Determinants of venous catheter hemodialysis onset and subsequent switch to arteriovenous fistula: An epidemiological study in Lazio region

2020 ◽  
pp. 112972982095994
Author(s):  
Luigi Tazza ◽  
Laura Angelici ◽  
Claudia Marino ◽  
Anteo Di Napoli ◽  
Maurizio Bossola ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Regression Models ◽  
Venous Catheter ◽  
Organizational Factors ◽  
Hemodialysis Patients ◽  
Lower Probability ◽  
First Year ◽  
Lazio Region ◽  
Factors Associated

Background: The factors associated with the inability to start hemodialysis with an arteriovenous fistula (AVF) in chronic kidney disease patients are not fully understood. Aim: Evaluating factors associated with type of vascular access at the first chronic hemodialysis and at 1 year after it. Methods: The study cohort includes patients registered in the Regional Dialysis and Transplant Registry of Lazio undergoing first hemodialysis between 2008 and 2015. Logistic regression models were used to evaluate the association between socio-demographic, clinical and care/organizational factors, and vascular access at first hemodialysis. Cox regression models were used to assess the odds of switching to AVF during the first year of hemodialysis among patients starting dialysis with central venous catheter (CVC). Results: In the cohort of 6208 incident hemodialysis patients, 52.7% had an AVF and 47.3% had a CVC. Among the 2939 incident patients with CVC, 27.4% switched to FAV after 1 year. A higher probability of starting dialysis with AVF was observed among males (OR = 1.83; 95% CI 1.63–2.06), while a lower probability was observed among patients aged >85 years (OR 0.64; IC 95% 0.51–0.80). Patients with early referral to a nephrologist had a triple probability of start dialysis with AVF. We observed a higher odds of switch to AVF among males (HR = 1.62; 95% CI 1.40–1.89) and a lower odds among patients over 65 years. Conclusion: The observed high rate of AVF at the start of hemodialysis and of the switch from CVC to AVF in the first year, although declining since 2008, is a positive outcome. However, over one-third of patients maintain the CVC as vascular access for the first year because of unmodifiable factors, such as gender, age, comorbidity. The present study suggests that logistics/management and assistance/welfare problems may contribute to the delay or lack of AVF placement in incident hemodialysis patients or within the first year of dialysis.

scholarly journals Vascular access for hemodialysis: Current practice in Vietnam

2018 ◽  
Vol 20 (1_suppl) ◽  
pp. 20-23 ◽  
Author(s):  
Long Duc Dinh ◽  
Dung Huu Nguyen
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Transluminal Angioplasty ◽  
Central Venous Catheters ◽  
Chronic Hemodialysis ◽  
Maintenance Hemodialysis ◽  
Central Venous ◽  
Advanced Country

A well-functioning vascular access is a mainstay to perform an efficient hemodialysis procedure, which directly affects the quality of life in hemodialysis patients. We use three main types of access: native arteriovenous fistula, arteriovenous graft, and central venous catheter. Arteriovenous fistula remains the first and best choice for chronic hemodialysis. It is the best access for longevity, the lowest related complications, and for this reason, arteriovenous fistula use is strongly recommended by guidelines from different countries, including Vietnam. In practice, well-functioning arteriovenous fistula creation is not always simple. In this case, arteriovenous fistula creation with vein transposition or translocation is certainly useful. When native vein options have been exhausted, prosthetic can be used as the second option of maintenance hemodialysis access alternatives. Central venous catheters are very common and have become an important adjunct in maintaining patients on hemodialysis. In Bach Mai hospital, we certainly create about 1000 new arteriovenous fistulas every year (among these, about 84.98% new hemodialysis patients start hemodialysis without permanent accesses and depend on temporary central venous catheters) and successfully matured arteriovenous fistula rate is 92.6%. Among hemodialysis population in Bach Mai, 2.29% have arteriovenous grafts and 2.81% of patients still depend on cuffed tunneled catheters. The preferable locations for catheter insertions are the internal jugular and femoral veins. Proper vascular access maintenance requires integration of different professionals to create a vascular access team. Percutaneous transluminal angioplasty is not available. In our circumstance, we have achieved some advantages for hemodialysis patients but still a big gap to an advanced country.

scholarly journals Predictors of Arteriovenous Fistula Failure: A Post Hoc Analysis of the FAVOURED Study

Kidney360 ◽  
2020 ◽  
Vol 1 (11) ◽  
pp. 1259-1269
Author(s):  
Yong Pey See ◽  
Yeoungjee Cho ◽  
Elaine M. Pascoe ◽  
Alan Cass ◽  
Ashley Irish ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Controlled Trial ◽  
Laboratory Data ◽  
Venous Catheter ◽  
Central Venous ◽  
Factors Associated ◽  
Female Sex ◽  
Post Hoc

