scholarly journals P1312EFFECT OF KIDNEY TRANSPLANTATION RATE ON THE ARTERIOVENOUS FISTULA RATE IN PREVALENT HEMODIALYSIS PATIENTS: ANALYSIS OF DATA FROM THE CATALAN RENAL REGISTRY (1997-2017)

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ramon Roca-Tey ◽  
Jordi Comas ◽  
Jaume Tort
Keyword(s):  
Kidney Transplantation ◽  
Arteriovenous Fistula ◽  
Kidney Graft ◽  
Fistula Rate ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Determining Factor ◽  
Tunneled Catheter ◽  
Over Time

Abstract Background Kidney transplantation (KT) is considered to be the best option of renal replacement therapy (RRT) for most end-stage renal disease (ESRD) patients (pts). Furthermore, arteriovenous fistula (AVF) is considered to be the best vascular access (VA) for most hemodialysis (HD) pts. Aims To analyze the effect of KT rate on the AVF rate in prevalent HD pts. In addition, the likelihood of receiving a kidney graft (KG) over time according to the first VA used to start HD program was also evaluated Method Data from the Catalan Registry of ESRD pts treated with either KT or HD were examined for a 20-year period Results The functioning KG rate increased progressively from 40.5% (n=2211) in 1997 to 57.0% (n=6149) in 2017 and, conversely, the AVF rate in prevalent HD patients decreased progressively from 86.0% (n=2609) to 63.2% (n=2546) during the same period (for both comparisons, p < 0.001). The characteristics of all prevalent HD pts dialyzed in 1997 (n=3104) vs 2017 (n=4205) were different regarding age 62.6±15.3 vs 70.3±14.2 yr, diabetic nephropathy (DN) 13.2% vs 21.8% and cardiovascular disease (CD) 67.6% vs 75.8% (for all comparisons, p<0.001). On December 31, 2017 (maximum KT rate), the characteristics of KG recipients were different compared with prevalent HD pts dialyzed through either an AVF or a tunneled catheter (n=1145): age 57.4±14.5 vs 69.9±13.8 vs 72.0±14.6 yr, DN 9.5% vs 21.7% vs 22.5%, CD 38.6% vs 74.3% vs 83.7% (for all comparisons, p<0.001). By analyzing the likelihood of prevalent pts performing HD through an AVF, we saw it was lower in pts with DN (OR: 0.86; 95% CI: 0.79-0.94, p=0.001) and it decreased progressively as they got older (reference >74 yr): <44 yr (OR:1.55, 95% CI: 1.41-1.70, p<0.001), 45-64 yr (OR: 1.47, 95% CI: 1.38-1.56, p<0.001) and 65-74 yr (OR: 1.22, 95% CI: 1.17-1.28, p<0.001). This probability was higher in males (OR: 1.84, 95% CI: 1.73-1.95, p<0.001), pts with polycystic kidney disease (OR: 1.54, 95% CI: 1.35-1.77, p<0.001) and pts without CD (OR: 1.32; 95% CI: 1.27-1.38, p<0.001) and it increased according to the time on RRT (reference < 1 month): >12 m (OR: 2.39, 95% CI: 2.17-2.64, p<0.001). In addition, this likelihood decreased progressively as the percentage of patients with a functioning KG increased (reference >55%): 40-45% (OR: 3.26, 95% CI: 3.05-3.48, p<0.001), 45-50% (OR: 1.82, 95% CI: 1.73-1.92, p<0.001) and 50-55% (OR: 1.27, 95% CI: 1.21-1.33, p<0.001). The rate of prevalent HD pts waitlisted for KT and dialyzed through AVF decreased progressively from 94.5% (639/676, 1997) to 77.9% (491/630, 2017). In parallel, but always remaining at a lower level, the rate of prevalent HD patients not waitlisted for KT and dialyzed through AVF also decreased progressively from 83.6% (1970/2357) to 60.5% (2055/3399) during the same period (for all comparisons, p<0.001). Considering the prevalent HD pts during the period 2014-2017 (n=4029), significant differences were observed between HD pts waitlisted (n=630, 15.6%) and not-waitlisted (n=3399, 84.4%) for KT regarding age (58.2±12.9 vs 72.8±13.1 yr), DN (16.2% vs 23.0%), CD (59.5% vs 80.5%) and distribution of AVF (77.9% vs 60.5%) or tunneled catheter (16.5% vs 30.6%) (for all comparisons, p<0.001). During the period 2012-2014, incident pts starting HD through an AVF (n=1026) had a significant higher likelihood of receiving a KG over time (HR: 1.68, 95% CI: 1.41-2.00, p<0.001) in comparison to pts who initiated HD through a catheter (n=1408). Conclusion 1) The fall of prevalent HD pts with AVF over time could be associated with a progressive worsening of their clinical profiles along with the increasing rate of KG recipients. 2) In addition to some demographic and clinical characteristics of prevalent HD pts, the annual KT rate was also a determining factor in their AVF rate. 3) Starting HD program through an AVF was independently associated with a greater likelihood of receiving a KG over time as compared to starting HD through a catheter.

