Venous distensibility is more important than venous diameter in primary survival of autogenous radiocephalic arteriovenous fistulas

2020 ◽  
Vol 21 (6) ◽  
pp. 963-968
Author(s):  
Guocun Hou ◽  
Yi Hou ◽  
Xiuli Sun ◽  
Na Yin ◽  
Guozhen Feng ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Confidence Interval ◽  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Odds Ratio ◽  
Diabetic Kidney Disease ◽  
Peak Systolic Velocity ◽  
Cephalic Vein ◽  
Venous Distensibility ◽  
Vein Diameter

Background: Many studies suggested that the optimal cephalic vein diameter for wrist radio-cephalic arteriovenous fistula construction should be at least 2 mm to predict successful maturation and primary patency. However, our experience has shown that many patients with smaller cephalic vein diameter (≤2 mm) in the neutral state (without a tourniquet) also have good clinical outcomes. The aim of this study was to identify predictors that affect primary survival of new wrist radio-cephalic arteriovenous fistula in patients with cephalic vein diameter ≤2 mm. Methods: We performed a retrospective review of 50 patients with preoperative cephalic vein diameters ≤2 mm in the neutral state who underwent wrist radio-cephalic arteriovenous fistula construction between September 2016 and October 2019. Internal diameters of the cephalic vein and radial artery, venous distensibility, peak systolic velocity, and resistance index of the radial artery were determined by ultrasound examination before wrist radio-cephalic arteriovenous fistula placement. Patients were divided into two groups: failure and survival. Results: The radio-cephalic arteriovenous fistula survival rate was 68% from the time of radio-cephalic arteriovenous fistula creation until the end of the study. Univariate analysis showed that larger venous distensibility (p < 0.001), non-diabetic kidney disease (p = 0.009), and slower peak systolic velocity of the radial artery (p = 0.033) were predictive factors for primary radio-cephalic arteriovenous fistula survival. Multivariate regression analysis revealed good venous distensibility (odds ratio = 9.637, 95% confidence interval = 1.893–49.050, p = 0.006) and non-diabetic kidney disease (odds ratio = 0.148, 95% confidence interval = 0.033–0.660, p = 0.012) to be independent predictors for primary radio-cephalic arteriovenous fistula survival. Receiver operating characteristic analysis showed that venous distensibility >0.52 mm (sensitivity: 70.6%, specificity: 68.8%) was the best cut-off value to predict primary radio-cephalic arteriovenous fistula survival. Conclusion: When cephalic veins with diameter ≤2 mm are found, venous distensibility should be used to aid in the surgery decision-making process. The outcome of wrist radio-cephalic arteriovenous fistula survival would be significantly improved through the use of cephalic vein with venous distensibility >0.52 mm.

Preoperative cephalic vein diameter and diabetes do not limit the choice of wrist radio-cephalic arteriovenous fistula

2019 ◽  
Vol 21 (3) ◽  
pp. 366-371 ◽  
Author(s):  
Guocun Hou ◽  
Yonghong Yan ◽  
Guangyi Li ◽  
Yi Hou ◽  
Xiuli Sun ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Confidence Interval ◽  
Arteriovenous Fistula ◽  
Odds Ratio ◽  
Diabetic Kidney Disease ◽  
Cephalic Vein ◽  
Clinical Effects ◽  
Diabetic Kidney ◽  
Arteriovenous Fistulas ◽  
Vein Diameter