BackgroundAn autologous arteriovenous fistula (AVF) is the preferred hemodialysis vascular access, but successful creation is hampered by high rates of AVF failure. This study aimed to evaluate patient and surgical factors associated with AVF failure to improve vascular access selection and outcomes.MethodsThis is a post hoc analysis of all participants of FAVOURED, a multicenter, double-blind, multinational, randomized, placebo-controlled trial evaluating the effect of fish oil and/or aspirin in preventing AVF failure in patients receiving hemodialysis. The primary outcome of AVF failure was a composite of fistula thrombosis and/or abandonment and/or cannulation failure at 12 months post-AVF creation, and secondary outcomes included individual outcome components. Patient data (demographics, comorbidities, medications, and laboratory data) and surgical factors (surgical expertise, anesthetic, intraoperative heparin use) were examined using multivariable logistic regression analyses to evaluate associations with AVF failure.ResultsOf 536 participants, 253 patients (47%) experienced AVF failure during the study period. The mean age was 55±14.4 years, 64% were male, 45% were diabetic, and 4% had peripheral vascular disease. Factors associated with AVF failure included female sex (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.20 to 2.68), lower diastolic BP (OR for higher DBP, 0.85; 95% CI, 0.74 to 0.99), presence of central venous catheter (OR, 1.49; 95% CI, 1.02 to 2.20; P=0.04), and aspirin requirement (OR, 1.60; 95% CI, 1.00 to 2.56).ConclusionsFemale sex, requirement for aspirin therapy, requiring hemodialysis via a central venous catheter, and lower diastolic BP were factors associated with higher odds of AVF failure. These associations have potential implications for vascular access planning and warrant further studies.

The association between vascular access type and depressive symptoms in geriatric hemodialysis population

Vascular ◽  
2020 ◽  
Vol 28 (4) ◽  
pp. 390-395
Author(s):  
Betul Nur Keser ◽  
Ulku Nur Kirman ◽  
Cemal Kocaaslan ◽  
Ebuzer Aydin
Keyword(s):  
Risk Factors ◽  
Depressive Symptoms ◽  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Multiple Logistic Regression Analysis ◽  
Depression Scale ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Central Venous

Objectives A well-functioning vascular access is crucial for hemodialysis treatment, and arteriovenous fistula is the recommended vascular access type. Arteriovenous fistula is superior to other vascular access types in many aspects, but the effect of arteriovenous fistula on patients’ psychiatric state is not well described yet. The aim of this study is to determine whether there is an association between vascular access type and depression scores. Methods This cross-sectional study was conducted at two hemodialysis centers. Geriatric Depression Scale-15 was administered to geriatric hemodialysis patients, using ≥5 score as the cut-off value for the presence of depressive symptoms. Descriptive tests, Kolmogorov–Smirnov test, Pearson’s Chi-square test, Mann–Whitney test, Kruskal–Wallis test, Spearman’s rank correlation calculation, and multiple logistic regression analysis were performed accordingly to analyze the data. Results Of 75 participants, 34 (45.3%) were female and the mean age was 73.4 ± 5.9 years (range: 65–92). The prevalence of depressive symptoms in the geriatric hemodialysis population was 53.3%. Central venous catheter, hypertension, and increased time on hemodialysis have been found to be risk factors for higher depression scores (aOR 10.505 (95% CI 1.435–76.900), p = 0.021; aOR 9.783 (95% CI 2.508–38.169), p = 0.001; aOR 1.019 (95% CI 1.003–1.035), p = 0.017, respectively). Among patients with arteriovenous fistula, those with hypertension had higher depression scores ( p = 0.008). Conclusions Geriatric hemodialysis patients were found to have depressive symptoms commonly, and central venous catheter, hypertension, and increased time on hemodialysis have been found to be risk factors for presence of depressive symptoms. To the best of our knowledge, this is the first study highlighting that arteriovenous fistula is associated with lower depression scores and lower prevalence of depressive symptoms.

scholarly journals Vascular access placement and mortality in elderly incident hemodialysis patients

2018 ◽  
Vol 35 (3) ◽  
pp. 503-511 ◽  
Author(s):  
Gang Jee Ko ◽  
Connie M Rhee ◽  
Yoshitsugu Obi ◽  
Tae Ik Chang ◽  
Melissa Soohoo ◽  
...  
Keyword(s):  
Vascular Access ◽  
Reference Group ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Survival Models ◽  
First Year ◽  
Type Conversion ◽  
Limited Life Expectancy ◽  
Arteriovenous Fistulas ◽  
Limited Life

