Factors associated with the prevalence of arteriovenous fistulas in hemodialysis patients in the HEMO Study (original) (raw)
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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...
Increasing arteriovenous fistulas in hemodialysis patients: Problems and solutions
Kidney International, 2002
Increasing arteriovenous fistulas in hemodialysis patients: [1, 2]. In an effort to improve vascular access outcomes Problems and solutions. National guidelines promote increasthe National Kidney Foundation published the Dialysis ing the prevalence of fistula use among hemodialysis patients. Outcome Quality Initiative (DOQI) guidelines in 1997, The prevalence of fistulas among hemodialysis patients reflects a set of evidence-based and opinion-based guidelines reboth national, regional, and local practice differences as well garding the optimal management of vascular access [3]. as patient-specific demographic and clinical factors. Increasing fistula prevalence requires increasing fistula placement, im-The DOQI guidelines have stimulated a large body of proving maturation of new fistulas, and enhancing long-term epidemiologic and clinical studies on vascular access, patency of mature fistulas for dialysis. Whether a patient rethereby expanding our understanding of this important ceives a fistula depends on several factors: timing of referral topic. One important DOQI guideline has urged nephrolfor dialysis and vascular access, type of fistula placed, patient demographics, preference of the nephrologist, surgeon, and ogists to increase the number of patients dialyzing with dialysis nurses, and vascular anatomy of the patient. Whether arteriovenous (A-V) fistulas, rather than grafts. The presthe placed fistula is useable for dialysis depends on additional ent review summarizes recent clinical research that helps factors, including adequacy of vessels, surgeon's experience, us understand how to achieve this important goal. patient demographics, nursing skills, minimal acceptable dialysis blood flow, and attempts to revise immature fistulas. Whether a mature fistula achieves long-term patency depends WHAT IS THE RATIONALE FOR INCREASING on the ability to prevent and correct thrombosis. An optimal outcome is likely when there is (1) a multidisciplinary team FISTULA PLACEMENT? approach to vascular access; (2) consensus about the goals Key words: preoperative vascular mapping, graft placement, hemodialcriteria, the chronic dialysis population has become subysis, end-stage renal disease, thrombosis, dialysis blood flow, vascular access, A-V fistula. stantially older, more likely to be female and diabetic, and has higher co-morbidity, including extensive athero
Retrospective analysis of 271 arteriovenous fistulas as vascular access for hemodialysis
Indian Journal of Nephrology, 2013
presence of on table bruit and thrill, role of postoperative anticoagulants and suture used to postoperative outcome and patency. Materials and Methods This retrospective observation study was carried out in our institute in patients who underwent surgical AVF creation between January 2004 and December 2009. During this period, AVF was created in 421 patients but we could follow up only 249 patients during January to July 2011. Follow up was obtained in collaboration with dialysis unit staff by telephonic calls and personal visits to the patients. The data extracted from hospital records included patient demographics, co-morbidities, details of previous access, location and type of AVF, operative details, patency, morbidity, and mortality. The data collection was difficult and took time of 6 months as some patients were taking dialysis at some other centers. Some were lost to follow up and others could not be reached. A total of 271 AVFs were placed in 249 patients. Maximum follow up was 7 years and minimum follow up was 1 year. Twenty-two patients required repeat procedure due to failure of previous fistula. This is single center, single surgeon retrospective study comparing preoperative vein and artery diameters,
Journal of Vascular Surgery, 2007
Background: Primary failure of the arteriovenous fistula (AVF) is a major problem affecting native hemodialysis access use. A multicenter guideline implementation program, Care Improvement by Multidisciplinary approach for Increase of Native vascular access Obtainment (CIMINO), was designed to identify modifiable and nonmodifiable factors involved in the early functionality of the AVF. Methods: Physicians and dialysis staff in 11 centers in the Netherlands (N ؍ 1092 prevalent vascular accesses) were strongly and repeatedly advised to adhere to current guidelines. It was advised to always perform a standard preoperative duplex examination and physicians were encouraged to attempt salvaging procedures for failing and failed fistulae. Specially appointed access nurses prospectively registered all created vascular accesses in an internet-linked database. Primary failure (PF) was defined as a complication of the AVF before the first successful cannulation for hemodialysis treatment. Modifiable and nonmodifiable factors were related to risk of primary failure using logistic regression models. We restricted the analyses to the first AVF of each patient that was placed during the observation period. Results: Between May 2004 and May 2006, an AVF was created in 395 patients. Primary failure occurred in one third (131 cases). Factors related to an increased risk of primary failure were female gender (odds ratio (OR): 1.73, 95% confidence interval (CI): 1.01-2.94), renal replacement therapy prior to AVF placement (OR: 1.19 per year on RRT, CI: 1.05-1.34), diabetes mellitus (OR: 3.08, CI: 1.53-6.20), and AVF placement at the wrist (compared with elbow) (OR: 1.86, CI: 1.03-3.36). Primary failure rate among the participating centers varied from 8% to 50%. Compared to the two centers with the lowest primary failure rates, six centers had a significantly higher primary failure rate. Adjustment for risk factors and surgery-related factors did not materially change the center-related findings. Conclusion: In conclusion, we have identified location of AVF placement as a modifiable factor influencing primary failure risk. More importantly, this study shows that the probability of primary failure is strongly related to the center of access creation, suggesting an important role for the vascular surgeon's skills and decisions.