Kidney Transplantation 1: An Overview--Recipient Evaluation and Immunosuppression

2013 ◽  
Author(s):  
Jamil Azzi ◽  
Belinda T. Lee ◽  
Anil Chandraker
Keyword(s):  
Kidney Transplantation ◽  
Primary Care Physicians ◽  
Human Leukocyte ◽  
Visual Aids ◽  
Coordinated Care ◽  
Comprehensive Overview ◽  
Successful Transplantation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Half a century after the first successful kidney transplantation, we still stand at the crossroads of immunology and transplantation, where science meets art in the management of complex end-stage renal disease (ESRD) patients. Successful transplantation requires not only a lifetime’s commitment from patients but also a multidisciplinary approach, bringing together surgeons, transplant nephrologists, primary care physicians, scientists, and nurses to provide coordinated care. Although transplantation is the treatment of choice for the vast majority of ESRD patients, many patients remain on dialysis due to a relative imbalance between demand for and supply of suitable organs. This chapter provides a comprehensive overview of recipient evaluation and immunosuppression. Risk factors that prohibit transplantation are discussed, as are human leukocyte antigen/ABO compatibility, transplant immunobiology, induction therapy, maintenance therapy, transplantation for special populations, and future directions in the field. Tables outline Amsterdam Living Donation Forum guidelines, ABO blood group compatibilities, and pretransplant immunologic testing. Visual aids include graphs, charts, cell illustrations, and an evaluative algorithm. This chapter contains 10 figures, 3 tables, 101 references, and 5 Board-styled MCQs.

The Predictive Factors of Arteriovenous Fistula Maturation in Patients with End-Stage Renal Disease

2020 ◽  
Vol 25 (1) ◽  
pp. 28-34
Author(s):  
Supomo Supomo ◽  
Satya Septia Wahyunigrum ◽  
Aditya Agam Nugraha
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Predictive Factors ◽  
End Stage Renal Disease ◽  
Arterial Diameter ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

Highlights Arterial diameter above 2 mm had an almost 5 times better AVF maturation outcome. Average age of ESRD patients who underwent the AVF procedure was above 50 years. Percentage of AVF maturation was higher in men. Hypertension was the most common comorbid factor in ESRD patients.

scholarly journals Nationwide Glaucoma incidence in end stage renal disease patients and kidney transplant recipients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jong Joo Moon ◽  
Yong Woo Kim ◽  
Baek-Lok Oh ◽  
Kyungdo Han ◽  
Dong Ki Kim ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Open Angle Glaucoma ◽  
Angle Closure ◽  
Healthy Controls ◽  
Kidney Transplant Recipients ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

AbstractGlaucoma shares common risk factors with chronic kidney disease (CKD) but previous cross-sectional studies have demonstrated discrepancies in the risk of glaucoma in CKD patients. This study enrolled kidney transplantation recipients (KTRs) (n = 10,955), end stage renal disease (ESRD) patients (n = 10,955) and healthy controls (n = 10,955) from National Health Insurance Service database of the Republic of Korea. A Cox proportional hazard regression model was used to calculate the hazard ratios (HR) for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) incidences. The incidence of POAG was higher in ESRD patients (3.36/1,000 person-years, P < 0.0001) and KTRs (3.22 /1,000 person-years, P < 0.0001), than in healthy controls (1.20/1,000 person-years). However, POAG risk showed no significant increase in either ESRD patients (P = 0.07) or KTRs (P = 0.08) when adjusted for the confounding factors. The incidence of PACG was significantly higher in ESRD patients (0.41/1,000 person-years) than in healthy controls (0.14/1,000 person-years, P = 0.008). The PACG incidence was significantly lower in KTRs than in ESRD patients (HR = 0.35, P = 0.015). In conclusion, this nationwide cohort study demonstrated that kidney transplantation can reduce the risk of PACG but not POAG in ESRD patients.

scholarly journals Inhibition of Lysyl Oxidase with β-aminopropionitrile Improves Venous Adaptation after Arteriovenous Fistula Creation

