Associations between Hemodialysis Access Type and Clinical Outcomes (original) (raw)
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Outcomes of vascular access for hemodialysis: A systematic review and meta-analysis
Journal of vascular surgery, 2016
The decision about the type and location of a hemodialysis vascular access is challenging and can be affected by multiple factors. We explored the effect of several a priori chosen patient characteristics on access outcomes. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through November 13, 2014. We included studies that evaluated patency, mortality, access infection, and maturation of vascular access in adults requiring long-term dialysis. Pairs of reviewers working independently selected the studies and extracted the data. Outcomes were pooled across studies using the random-effects model. Two hundred studies met the eligibility criteria reporting on 875,269 vascular accesses. Overall, studies appeared to have provided incidence rates at low to moderate risk of bias. The overall primary patency at 2 years was higher for fistulas than for grafts and catheters (55%, 40%, and 50%, respectively). Patenc...
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...
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
Canadian journal of kidney health and disease, 2016
Current guidelines favor fistulas over catheters as vascular access. Yet, the observational literature comparing fistulas to catheters has important limitations and biases that may be difficult to overcome in the absence of randomization. However, it is not clear if physicians would be willing to participate in a clinical trial comparing fistulas to catheters. We also sought to elicit participants' opinions on willingness to participate in a future trial regarding catheters and fistulas. We created a three-part survey consisting of 19 questions. We collected demographic information, respondents' knowledge of the vascular access literature, appropriateness of current guideline recommendations, and their willingness to participate in a future trial. Participants were recruited from Canada, Europe, Australia, and New Zealand. Participants include physicians and trainees who are involved in the care of end-stage renal disease patients requiring vascular access. Descriptive stati...
2021
Background: Although the arteriovenous fistula (AVF) confers superior benefits over central venous catheters (CVC), utilisation rates remain low among prevalent haemodialysis (HD) patients. The goal of this study was to determine the evolution of vascular access type in the first year of dialysis and identify factors associated with conversion from CVC to a functioning AVF. Methods: We studied adult patients (n=610) who began HD between the 01/01/2015 and 31/12/2016 and were treated for at least 90 days using data from the National Kidney Disease Clinical Patient Management System in the Irish Health System. Prevalence of vascular access type was determined at day 90 and 360 following dialysis initiation and at 30-day intervals. Multivariable logistic regression explored factors association with CVC at day 90, and Cox regression evaluated predictors of conversion from CVC to AVF on day 360. Results: CVC use was present in 77% of incident patients at day 90 with significant variation...
American Journal of Kidney Diseases, 2004
The Kidney Disease Outcomes Quality Initiative Guidelines for Vascular Access in hemodialysis patients recommend native arteriovenous (AV) fistulae over AV grafts or catheters for permanent vascular access. They recommend letting fistulae mature > or =1 month before cannulation. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides an unparalleled means to examine vascular access practice patterns and guidelines internationally, with particular attention to associations with mortality risk. Most patients in Europe and Japan dialyze through AV fistulae and very few use AV grafts; in the United States, more patients use grafts than fistulae. Patients who receive nephrologic care for over 30 days before starting dialysis have significantly higher chances of commencing via AV fistula. Medical directors of dialysis facilities in the United States commonly prefer grafts; in Europe and Japan, most prefer fistulae. In the United States, there is a relatively long average time between fistula creation and cannulation but significantly worse fistula survival than that seen in Europe. Tunneled catheters pose a higher mortality risk than permanent accesses and are associated with increased risk of failure of a subsequent fistula. The percentage of prevalent patients in the DOPPS countries using catheters has increased in recent years. DOPPS data suggest that performance in some countries falls short of practices achieved in other countries. AV fistula use is low in the United States but has been improving. The trend of increasing use of catheters in most countries is discouraging. The DOPPS will continue to monitor practice trends and explore whether greater application of guidelines will lead to fewer access complications and improved longevity for hemodialysis patients.
Nephron Clinical Practice, 2013
Background: Vascular access (VA) guidelines recommend the native arteriovenous fistula (AVF) as VA of first choice for chronic hemodialysis patients. AVF management is important in hemodialysis patient care. AVF survival is associated with various physical factors, but the effects of dialysis treatment factors upon AVF survival are still not clear. Methods: Study patients were treated at 498 dialysis facilities participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) 2 or 3 (2002-2007). Analyses included 1,183 incident hemodialysis patients (on dialysis ≤7 days and using an AVF at study entry) and 949 prevalent patients (on dialysis >7 days at DOPPS entry and using a new AVF created during study observation). AVF survival was modeled from the study entry date for incident patients and date of first AVF use for prevalent patients. Predictors of primary and final AVF survival were compared across Japan, North America and Europe/Australia/New Zealand (EUR/ANZ) with...
2021
Introduction: Arteriovenous fistula (AVF), permanent catheter (PC), and vascular graft are three vascular access types used for hemodialysis (HD) procedure. Due to insufficient reliable information on the comparison between AVF and PC. This study was conducted to compare AVF and PC regarding adequacy of dialysis. Material and Methods: This prospective study was carried out in tertiary care center over 6 months (Jan 2021 to June 2021). In this study, 100 HD pts were enrolled and assigned to two unequal groups of AVF and PC. Before and after the dialysis session, blood samples were taken for laboratory examinations and measurement of urea reduction ratio and Kt/V. The patients were followed up for six months, and then laboratory examinations were repeated. Results: Out Of the 100 HD pts, 40 had AVF and 60 patients on PC. During the 6-month follow-up, 30 patients in PC group but only two patient in AVF group showed infection (P = 0.050), while in each group, thrombosis were seen in 6 p...
Journal of Nephrology, 2023
Introduction Although arteriovenous autologous fistula is the vascular access of choice due to better long-term outcome than central venous catheters, the use of central venous catheters is increasing. Our study aims to describe the survival and epidemiological features of a cohort of dialysis patients with a focus on the role of vascular access. Methods Our study comprises a follow-up period from 2001 to 2020 in a single center. Descriptive analysis was performed on baseline data. Moreover, we analysed predictive variables of death with univariable and multivariable logistic regressions. Predictors of survival were analysed by univariable and multivariable Cox regression. Results Our analysis includes 754 patients undergoing chronic haemodialysis. In the multivariable logistic regression, the use of tunnelled catheters resulted protective against death from any cause (Odds Ratio 0.43; p = 0.017). In the multivariable Cox analysis, being "late referral" was associated with decreased survival in the first 6 months since haemodialysis start (Hazard Ratio 3.79; p = 0.001). In the subgroup of elderly (age ≥ 75 years) patients (n = 201/472) with a follow up of 7-60 months, multivariable logistic regression showed that tunnelled catheters at the start of haemodialysis were associated with lower mortality (Odds Ratio, 0.25; p = 0.021), whereas vascular disease was found to be the main risk factor for death (Odds Ratio, 5.11; p = 0.000). Moreover, vascular disease was confirmed as the only independent risk factor by Cox analysis (Hazard Ratio, 1.58; p = 0.017). Conclusions In our cohort, mortality was found to be more closely associated with comorbidities than with the type of vascular access. Tunnelled central venous catheters might be a viable option for haemodialysis patients.