Maturing arteriovenous accesses in incident haemodialysis patients and first-year outcomes

2019 ◽  
Vol 21 (3) ◽  
pp. 322-327
Author(s):  
Rita L McGill ◽  
Eduardo K Lacson
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Odds Ratio ◽  
Venous Catheter ◽  
The United States ◽  
First Year ◽  
Central Venous ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Access ◽  
One Year

Introduction: Nephrologists have increased arteriovenous access placement in patients with chronic kidney disease. Not yet usable ‘maturing’ arteriovenous fistulas and grafts are nearly as common as mature arteriovenous fistulas or grafts. Little has been reported about patients initiating haemodialysis with unready arteriovenous fistulas or grafts. Methods: The United States Renal Data System records for all adult patients initiating haemodialysis with central venous catheters between July 2010 and December 2011. Patients were categorized by whether a maturing arteriovenous fistula or graft was present. Transition to working arteriovenous fistula or graft was determined from linked Medicare claims. Modality changes and survival were ascertained. A logistic model for one-year survival and a subdistribution hazards model for transition to working arteriovenous fistula or graft, accounting for the competing risk of death, were constructed. Results: Compared to central venous catheter-only, maturing arteriovenous fistula or graft was associated with access conversion (hazard ratio = 2.23 (2.17–2.30) and 3.25 (2.97–3.56), respectively, p < 0.001 for both). Median time to conversion, among those who transitioned, was 95 days (interquartile range = 56–139) for patients with a maturing arteriovenous graft and 135 days (98–198) with a maturing arteriovenous fistula, versus 193 days (138–256) with central venous catheter-only. Pre-dialysis nephrology care, male sex and non-Caucasian race were associated with access conversion. Patients without a maturing arteriovenous fistula or graft had decreased odds of one-year survival (odds ratio = 0.61 (0.58–0.66), p < 0.001), which attenuated with adjustment for access conversion (adjusted odds ratio = 1.06 (0.98–1.13), p = 0.2). Conclusion: Maturing arteriovenous fistulas or grafts were associated with enhanced first-year survival and increased opportunity for working arteriovenous fistulas or grafts, which may reflect pre-dialysis decision-making, quality of care and comorbid diseases. Central venous catheter exposure was substantial, even among patients with maturing access. Contributory factors prolonging conversion to arteriovenous access need to be identified and addressed.

Aneurysm of Arteriovenous Fistula in Uremic Patients: Is Endograft a Viable Therapeutic Approach?

2002 ◽  
Vol 3 (2) ◽  
pp. 85-88 ◽  
Author(s):  
P.M. Allaria ◽  
E. Costantini ◽  
A. Lucatello ◽  
E. Gandini ◽  
F. Caligara ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Venous Catheter ◽  
Good Alternative ◽  
Central Venous ◽  
Arteriovenous Fistulas ◽  
Risk Of Rupture ◽  
Arterial Aneurysms ◽  
Percutaneous Insertion

One of the complications of arteriovenous fistulas in chronic hemodialyzed patients is the onset of an aneurysm which can be at risk of rupture. Traditional surgical repair is not always feasible and may not be successful in these cases, leading therefore to the loss of a functioning vascular access and requiring in any case the temporary use of a central venous catheter to allow regular hemodialysis sessions. We applied to this kind of aneurysm the same experience developed in the management of major arterial aneurysms and we considered endografting repair a good alternative in this case. In this paper we present the successful treatment of an arteriovenous fistula aneurysm using that technique. A distal radio-cephalic arteriovenous fistula in one of our patients presented an aneurysm with high risk of rupture. The endografting repair with percutaneous insertion of a Wallgraft™ endoprosthesis was well tolerated and the vascular access could be used the day after, without the need for a central venous catheter insertion.

scholarly journals Racial and Sex Disparities in Catheter Use and Dialysis Access in the United States Medicare Population

2020 ◽  
Vol 31 (3) ◽  
pp. 625-636 ◽  
Author(s):  
Shipra Arya ◽  
Taylor A. Melanson ◽  
Elizabeth L. George ◽  
Kara A. Rothenberg ◽  
Manjula Kurella Tamura ◽  
...  
Keyword(s):  
United States ◽  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Venous Catheter ◽  
The United States ◽  
Dialysis Access ◽  
Central Venous ◽  
Observational Cohort ◽  
System Data ◽  
White Patients

