Differences in Initial Hemodialysis Vascular Access Use Among Glomerulonephritis Subtypes in the United States

Complications associated with hemodialysis vascular access represent one of the most important sources of morbidity among ESRD patients in the United States today. In this study, new data on the magnitude and growth of vascular access-related hospitalization in the United States is presented, demonstrating that the costs of this morbidity will soon exceed $1 billion per yr. This study also reviews published literature on the morbidity associated specifically with native arteriovenous fistulae, polytetrafluoroethylene bridge grafts, and permanent central venous catheters. Next, new information on the changing patterns of vascular access type in the United States is presented, demonstrating the continuing evolution of medical practice away from the use of arteriovenous fistulae in favor of more reliance on synthetic bridge grafts. Based on these data, a discussion is provided of the tradeoffs among the most commonly available modalities of vascular access today. Although radial arteriovenous fistulae continue to represent the optimal access modality, the appropriate roles for brachial arteriovenous fistulae, synthetic bridge grafts, and central venous catheters are less certain because of inadequate data on the long-term function of the first and the high rates of complications associated with the latter two. To reduce vascular access-related morbidity, strategies must be developed not only to prevent and detect appropriately early synthetic vascular access dysfunction, but to better identify the patients in a whom radial arteriovenous fistula is a viable clinical option.

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Buttonhole Cannulation of Arteriovenous Fistulas in the United States

Kidney360 ◽

10.34067/kid.0000052020 ◽

2020 ◽

Vol 1 (4) ◽

pp. 306-313 ◽

Cited By ~ 1

Author(s):

Tushar J. Vachharajani ◽

Leslie Wong ◽

Vandana D. Niyyar ◽

Kenneth D. Abreo ◽

Michele H. Mokrzycki

Keyword(s):

United States ◽

Vascular Access ◽

The United States ◽

Current Evidence ◽

Maintenance Hemodialysis ◽

Arteriovenous Fistulas ◽

Randomized Controlled Studies ◽

Hemodialysis Vascular Access ◽

Increased Risk ◽

Cannulation Technique

The cannulation technique of a hemodialysis vascular access has remained controversial with differing viewpoints. The quality of dialysis, overall patient safety, and individual dialysis experience often dictate the type of cannulation technique used in clinical practice. The three commonly used techniques to access a hemodialysis vascular access are the rope ladder, area, and buttonhole. Although the buttonhole technique has been around since the mid-1970s, the dialysis community remains divided on its suitability for routine use to provide maintenance hemodialysis therapy. The proponents of this technique value the ease of cannulation with less pain and discomfort whereas the opponents highlight the increased risk of infection. The actual clinical evidence from the United States is limited and remains inconclusive. The current review provides an overview of the available experience from the United States, highlighting the correct technique of creating a buttonhole, summarizing the current evidence, and recommending a need for larger randomized controlled studies in both in-center and home hemodialysis populations.

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Hemodialysis Vascular Access Morbidity in the United States by HI Feldman, PJ Held, JT Hutchinson, E Stoiber, MF Hartigan, JA Berlin. Kidney Int 43:1091-1096, 1993

Seminars in Dialysis ◽

10.1111/j.1525-139x.1993.tb00514.x ◽

2007 ◽

Vol 6 (5) ◽

pp. 332-332

Author(s):

John A. Walker

Keyword(s):

United States ◽

Vascular Access ◽

The United States ◽

Hemodialysis Vascular Access

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Gender Disparities in Vascular Access Surgical Outcomes in Elderly Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000495261 ◽

2018 ◽

Vol 49 (1) ◽

pp. 11-19 ◽

Cited By ~ 10

Author(s):

Timmy Lee ◽

Joyce Qian ◽

Mae Thamer ◽

Michael Allon

Keyword(s):

United States ◽

Vascular Access ◽

Surgical Outcomes ◽

Relative Rate ◽

Venous Catheter ◽

The United States ◽

Hemodialysis Patients ◽

Elderly Male ◽

Female Patients ◽

Arteriovenous Fistulas

Background: Despite national vascular access guidelines promoting the use of arteriovenous fistulas (AVF) over arteriovenous grafts (AVGs) for dialysis, AVF use is substantially lower in females. We assessed clinically relevant AVF and AVG surgical outcomes in elderly male and female patients initiating hemodialysis with a central venous catheter (CVC). Methods: Using the United States Renal Data System standard analytic files linked with Medicare claims, we assessed incident hemodialysis patients in the United States, 9,458 elderly patients (≥67 years; 4,927 males and 4,531 females) initiating hemodialysis from July 2010 to June 2011 with a catheter and had an AVF or AVG placed within 6 months. We evaluated vascular access placement, successful use for dialysis, assisted use (requiring an intervention before successful use), abandonment after successful use, and rate of interventions after successful use. Results: Females were less likely than males to receive an AVF (adjusted likelihood 0.57, 95% CI 0.52–0.63). Among patients receiving an AVF, females had higher adjusted likelihoods of unsuccessful AVF use (hazard ratio [HR] 1.46, 95% CI 1.36–1.56), assisted AVF use (OR 1.34, 95% CI 1.17–1.54), and AVF abandonment (HR 1.28, 95% CI 1.10–1.50), but similar relative rate of AVF interventions after successful use (relative risk [RR] 1.01, 95% CI 0.94–1.08). Among patients receiving an AVG, females had a lower likelihood of unsuccessful AVG use (HR 0.83, 95% CI 0.73–0.94), similar rates of assisted AVG use (OR 1.05, 95% CI 0.78–1.40) and AVG abandonment, and greater relative rate of interventions after successful AVG use (RR 1.16, 95% CI 1.01–1.33). Conclusions: While AVFs should be considered the preferred vascular access in most circumstances, clinical AVF surgical outcomes are uniformly worse in females. Clinicians should also consider AVGs as a viable alternative in elderly female patients initiating hemodialysis with a CVC to avoid extended CVC dependence.

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