American Journal of Kidney Diseases
Background: Lok et al previously reported a risk equation for arteriovenous fistula (AVF) maturation failure. It is unclear whether this model or a more comprehensive model correlates with incident AVF use in the US hemodialysis population. Study Design: Cross-sectional study. Setting & Participants: 195,756 adult patients initiating outpatient hemodialysis therapy in the United States between July 1, 2005, and December 31, 2009, with 6 months or more prior nephrology care. Predictor: Patient characteristics (age, peripheral vascular disease, coronary artery disease, and race) populating the AVF maturation failure risk equation and other demographic and clinical variables from the Centers for Medicare & Medicaid Services (CMS) Medical Evidence Report (CMS 2728). Outcomes & Measurements: AVF use at first outpatient dialysis treatment as recorded on the CMS 2728. Results: Using the risk categories defined by Lok et al, AVF use varied from 19.0% (very high risk) to 25.6% (low risk). In...
Some of the Dilemmas About Creating Arteriovenous Fistulas for Hemodialysis
Experimental and Applied Biomedical Research (EABR), 2023
The native arteriovenous fistula for haemodialysis has been described as the Achilles heel but also the Cinderella of haemodialysis. Arteriovenous fistula has been the vascular access of choice for haemodialysis, because of lower cost, morbidity and mortality. The significance of a functioning vascular access is that it takes on a major role in determining a positive outcome. Yet, they are a cause of great stress, both for patients and healthcare professionals. About 80% of patients begin dialysis with central venous catheters, 20-70% of fistulas do not reach maturity, and a fifth, of all fistulas, thrombosed before use. A quarter die from poor vascular access. Insufficient number of vascular surgeons and inadequate training to create vascular access often lead to "congestion" of the bed stock in nephrology. Surgeons and radiologists perform all procedures related to vascular approaches, but the dominant role of nephrologists is in the organization of planning and realization of creating a vascular access. Initiation of dialysis in the elderly and diabetics, as a risk population of patients for arteriovenous fistula, is associated with many problems, among which the creation, functioning and maturation of the vascular access dominate. Hyperdynamic conditions, due to arteriovenous communication in patients with arteriovenous fistula, are cited as a possible mechanism for increasing morbidity. However, there is still no agreement within the nephrology community regarding the height of the hemodynamic load and the indication for closing the vascular access. There are many dilemmas associated with creating, care and using an arteriovenous fistulas, and that could be the reason and justification to form a team for vascular access, which would, in addition to nephrologists, include vascular surgeons, interventional radiologists and nurses.
The Journal of Vascular Access, 2008
PurposeWe describe the development and implementation of a comprehensive multidisciplinary vascular access (VA) program and describe its impact on VA distribution rates.MethodsA retrospective review of all incident and prevalent patients in our hemodialysis (HD) unit was conducted in September 2001 to determine baseline data including: type of VA along with patient characteristics and comorbidities. Similar data was extracted from the database in 2005 for incident and prevalent patients.ResultsThe VA program had a significant impact on arteriovenous fistulae (AVF) rates in both incident and prevalent HD patients: incident AVF rates increased from 14 to 39% (p=0.04) and prevalent AVF rates from 60 to 64% (p=0.015). Multivariate analysis revealed that male gender (OR 1.79 [CI 0.85–0.98, p=0.006]) and year of dialysis initiation 2005 vs. 2001 (OR 1.65 [CI 1.09–2.5, p=0.017]) were associated with AVF use among prevalent HD patients. Furthermore, age (per 5 years over 70) is associated w...