Aim: To identify predictors that affect initial maturation of new wrist radio-cephalic arteriovenous fistula and evaluate the clinical effects of the ipsilateral mid-forearm radio-cephalic arteriovenous fistulas creation in the event of first wrist radio-cephalic arteriovenous fistula failure. Methods: We performed a retrospective review of all patients who underwent first wrist radio-cephalic arteriovenous fistula creation between September 2016 and May 2018. Currently, we prefer to re-create an ipsilateral mid-forearm radio-cephalic arteriovenous fistula when the first wrist radio-cephalic arteriovenous fistula fails. Predictors of successful radio-cephalic arteriovenous fistulas were identified using univariate and multivariate analyses. Kaplan–Meier survival analysis and log-rank test were used to calculate successful radio-cephalic arteriovenous fistula rates. Results: Univariate analysis showed that predictive factors for successful wrist radio-cephalic arteriovenous fistula include larger preoperative cephalic vein diameter ( p = 0.001) and non-diabetic kidney disease ( p = 0.007). Multivariate binary logistic regression analysis revealed cephalic vein diameter ⩾2 mm (odds ratio = 4.55, 95% confidence interval = (1.49–13.92), p = 0.008) and non-diabetic kidney disease (odds ratio = 4.22, 95% confidence interval = (1.38–12.88), p = 0.011) to be independent predictors for successful radio-cephalic arteriovenous fistula. We re-created ipsilateral mid-forearm radio-cephalic arteriovenous fistulas in 15 patients among the 21 failed wrist radio-cephalic arteriovenous fistulas; all these arteriovenous fistulas maintained clinical maturation following up for 1–2 years. Conclusion: Small cephalic vein diameter (<2 mm) and diabetes were independent risk factors for failed wrist radio-cephalic arteriovenous fistulas, but this risk could be overcome by aggressive ipsilateral mid-forearm radio-cephalic arteriovenous fistula to address a failed first attempt. Cephalic vein diameter is more important during the maturation stage, and once maturation has occurred, diabetes has an additive role in determining the patency of wrist radio-cephalic arteriovenous fistula. The “wrist RCAVF first, ipsilateral mid-forearm RCAVF second” strategy is the most clinically significant message of our study.

scholarly journals Albuminuria Is Associated with Left Ventricular Hypertrophy in Patients with Early Diabetic Kidney Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Nan Wu ◽  
Weiwei Zhao ◽  
Kuanping Ye ◽  
Yintao Li ◽  
Min He ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Linear Regression ◽  
Left Ventricular Hypertrophy ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Ventricular Hypertrophy ◽  
Diabetic Kidney Disease ◽  
Left Ventricular ◽  
Multivariate Linear Regression ◽  
Diabetic Kidney

Aims.Left ventricular hypertrophy (LVH) and albuminuria are both markers for cardiovascular diseases (CVDs) in patients with type 2 diabetes mellitus (T2DM). We speculate that albuminuria in T2DM patients with early diabetic kidney disease (DKD) could predict LVH.Methods.333 diabetic patients (219 non-DKD and 114 early DKD) were enrolled. The association between albuminuria and LVMI was examined using multivariate linear regression and logistic regression.Results.The rate of LVH was significantly higher in patients with early DKD versus those without DKD (57.0% versus 32.9%;P<0.001). Multivariate linear regression analysis demonstrated that albuminuria status (no, micro-, and macroalbuminuria;P<0.001), age (P<0.001), systolic blood pressure (P=0.0578), and the use of ACEI/ARB drug (P<0.001) were independently associated with LVMI. The risks were substantially higher for LVH in the microalbuminuria group (odds ratio 2.473 (95% confidence interval 1.370–4.464)) and macroalbuminuria group (odds ratio 3.940 (95% confidence interval 1.553–9.993)) compared with that in non-DKD group. Concentric hypertrophy was the most common geometric pattern in patients with early DKD (36.0%), followed by eccentric hypertrophy (21.0%).Conclusions.Albuminuria is associated with higher LVMI and higher rate of LVH in patients with early phase DKD.

scholarly journals Sex modulates the association of radial artery augmentation index with renal function decline in individuals without chronic kidney disease

2021 ◽  
Author(s):  
Qiao Qin ◽  
Fangfang Fan ◽  
Jia Jia ◽  
Yan Zhang ◽  
Bo Zheng
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Arterial Stiffness ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Augmentation Index ◽  
Renal Function Decline