BackgroundDespite efforts to increase arteriovenous fistula and graft use, 80% of patients in the United States start hemodialysis on a central venous catheter (CVC).MethodsTo better understand in incident hemodialysis patients how sex and race/ethnicity are associated with time on a central venous catheter and transition to an arteriovenous fistula and graft, our observational cohort study analyzed US Renal Data System data for patients with incident ESKD aged ≥66 years who started hemodialysis on a CVC in July 2010 through 2013.ResultsAt 1 year, 32.7% of 74,194 patients transitioned to an arteriovenous fistula, 10.8% transitioned to an arteriovenous graft, 32.1% stayed on a CVC, and 24.5% died. Women spent a significantly longer time on a CVC than men. Compared with white patients, patients who were black, Hispanic, or of another racial/ethnicity minority spent significantly more days on a CVC. In competing risk regression, women were significantly less likely than men to transition to a fistula and more likely to transition to a graft. Compared with white patients, blacks were significantly less likely to transition to a fistula but more likely to transition to a graft, Hispanics were significantly more likely to transition to a fistula, and other races/ethnicities were significantly more likely to transition to either a fistula or a graft.ConclusionsFemale patients spend a longer time on a CVC and are less likely to transition to permanent access. Compared with white patients, minorities also spend longer time on a CVC, but are more likely to eventually transition to permanent access. Strategies to speed transition to permanent access should target groups that currently lag in this area.

Patient factors and haemodialysis arteriovenous fistula outcomes

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S19-S23 ◽  
Author(s):  
Agnes Masengu ◽  
Jennifer Hanko
Keyword(s):  
Life Expectancy ◽  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Venous Catheter ◽  
Optimal Outcome ◽  
Central Venous ◽  
Patient Factors ◽  
Limited Life Expectancy ◽  
Arteriovenous Fistulas ◽  
Limited Life

Arteriovenous fistulas (AVF) improve survival and morbidity for most haemodialysis (HD) patients. Are they better for all patients? In the enthusiastic pursuit of AVFs for all, concerns have been raised regarding high primary AVF failure rates, continued high incident central venous catheter (CVC) use in some countries, and the limited life expectancy of some HD patients. “Fistula first” is changing to “catheter last”. The focus must be on decreasing AVF failure to mature and decreasing incident CVC use. An optimal outcome should be sought for each individual patient, and multiple failed attempts at AVF creation avoided.

scholarly journals The influence of a doppler ultrasound in arteriovenous fistula for dialysis failure related to some risk factors

2020 ◽  
Vol 42 (2) ◽  
pp. 147-152
Author(s):  
Jocefábia Reika Alves Lopes ◽  
Ana Lígia de Barros Marques ◽  
João Antonio Correa
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Doppler Ultrasound ◽  
Odds Ratio ◽  
Venous Catheter ◽  
Clinical Group ◽  
Central Venous ◽  
Significant Difference ◽  
A Prospective Study

ABSTRACT Introduction: The increasing prevalence of chronic kidney disease has increased the demand for arteriovenous fistula (AVF) care. The objective of this study was to assess the relationship between some risk factors for AVF failure (advanced age, female sex, diabetes, obesity, central venous catheter, previous fistula, and hospitalization) and having a Doppler ultrasound performed preoperatively. Methods: A prospective study was performed with 228 dialysis patients from Imperatriz, Maranhão. Half of the sample was randomly selected to receive preoperative Doppler ultrasound and the other half did not, from the period of October 2016 to September 2018. Results: There were 53 total failures corresponding to 23.2% of our sample, which is almost double that of the patients in the clinical group. Considering the failures and risk factors associated with the overall sample, there was a statistically significant association between a central venous catheter on the same side of the AVF with P = 0.04 (Odds Ratio 1.24) and obesity with P = 0.05 (Odds Ratio 1.36), which was not repeated in the Doppler ultrasound group individually. There was no statistically significant difference between the Doppler group and clinical group with respect to the amount of days of previous AVF hospitalization and failure. Conclusions: We concluded that the reduction of failures with an introduction of the Doppler was statistically significant in the overall sample, but establishing a relationship between specific risk factors and failure was only possible with two of the risk factors in the study - obesity and central venous catheter on the same side of the AVF.

scholarly journals Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

2010 ◽  
Vol 18 (1) ◽  
pp. 73-80 ◽  
Author(s):  
Cibele Grothe ◽  
Angélica Gonçalves da Silva Belasco ◽  
Ana Rita de Cássia Bittencourt ◽  
Lucila Amaral Carneiro Vianna ◽  
Ricardo de Castro Cintra Sesso ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Severe Infection ◽  
Venous Catheter ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Double Lumen ◽  
One Year ◽  
Very High

This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo - UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

Use of Maximal Sterile Barrier Precautions and/or Antimicrobial-Coated Catheters to Reduce the Risk of Central Venous Catheter-Related Bloodstream Infection