Kidney360 ◽  
2020 ◽  
pp. 10.34067/KID.0005012020
Author(s):  
Diana R. Hernandez ◽  
Brandon Applewhite ◽  
Laisel Martinez ◽  
Tyler Laurito ◽  
Marwan Tabbara ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Remodeling ◽  
Lysyl Oxidase ◽  
Venous Compliance ◽  
Covalent Bonds ◽  
Collagen Crosslinking ◽  
Local Inhibition ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: The arteriovenous fistula (AVF) is the preferred hemodialysis access for end-stage renal disease (ESRD) patients. Yet, establishment of a functional AVF presents a challenge, even for the most experienced surgeons, since postoperative stenosis frequently occludes the AVF. Stenosis results from the loss of compliance in fibrotic areas of the fistula which turns intimal hyperplasia into an occlusive feature. Fibrotic remodeling depends on deposition and crosslinking of collagen by lysyl oxidase (LOX), an enzyme that catalyzes the deamination of lysine and hydroxylysine residues, facilitating intra/intermolecular covalent bonds. We postulate that pharmacological inhibition of lysyl oxidase (LOX) increases postoperative venous compliance and prevents stenosis in a rat AVF model. Methods: LOX gene expression and vascular localization were assayed in rat AVFs and human pre-access veins, respectively. Collagen crosslinking was measured in humans AVFs that matured or failed, and in rat AVFs treated with β-aminopropionitrile (BAPN), an irreversible LOX inhibitor. BAPN was either injected systemically or delivered locally around rat AVFs using nanofiber scaffolds. The major endpoints were AVF blood flow, wall fibrosis, collagen crosslinking, and vascular distensibility. Results: Non-maturation of human AVFs was associated with higher LOX deposition in pre-access veins (N=20, P=0.029), and increased trivalent crosslinks (N=18, P=0.027) in human AVF tissues. Systemic and local inhibition of LOX increased AVF distensibility, while reducing wall fibrosis and collagen crosslinking in rat fistulas. Conclusions: Our results demonstrate that BAPN-mediated inhibition of LOX significantly improves vascular remodeling in experimental fistulas.

Outcomes of Simultaneous Peritoneal Dialysis and Arteriovenous Fistula Placement in End-Stage Renal Disease Patients

2017 ◽  
Vol 37 (6) ◽  
pp. 658-661 ◽  
Author(s):  
Nosratollah Nezakatgoo ◽  
Albert Ndzengue ◽  
Manhunath Ramaiah ◽  
Elvira O. Gosmanova
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Catheter Insertion ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Peritoneal dialysis (PD) interruption requiring hemodialysis (HD) is not uncommon and its frequently abrupt nature prevents timely creation of permanent HD access and avoidance of central venous catheters (CVC). We retrospectively studied a cohort of 24 end-stage renal disease (ESRD) patients (mean age 50.7 years, 83.3% African-Americans, 58.3% females, time on dialysis interquartile range [IQR] 0 - 65 days) who had simultaneous PD catheter insertion and backup arteriovenous fistula (AVF) creation between January 1, 2012, and December 31, 2013. The primary outcome of interest was the percent of patients receiving HD through the backup AVF at the time of PD interruption. A median (IQR) for PD catheter use after its insertion was 10.5 (2 - 20) days. After the mean follow-up of 19.6 months, 12 patients remained on PD, 2 patients received a kidney transplant, and 1 patient died. The overall AVF patency was 66.7%. A total of 9 (37.5%) patients had PD interruption requiring permanent (8 patients) or temporary (1 patient) HD after the mean (standard deviation [SD]) follow-up of 12.3 (8.2) months. Arteriovenous fistula was used as the initial access in 4 patients, and in 3 patients the original AVF was used after additional surgical revision. Forty-four percent of patients with a backup AVF fistula avoided CVC at the time of PD interruption requiring HD. The simultaneous AVF creation at the time of PD catheter insertion reduced but did not fully eliminate CVC at the time of PD interruption. Larger studies are needed to evaluate the utility of a backup AVF in PD patients.

scholarly journals A survey of waiting lists for kidney transplantation in northeastern Iran

2020 ◽  
Vol 5 (2) ◽  
pp. e20-e20
Author(s):  
Majid Jangi ◽  
Hamed Tabesh ◽  
Mahin Ghorban Sabbagh ◽  
Ebrahim Khaleghi Baigi ◽  
Sayyed Mostafa Mostafavi ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Waiting List ◽  
Unknown Etiology ◽  
Time Period ◽  
The Status ◽  
Linkage Method ◽  
Stage Renal Disease ◽  
Clinical Records ◽  
End Stage ◽  
Esrd Patients