Abstract Purpose An increase in arterial stiffness is associated with rapid renal function decline (RFD) in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether the radial augmentation index (rAI), a surrogate marker of arterial stiffness, affects RFD in individuals without CKD. Methods A total of 3165 Chinese participants from an atherosclerosis cohort with estimated glomerular filtration rates (eGFR) of ≥ 60 mL/min/1.73 m2 were included in this study. The baseline rAI normalized to a heart rate of 75 beats/min (rAIp75) was obtained using an arterial applanation tonometry probe. The eGFRs at both baseline and follow-up were calculated using the equation derived from the Chronic Kidney Disease Epidemiology Collaboration. The association of the rAIp75 with RFD (defined as a drop in the eGFR category accompanied by a ≥ 25% drop in eGFR from baseline or a sustained decline in eGFR of > 5 mL/min/1.73 m2/year) was evaluated using the multivariate regression model. Results During the 2.35-year follow-up, the incidence of RFD was 7.30%. The rAIp75 had no statistically independent association with RFD after adjustment for possible confounders (adjusted odds ratio = 1.12, 95% confidence interval: 0.99–1.27, p = 0.074). When stratified according to sex, the rAIp75 was significantly associated with RFD in women, but not in men (adjusted odds ratio and 95% confidence interval: 1.23[1.06–1.43], p = 0.007 for women, 0.94[0.76–1.16], p = 0.542 for men; p for interaction = 0.038). Conclusion The rAI might help screen for those at high risk of early rapid RFD in women without CKD.

scholarly journals Initial renal histology and early response predict outcomes of Brazilian lupus nephritis patients

Lupus ◽  
2019 ◽  
Vol 29 (1) ◽  
pp. 83-91
Author(s):  
G Vajgel ◽  
C B L Oliveira ◽  
D M N Costa ◽  
M A G M Cavalcante ◽  
L M Valente ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Lupus Nephritis ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Estimated Glomerular Filtration Rate ◽  
Interstitial Fibrosis ◽  
End Stage ◽  
Class Iv

Objective We analyzed baseline and follow-up characteristics related to poorer renal outcomes in a Brazilian cohort of admixture race patients with lupus nephritis. Methods Overall, 280 outpatients with a diagnosis of systemic lupus erythematosus and previous kidney biopsy of lupus nephritis were recruited from August 2015 to December 2018 and had baseline laboratory and histologic data retrospectively analyzed; patients were then followed-up and data were recorded. The main outcome measure was the estimated glomerular filtration rate at last follow-up. Secondary analyses assessed the impact of initial kidney histology and treatment in long-term kidney survival. Results Median duration of lupus nephritis was 60 months (interquartile range: 27–120); 40 (14.3%) patients presented progressive chronic kidney disease (estimated glomerular filtration rate <30 and ≥10 ml/min/1.73 m2) or end-stage kidney disease at last visit. Adjusted logistic regression analysis showed that class IV lupus nephritis (odds ratio 14.91; 95% confidence interval 1.77–125.99; p = 0.01) and interstitial fibrosis ≥25% at initial biopsy (odds ratio 5.87; 95% confidence interval 1.32–26.16; p = 0.02), lack of complete or partial response at 12 months (odds ratio 16.3; 95% confidence interval 3.74–71.43; p < 0.001), and a second renal flare (odds ratio 4.49; 95% confidence interval 1.10–18.44; p = 0.04) were predictors of progressive chronic kidney disease. In a Kaplan-Meier survival curve we found that class IV lupus nephritis and interstitial fibrosis ≥25% were significantly associated with end-stage kidney disease throughout follow-up (hazard ratio 2.96; 95% confidence interval 1.3–7.0; p = 0.036 and hazard ratio 4.96; 95% confidence interval 1.9–12.9; p < 0.0001, respectively). Conclusion In this large cohort of admixture race patients, class IV lupus nephritis and chronic interstitial damage at initial renal biopsy together with non-response after 1 year of therapy and relapse were associated with worse long-term renal outcomes.