2008 ◽  
Vol 29 (10) ◽  
pp. 947-950 ◽  
Author(s):  
Duk-hee Lee ◽  
Koo Young Jung ◽  
Yoon-Hee Choi
Keyword(s):  
Multivariate Analysis ◽  
Mortality Rate ◽  
Central Venous Catheter ◽  
Confidence Interval ◽  
Bloodstream Infection ◽  
Odds Ratio ◽  
Venous Catheter ◽  
Central Venous ◽  
Factors Associated ◽  
Catheter Related Bloodstream Infection

Central venous catheter-related bloodstream infection is clinically important because of its high mortality rate. This prospective study shows by multivariate analysis that the use of maximal sterile barrier precautions (odds ratio, 5.205 [95% confidence interval, 0.015-1.136]; P= .023) and the use of antimicrobial-coated catheters (odds ratio, 5.269 [95% confidence interval, 0.073-0.814]; P = .022) are independent factors associated with a lowered risk of acquiring a central venous catheter-related bloodstream infection.

Brachial Arteriovenous Fistula as a Complication of Placement of a Peripherally Inserted Central Venous Catheter: A Case Report and Review of the Literature

2006 ◽  
Vol 72 (9) ◽  
pp. 833-836 ◽  
Author(s):  
Hoang S. Tran ◽  
Brian J. Burrows ◽  
William A. Zang ◽  
David C. Han
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Duplex Ultrasound ◽  
Venous Catheter ◽  
Central Venous ◽  
Arterial Tree ◽  
Line Placement ◽  
Term Administration ◽  
History Of ◽  
Picc Line

Peripherally inserted central venous catheter (PICC) lines have become a frequently used method of intravenous access for long-term administration of antibiotics, chemotherapy, and parenteral nutrition. Catheter-related complications involving the arterial tree are rare. We report a case of a 25-year-old woman with a history of difficult PICC line placement that presented with an arteriovenous fistula in the left arm. Duplex ultrasound confirmed the diagnosis of a brachial artery-to-brachial vein arteriovenous fistula (AVF), and the patient underwent surgical repair. To our knowledge, this is the first reported case of an AVF resulting from PICC line placement. Correction of AVF is indicated to alleviate symptoms as well as to prevent future complications.

Point-of-care ultrasound for assessing arteriovenous fistula maturity in outpatient hemodialysis

2020 ◽  
Vol 21 (6) ◽  
pp. 923-930
Author(s):  
George N Coritsidis ◽  
Orlando N Machado ◽  
Farzin Levi-Haim ◽  
Sean Yaphe ◽  
Roshan A Patel ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Point Of Care ◽  
Demographic Data ◽  
Venous Catheter ◽  
Fisher Exact Test ◽  
Point Of Care Ultrasound ◽  
Central Venous ◽  
Exact Test ◽  
Central Venous Catheter Removal

Background: Point-of-care ultrasound in end-stage renal disease is on the rise. Presently the decision to cannulate an arteriovenous fistula is based on its duration since surgery and physical exam. This study examines the effects of point-of-care ultrasound on decreasing the time to arteriovenous fistula cannulation, time spent with a central venous catheter, and the complications and infections that arise. Methods: Prospective point-of-care ultrasound patients were recruited between January 2015 and January 2018, while retrospective data (non-point-of-care ultrasound) were collected via chart review from patients who had fistula creation between November 2011 and May 2014. Patients had point-of-care ultrasound within 3 weeks after arteriovenous fistula creation and were followed for 1 year. Arteriovenous fistula cannulation was initiated when the following parameters were met: diameter > 6 mm (with no depreciable narrowing of more than 20% throughout), depth < 6 mm, and length > 6 cm. Demographic data, as well as time to cannulation and central venous catheter removal, number of infections, complications, and interventions were compared between point-of-care ultrasound and non-point-of-care ultrasound groups using unpaired t-test, chi-square, and Fisher exact test statistical analysis. Results: A total of 37 patients with new arteriovenous fistulas were followed by point-of-care ultrasound compared to 29 non-point-of-care ultrasound patients. Point-of-care ultrasound patients had earlier cannulations (35.5 vs 63.3 days, p < 0.05), shorter central venous catheter duration (68.2 vs 98.3 days, p < 0.05), and less infections (12 vs 19) without differences in complication compared to the non-point-of-care ultrasound. Conclusion: Point-of-care ultrasound facilitates early and safe arteriovenous fistula cannulation leading to a reduction in central venous catheter time and risk of infection. Point-of-care ultrasound may also aid in earlier identification of complications and difficult cannulations.

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