HOMOCYSTEINE AND VASCULAR ACCESS THROMBOSIS IN HEMODIALYSIS PATIENTS

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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Superficialization of Basilic Vein: Last Chance for a Native Arteriovenous Fistula in Hemodialysis Patients

The Journal of Vascular Access ◽

10.5301/jva.2008.4872 ◽

2003 ◽

Vol 4 (1) ◽

pp. 21-24 ◽

Cited By ~ 1

Author(s):

M. Onaran ◽

D. Erer ◽

I. Şen ◽

E.E. Elnur ◽

E. Iriz ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Brachial Artery ◽

Subcutaneous Tissue ◽

Vascular Grafts ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Basilic Vein ◽

Number Of Patients

Background Although the best type of vascular access for chronic hemodialysis patients is a native arteriovenous fistula, in an increasing number of patients all the superficial veins have been used and only the placement of vascular grafts or permanent catheters is left. Superficialization of the basilic vein is a possible alternative. Materials and Methods In 49 chronic hemodialysis patients who had no possibilities to have a native arteriovenous fistula created, we performed a basilic vein- brachial artery fistula in the arm. During the same operation the basilic vein was then superficialized for easier access for hemodialysis. Results Mean follow-up was 22.36±15.56 months. Forty-eight patients are still undergoing hemodialysis with their superficialized basilic vein native A-V fistula without any complications. Only one fistula was thrombosed just after the procedure because of poor vessel quality. Conclusion For hemodialysis patients who have no suitable superficial veins at the wrist or elbow, performing a basilic vein - brachial artery fistula and superficializing the vein to the subcutaneous tissue is an acceptable choice before deciding to use more complicated procedures like vascular grafts.

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SP590CORONARY ARTERY CALCIFICATION PREDICTS MICROCALCIFICAION OF VASCULAR ACCESS IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx153.sp590 ◽

2017 ◽

Vol 32 (suppl_3) ◽

pp. iii334-iii334 ◽

Cited By ~ 1

Author(s):

Young Ok Kim ◽

Bomi Choi ◽

Young Soo Kim ◽

Ho Cheol Song

Keyword(s):

Vascular Access ◽

Hemodialysis Patients

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Effects of Patient-Selected Music Listening on the Pain and Anxiety of Patients Undergoing Hemodialysis: A Randomized Controlled Trial

Healthcare ◽

10.3390/healthcare9111437 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1437

Author(s):

SukKyong Kim ◽

HyeonCheol Jeong

Keyword(s):

Vascular Access ◽

Controlled Trial ◽

Clinical Intervention ◽

Hemodialysis Patients ◽

Control Group ◽

Music Listening ◽

Anxiety States ◽

Subjective Pain ◽

Anxiety Levels ◽

Experimental Group

This study aimed to analyze the influence of patient-selected music listening on the pain and anxiety levels of hemodialysis patients after undergoing a vascular access operation. Methods: Sixty five patients were randomly assigned to the experimental group (n = 32) or the control group (n = 33). The experimental group was instructed to listen to their favorite music using headphones during their operations at the center. The control group underwent the operations without listening to any music. The pain measurement during vascular access operation was measured by subjective pain and objective pain behavior; anxiety was measured by subjective anxiety and anxiety states. Results: The experimental group reported significantly lower subjective pain levels than the control group (t = 9.36, p = 0.003). Regarding objective pain behaviors, the experimental group had a significantly lower score than the control group (t = 4.59, p = 0.036). The experimental group had significantly lowered subjective anxiety compared to the control group (F = 10.10, p = 0.002). Regarding anxiety states, the experimental group had significantly lower scores than the control group (F = 23.34, p < 0.001). Conclusion: The results suggest that patient-selected music listening reduced hemodialysis patients’ pain and anxiety levels during vascular access operations. Therefore, music medicine can be included as a new clinical intervention.

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