Does blood flow restriction training increase the diameter of forearm vessels in chronic kidney disease patients? A randomized clinical trial

2018 ◽  
Vol 19 (6) ◽  
pp. 626-633 ◽  
Author(s):  
Jefferson BN Barbosa ◽  
Tuíra O Maia ◽  
Priscila S Alves ◽  
Shirley D Bezerra ◽  
Elaine CSC Moura ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Chronic Kidney Disease ◽  
Blood Flow ◽  
Kidney Disease ◽  
Radial Artery ◽  
Handgrip Strength ◽  
Cephalic Vein ◽  
Blood Flow Restriction ◽  
Control Group ◽  
Flow Restriction

Introduction: Blood flow restriction training can be used as an alternative to conventional exercise in chronic kidney disease patients with indication of arteriovenous fistula. Objective: Evaluating the efficacy of blood flow restriction training in the diameter and distensibility change of the cephalic vein and the diameter and flow of the radial artery, muscle strength and forearm circumference in chronic kidney disease patients with arteriovenous fistula pre-creation. Methods: A blind randomized clinical trial consisting of 26 chronic kidney disease patients allocated into a blood flow restriction training group (blood flow restriction; n = 12) and a group without blood flow restriction training (control group; n = 14). Blood flow restriction was performed at 50% of systolic blood pressure and using 40% of handgrip strength as load for the isometric exercises in both groups. Results: An increase in the diameter of the cephalic vein in the 2 cm (p = 0.008) and 10 cm segments (p = 0.001) was observed in the control group. The diameter of the radial artery increased in all segments in the blood flow restriction group (2, 10 and 20 cm; p = 0.005, p = 0.021 and p = 0.018, respectively) and in the 10 and 20 cm segments (p = 0.017 and p = 0.026) in the control group. Handgrip strength only increased in the control group (p = 0.003). Conclusion: Physical training associated with blood flow restriction increased cephalic vein diameters in both groups and was effective in increasing the diameter of the radial artery; however, it did not demonstrate superiority over the exercise group protocol without blood flow restriction.

scholarly journals MO638ANEMIA IN DIABETIC PATIENTS REFLECTS SEVERE TUBULOINTERSTITIAL INJURY AND ASSISTS CLINICALLY IN PREDICTING DIAGNOSIS OF DIABETIC NEPHROPATHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Soichiro Yokota ◽  
Kenji Ito ◽  
Maho Watanabe ◽  
Koji Takahashi ◽  
Naoko Himuro ◽  
...  
Keyword(s):  
Renal Function ◽  
Regression Analysis ◽  
Diabetic Nephropathy ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Kidney Biopsy ◽  
Renal Pathology ◽  
Diabetic Patients ◽  
Pathological Findings

Abstract Background and Aims Diabetic nephropathy (DN) is currently a leading cause of end-stage kidney disease worldwide. Kidney biopsy is generally performed in diabetic patients to discriminate between DN and non-diabetic kidney disease (NDKD), and to provide more specific treatments. In addition to conventional predicting factors of DN, recent studies suggested the predictive value of anemia in the diagnosis of DN, however detailed pathophysiology and the significance of anemia in renal pathology are not fully understood. This study aimed to investigate the impact of anemia on renal pathology and clinical course in patients who underwent kidney biopsy. Method We reviewed 81 patients (60.4 ± 13.7 years, 54 men and 27 women) with type 2 diabetes who underwent percutaneous kidney biopsy in Fukuoka University Hospital from January 2001 through March 2020. DN was diagnosed by mesangial expansion or nodular glomerulosclerosis observed under a light microscope, and immunofluorescence assisted in differentiating NDKD from DN. Anemia was defined as hemoglobin level &lt;13 g/dL in males and &lt;12 g/dL in females in accordance with the World Health Organization standards. Laboratory and pathological findings, and clinical courses were investigated. Results According to their pathological findings, patients were classified into two groups: isolated DN (DN group, n=30) and NDKD alone or concurrent DN (NDKD group, n=51). There were 11 types of NDKD. Of these, membranous nephropathy was the most common (23.5%), followed by IgA nephropathy (17.6%), and crescentic glomerulonephritis (13.7%). In multiple logistic regression analysis, absence of severe hematuria (odds ratio (OR) 11.66, 95% confidence interval (CI) 1.68 - 89.9) and presence of anemia (OR 11.38, 95% CI 2.51 - 51.52) were significantly related with the diagnosis of DN. Akaike’s information criterion (AIC) and net reclassification improvement (NRI) analyses revealed improved predictive performance by adding anemia to the conventional factors (AIC 100.152 to 91.844; NRI 27.0%). The tissues of patients in the DN group demonstrated more severe interstitial fibrosis and tubular atrophy (IF/TA) than the NDKD group (p&lt;0.05) regardless of the rate of global glomerulosclerosis (figure), and IF/TA was related to the prevalence of anemia (odds ratio: 7.31, 95% confidence interval: 2.33 - 23.00) in multivariate regression analysis. These results suggest DM-associated severe IF/TA (compared with NDKD) impaired erythropoietin production, resulting in earlier anemia, independent of glomerular injuries and renal function. Furthermore, the renal prognosis was significantly better in the NDKD group than in the DN group using Log-rank test (p&lt;0.05). Conclusion DN is associated with anemia because of severe IF/TA regardless of renal function, and anemia helps clinician discriminate clinically between isolated DN and NDKD.