Introduction: End-stage renal disease (ESRD) continues to be a public health challenge. In ESRD patients, renal replacement therapy is essential. Kidney transplantation is considered as an effective therapeutic procedure for ESRD. On the advice of a qualified nephrologist, ESRD patients are registered on a waiting list, seeking organ transplantation. Objectives: This study aimed to report the status of the waiting list for kidney transplantation in the northeastern Iran region, with data covering the time period until 2017. Patients and Methods: The study was conducted at Montaserie hospital in Mashhad, Iran. We reviewed the clinical records of all ESRD patients referred to the hospital, retrospectively. Patients’ data were completed using a data linkage method and analyzed using SPSS version 23. Results: A total of 1956 patients were studied from the waiting list with a mean age of 44.7 ± 14.4 years (3-80 years). The described etiology reveals that the main causes of ESRD were unknown sources (44.1%), diabetes (18.4%) and hypertension (10.9%). Hemodialysis therapy was conducted for 91.1% of the patients. The maximum registered waiting time was 295 months and the minimum was one month, with an average of 63 months. The proportion of patients waiting for the first, second and third kidney transplantation was 86%, 13.2% and 0.7%, respectively. Conclusion: This study highlights that in the population under study, the number of registered patients on the waiting list followed an increasing pattern, while the age of patients decreased. Unfortunately, in most case studies in Iran, the true etiology of nephrology diseases is still unknown. More effort to define the ESRD causes is necessary. The most likely reason for reported cases with unknown etiology is delays in referral problems.

scholarly journals Propensity-Matched Survival Analysis of Upper Urinary Tract Urothelial Carcinomas between End-Stage Renal Disease with and without Kidney Transplantation

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Hao Lun Luo ◽  
Po Hui Chiang ◽  
Yuan Tso Cheng ◽  
Yen Ta Chen
Keyword(s):  
Kidney Transplantation ◽  
Urinary Tract ◽  
Propensity Score ◽  
Urothelial Carcinoma ◽  
End Stage Renal Disease ◽  
Upper Urinary Tract ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Urinary Tract Urothelial Carcinoma

Urothelial carcinoma is the most common cancer following kidney transplantation (KT) in Taiwan. Unusual presentation of upper urinary tract urothelial carcinoma (UTUC) is noted in Taiwan and China. As the post-KT-UTUC oncological course is not fully understood, the aim of this study is to identify postulated significant differences for the clinical cancer course of UTUC among end-stage renal disease (ESRD) patients with and without KT. From 2005 January to 2016 March, 194 ESRD patients underwent radical nephroureterectomy due to UTUC in our hospital. The parameters were obtained from the chart record and pathology report. SPSS version 21 software was used for all statistical analyses. Unequal matching created study groups wherein a 0.2 caliper width was performed for adjusting these confounding pathological factors. Propensity score-matching cohort was performed for each population first, and then for all the study patients. We observed that the average age of UTUC in ESRD patients after KT was younger than in those without KT. The pathological factors such as stage, bladder cancer history, papillary structure, lymphovascular invasion, and variant histology were equal in these two groups. However, younger onset (p<0.001), more multifocal tumors, and carcinomas in situ were observed in post-KT UTUC (p<0.001 and 0.006, respectively). After adjustment of pathological factors by propensity score-matched analysis, the 5-year systemic UTUC recurrence was significantly more in ESRD after KT compared with ESRD without KT (p=0.03). No obvious difference in 5-year cancer related death could be observed between these two groups (p=0.314). Post-kidney transplantation upper urinary tract urothelial carcinoma in Taiwan is relatively common, has younger onset, and is associated with aggressive pathological features. The oncologic outcome of UTUC after KT is poor in our observation, even after propensity scored-matched analysis. It indicates the immunosuppression status is still associated with more malignant UTUC behavior.

scholarly journals Effect of Systemic Intraoperative Heparin Use on Upper Extremity Arteriovenous Fistula Patency in End-Stage Renal Disease Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Morwan Bahi
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Life Quality ◽  
Review Article ◽  
Fistula Formation ◽  
Important Method ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

The formation of the arteriovenous fistula is an important method of vascular access for patients with end-stage renal disease (ESRD). This allows renal filtration resulting in improved life quality and expectancy for ESRD patients. The biggest drawback to arteriovenous fistula formation is thrombosis, which can occur at an early or delayed stage. One suggested method of reducing postoperative arteriovenous fistula thrombosis rates is the administration of intraoperative systemic heparin. Heparin use in this context is debated, and there is currently no consensus on its use. There are a number of small randomised control studies trialling use of heparin but no large systematic trials. In this report, we collate existing evidence in the form of a review article and attempt to extrapolate a consensus of the evidence.

