease in heart rate (67 vs 58 bpm, p < 0.001) and 14 (82.4%) had an increase in mean blood pressu...
Predictors of early vascular-access failure in patients on hemodialysis
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2012
Vascular access management is key and critical in the successful management of hemodialysis patients, and an arteriovenous fistula (AVF) is considered the access of choice. This study was conducted between January 2007 and October 2009 at the Military Hospital in Rabat. Data on 115 patients who underwent 138 AVFs were retrospectively studied. Wrist AVF was the most common site of use. The primary course was uncomplicated in 63% of the patients, while primary failure occurred in 23.9% of the patients. Presence of diabetes was the most important risk factor for primary failure.
Type of vascular access and mortality in U.S. hemodialysis patients
Kidney International, 2001
U.S. hemodialysis ysis Outcomes Quality Initiative (DOQI) recommend arpatients. teriovenous fistula (AVF) to be the VA of choice for he-Background. Vascular access (VA) complications account for modialysis [3]. These guidelines are based on studies that 16 to 25% of hospital admissions. This study tested the hypothesuggest improved access survival and function for AVF sis that the type of VA in use is correlated with overall mortality and cause-specific mortality. when compared with arteriovenous graft (AVG) [4-8]. Methods. Data were analyzed from the U.S. Renal Data A substantial geographic variation exists in the distribu-System Dialysis Morbidity and Mortality Study Wave 1, a rantion of AVF and AVG among patients with end-stage dom sample of 5507 patients, prevalent on hemodialysis as of renal disease (ESRD). While in Europe 81% of VA are December 31, 1993. The relative mortality risk during a two-AVF, the percentage of hemodialysis patients with AVF