scholarly journals Understanding patterns and factors associated with place of death in patients with end-stage kidney disease: A retrospective cohort study

2016 ◽  
Vol 31 (3) ◽  
pp. 283-288 ◽  
Author(s):  
Natasha Lovell ◽  
Chris Jones ◽  
Dawn Baynes ◽  
Sarah Dinning ◽  
Katie Vinen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Place Of Death ◽  
Renal Unit ◽  
End Stage Kidney Disease ◽  
End Stage

Background: Meeting place-of-death preferences is an important measure of the quality of end-of-life care. Systematic review shows that 42% of end-stage kidney disease patients prefer home death. Little research has been undertaken on place of death. Aim: To understand patterns of place of death in patients with end-stage kidney disease known in one UK renal unit. Design: A retrospective cohort study of all patients with chronic kidney disease stage 4–5, age ⩾75 and known to one UK renal unit, who died between 2006 and 2012. Patients were categorised into three management pathways: haemodialysis, conservative and pre-dialysis. Results: A total of 321 patients (mean age, 82.7; standard deviation, 5.21) died (61.7% male). In all, 62.9% died in hospital (95% confidence interval, 57.5%–68.1%), 21.8% died in their usual place of residence (95% confidence interval, 17.5%–26.6%) and 15.3% died in an inpatient palliative care unit (95% confidence interval, 11.6%–19.5%). Management pathway and living circumstances were most strongly associated with place of death. Patients on the conservative pathway had four times the odds of dying out of hospital (odds ratio, 4.0; 95% confidence interval, 2.1–7.5; p < 0.01). Patients living alone were less likely to die out of hospital (odds ratio, 0.3; 95% confidence interval, 0.1–0.6; p < 0.01). There were also changes in place of death over time, with more patients dying out of hospital in 2012 compared to 2006 (odds ratio, 3.1; 95% confidence interval, 1.0–9.7; p < 0.05). Conclusion: Most patients with end-stage kidney disease die in hospital, but patients managed without dialysis are significantly more likely to die outside of hospital. Planning ahead is key to be able to meet preference for place of death.

scholarly journals Accuracy of Peak Systolic Velocity of Radial Artery as Predictor of Maturation of Radiocephalic Arteriovenous Fistula in Cipto Mangunkusumo Hospital

2019 ◽  
Vol 1 (1) ◽  
pp. 30-33
Author(s):  
Dedy Pratama ◽  
Richard Yehuda Limen ◽  
Akhmadu Muradi
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Peak Systolic Velocity ◽  
Cross Sectional ◽  
Arteriovenous Fistulas ◽  
The Mean ◽  
Cross Sectional Design ◽  
Stage Renal Disease ◽  
End Stage ◽  
Relationship Of