scholarly journals Our experience of arteriovenous fistula creation as vascular access for hemodialysis

2020 ◽  
Vol 7 (7) ◽  
pp. 2321
Author(s):  
Pradeep K. Sharma ◽  
Rupesh Nagori ◽  
Shekhar Baweja ◽  
Vikas Aggarwal ◽  
Pawan Katti ◽  
...  
Keyword(s):  
Physical Examination ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Color Doppler ◽  
Postoperative Outcome ◽  
Arterial System ◽  
Dominant Hand ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: End stage renal disease (ESRD) patients depend on lifelong renal replacement therapy. The arteriovenous fistula (AVF) is the preferred hemodialysis access. Cimino fistulas are currently accepted as the best mode of vascular access for hemodialysis (HD). The present study was planned to study for presence of on table bruit and thrill and to know postoperative outcome and patency.Methods: This single center, prospective study was carried out in department of Urology at SNMC, Jodhpur from November 2018 to May 2019.  Dominance of hand was examined, and preference was given to non-dominant hand. Physical examination of the arterial system along with physical examination of the venous system was done.  Preoperative color Doppler of upper limb veins and arteries was done in selected patients. End to side anastomosis was done between cephalic vein and radial artery.Results: In this study of 70 cases of AVFs, there were 53 (75.71%) successful cases and 17 (24.2%) were failures.  End (vein) to side (artery) anastomosis was done in 70 (100%) cases.  On table bruit was present in 63 (90%) and thrill in 58 (82.8%) cases. All patients with failed post-operative fistula were not doing ball exercise.Conclusions: Presence of on table thrill and bruit are indicators of successful AVF. Post-operative ball exercise should be done for better results.

scholarly journals Correlation between preoperative vein and artery diameters and arteriovenous fistula outcome in patients with end-stage renal disease

2018 ◽  
Vol 91 (4) ◽  
pp. 399-407
Author(s):  
Alexandru Oprea ◽  
Adrian Molnar ◽  
Dan Vlăduțiu ◽  
Traian Scridon ◽  
Cătălin Trifan ◽  
...  
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Arterial Disease ◽  
Primary Patency ◽  
Clinical Covariates ◽  
Maturation Rate ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background and aims: Arteriovenous fistula (AVF) maturation failure rates remain high in patients with end-stage renal disease (ESRD). Although preoperative morphological and functional assessment of blood vessels by duplex ultrasonography (DUS) has been shown to improve AVF maturation, there is no consensus regarding the optimal vein (VD) and artery (AD) diameters to be universally used for AVF creation. To improve patient selection, set out to investigate if there is a correlation between preoperative VD/AD and clinical covariates, and postoperative AVF outcome.Methods: This was a prospective cohort study conducted during January–August 2014. ESRD patients referred to “Niculae Stăncioiu” Heart Institute Cluj-Napoca, who had a VD ≥1.9 mm and AD ≥1.5 mm, as measured by DUS, and underwent AVF creation were enrolled. We assessed whether preoperative VD/AD and clinical covariates were associated with AVF maturation rate and primary patency at 2 years after AVF creation.Results: Of 115 patients referred for AVF creation, 93 were included in the study. Mean (± standard deviation) VD was 3.3 ± 1.1 mm and VDs were distributed in quartile Q1 <2.55 mm, Q2: 2.56-3.10 mm, Q3: 3.11-3.70 mm and Q4: >3.71 mm. Mean AD was 3.3 ± 1.4 mm and ADs were distributed in Q1 <2.55 mm, Q2: 2.56-3.10 mm, Q3: 3.11-3.70 mm, and Q4, >3.71 mm. AVF maturation rate increased proportionally with VD from Q1 (62%) to Q2 (70%), Q3 (82%) to Q4 (96%) (p=0.03). Based on AD, a higher AVF maturation rate was observed in Q3 (86%), Q4 (83%) vs Q1 (71%) and Q2 (67%). Long-term primary patency of AVFs seemed not to be influenced by VD and AD. In older patients and those with peripheral arterial disease, AVF maturation failure tended to be higher.Conclusions: Our findings suggest that a preoperative VD ≥1.9 mm and AD ≥1.5 mm have a successful maturation rate of AVF greater than 60% in ESRD patients. The maturation rate of surgical AVF increases proportionally with the size of VD used for AVF creation.

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