Introduction: Hemodialysis is an essential treatment in patients with stage 5 chronic kidney disease (CKD) or End-Stage Renal Disease (ESRD). The maturity of arteriovenous fistulas determines the success of hemodialysis. FAV maturity depends on preoperative preparation. The study aims to examine the preoperative and intraoperative peak systolic velocity (PSV) of the radial artery as a predictor of the successful maturation of the radiocephalic FAV. Method: This study used an analytic cross-sectional design to obtain the relationship of FAV maturation with preoperative and intraoperative PSV. Subjects were those who will undergo radiocephalic FAV surgery with preoperative ultrasound mapping. Shortly after anastomosis, PSV was measured. After 6 weeks, FAV was assessed for its maturity. Results: As many as 71 patients were undergone radiocephalic FAV surgery and followed for six weeks. The mean preoperative PSV of mature fistula was significantly higher than immature (54.6 ± 11.7 cm/s and 26.7 ± 7.7 cm/s; p <0.001). The mean intraoperative PSV of mature fistula was significantly higher than immature (57.9 + 12.6 cm/s and 27.1 + 8.1 cm/s; p <0.001). The mean PSV difference in mature fistulas was significantly higher than immature (3 cm/s and 0 cm/s; p <0.001). Preoperative PSV with a cut-off of 40 cm/s, intraoperative with a cut-off of 42 cm/s, and a difference of PSV with a cut-off of 42 cm/s all had 92.9% accuracy as a predictor of FAV maturation compared to “rule of 6” as a reference standard. Conclusion: Preoperative PSV >40 cm/s and intraoperative PSV >42 cm/s had a good predictor value for radiocephalic FAV maturation. Keywords: peak systolic velocity, maturation, arteriovenous fistula, radial artery

Accessory Veins and Radial-Cephalic Arteriovenous Fistula Non-Maturation: A Prospective Analysis Using Contrast-Enhanced Magnetic Resonance Angiography

2007 ◽  
Vol 8 (4) ◽  
pp. 281-286 ◽  
Author(s):  
R.N. Planken ◽  
L.E. Duijm ◽  
A.G. Kessels ◽  
T. Leiner ◽  
J.P. Kooman ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Arteriovenous Fistula ◽  
Predictive Value ◽  
Preoperative Assessment ◽  
Cephalic Vein ◽  
Salvage Procedure ◽  
Venous Stenosis ◽  
Contrast Enhanced ◽  
Vein Diameter

Purpose To determine if large caliber accessory veins are associated with radial-cephalic arteriovenous fistula (RC-AVF) non-maturation. Methods RC-AVFs were created in 15 consecutive patients (radial artery and cephalic vein diameter >2 mm, in the absence of arterial inflow or venous outflow stenoses or occlusions). Contrast-enhanced magnetic resonance angiography (CE-MRA) was performed preoperatively for the determination of vessel diameters, stenoses and occlusions. The location and caliber of accessory veins was determined. Vascular access (VA) function was monitored and all interventions required to obtain a functioning VA were recorded. Non-maturation was defined as a nonfunctional VA at 2 months after creation. The predictive value of accessory vein caliber for prediction of RC-AVF non-maturation was evaluated using receiver operating characteristic (ROC) analysis. Results Non-maturation occurred in 10 (67%) out of 15 RC-AVFs. Large caliber accessory veins (n=4), venous stenosis (n=3) or both (n=2) were associated with RC-AVF non-maturation. The presence of large caliber accessory veins was the only significant predictor for RC-AVF non-maturation (p=0.01). Preoperatively detected accessory veins with a diameter >70% of the cephalic vein diameter, had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 80, 100, 100 and 91% for prediction of RC-AVF non-maturation on patient level. Accessory vein ligation and dilatation of venous stenosis resulted in an overall salvage success rate of 89% (8/9). Conclusion Large caliber accessory veins are associated with RC-AVF non-maturation. Ligation of large caliber accessory veins is a successful salvage procedure in a substantial group of patients. Furthermore, ligation of these accessory veins during initial RC-AVF creation can potentially reduce non-maturation rates; and therefore, preoperative assessment of accessory veins is recommended.

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