Abstract Background Arteriovenous fistulas (AVFs) are the preferred vascular access type in most hemodialysis patients. However, the optimal vascular access type in octogenarians and older (≥80 years) hemodialysis patients remains widely debated given their limited life expectancy and lower AVF maturation rates. Methods Among incident hemodialysis patients receiving care in a large national dialysis organization during 2007–2011, we examined patterns of vascular access type conversion in 1 year following dialysis initiation in patients <80 versus ≥80 years of age. Among a subcohort of patients ≥80 years of age, we examined the association between vascular access type conversion and mortality using multivariable survival models. Results In the overall cohort of 100 804 patients, the prevalence of AVF/arteriovenous graft (AVG) as the primary vascular access type increased during the first year of hemodialysis, but plateaued thereafter. Among 8356 patients ≥80 years of age and treated for >1 year, those with initial AVF/AVG use and placement of AVF from a central venous catheter (CVC) had lower mortality compared with patients with persistent CVC use. When the reference group was changed to patients who had AVF placement from a CVC in the first year of dialysis, those with initial AVF use had similar mortality. A longer duration of CVC use was associated with incrementally worse survival. Conclusions Among incident hemodialysis patients ≥80 years of age, placement of an AVF from a CVC within the first year of dialysis had similar mortality compared with initial AVF use. Our data suggest that initial CVC use with later placement of an AVF may be an acceptable option among elderly hemodialysis patients.

MO785CAUSES OF THE DELAY IN CREATING PERMANENT VASCULAR ACCESS IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Abdulla Al-Sayyari
Keyword(s):  
Vascular Access ◽  
Venous Catheter ◽  
Cross Sectional ◽  
Factors Associated ◽  
Practical Concern ◽  
Significant Difference ◽  
Patient Noncompliance ◽  
Hospital Factors ◽  
Patient Factor ◽  
Main Factor

Abstract Background and Aims Many patients start HD with central venous catheter (CVC) which has multiple complications This study aims at identifying the physicians’ perspectives regarding the reasons of delayed AVF creation Method This is a cross-sectional questionnaires-based survey designed at discovering the physicians' opinions and perception about the reasons for the delay in the creation of permanent vascular access and patient’s factors, physicians factors, and hospital factors leading to this delay, Results There was a total of 212 participants, of whom 131 (61.8%) were of consultant level. The three most important factors associated with delay in AVF creation were “denial of kidney disease or the need of AVF” (76.4%), “dialysis fears and practical concern” (75.9%) and “the patient refusing to undergo AVF surgery” (73.1%). Significantly fewer consultants (42.7%) than below consultants (45.7%) pointed out that “patient noncompliance with nephrology appointments” was a significant factor (p=0.046). The most important physicians & hospital factors was “insufficient conduction of pre-dialysis care and education about AVF initiation to the patient (63.7%) The respondents were asked to choose one of four possible factors that they felt was the main factor in delaying AVF creation. Over two thirds (68.4%) chose the patient factor as the main factor There was no significant difference in this response whether the respondents were consultants or below consultants (p=0.8)) Conclusion The most agreed on factors associated with AVF creation delay are the denial of the need for dialysis, fear of dialysis and practical concern, insufficient conduction of pre-dialysis care and education about AVF initiation to the patient, and late referral to a nephrologist. a validated approach to patients' selection and referral to vascular access creation that could be applied on different types of patient in different regions is required .

scholarly journals Gender Disparities in Vascular Access Surgical Outcomes in Elderly Hemodialysis Patients

2018 ◽  
Vol 49 (1) ◽  
pp. 11-19 ◽  
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.

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

2003 ◽  
Vol 4 (1) ◽  
pp. 21-24 ◽  
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.

Relationship between hemodialysis patients’ educational level and arteriovenous fistula patency

Vascular ◽  
2020 ◽  
Vol 28 (5) ◽  
pp. 604-608
Author(s):  
Atıf Yolgösteren
Keyword(s):  
High School ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Educational Level ◽  
Hemodialysis Patients ◽  
Binary Logistic Regression Analysis ◽  
School Graduate ◽  
Dialysis Unit ◽  
Educational Levels ◽  
Significant Difference

Objectives Vascular access is a lifeline for the patients who are in need of long-term hemodialysis. Native arteriovenous fistula is the most intensively preferred vascular access method owing to its longevity and convenience of use. Therefore, in this study, we aimed to determine whether there might be a relationship between hemodialysis patients’ educational levels and arteriovenous fistula patency. Methods A total of 349 patients who were attending in a chronic hemodialysis program between June 2018 and September 2018 at Bursa Uludağ University, Faculty of Medicine Dialysis Unit and in a private dialysis center in İstanbul were included in this study. The patients were grouped into two: those who have had arteriovenous fistula primary failure at least once and those who have never had arteriovenous fistula primary failure. Educational levels of the patients were classified according to Turkish National Education system (illiterate, primary school graduate, secondary school graduate, high school graduate, and university graduate). Mann–Whitney U and Chi-square tests were performed for statistical analyses. Risk factors were determined by applying backward binary logistic regression analysis. Results A total of 349 patients, 161 (46.1%) females and 188 (53.9%) males, were examined retrospectively. The median age of the patients was 64 years (range: 18–90 years). Educational level comparison revealed statistically significant difference in terms of fistula patency ( p = 0.016). In particular, fistula patency was significantly lower in illiterate, primary, secondary, and high school graduates in comparison with university graduates ( p = 0.001, p = 0.015, p = 0.003, and p = 0.018, respectively). When each group of educational level was analyzed separately in terms of fistula patency, it was observed that the higher the educational level was, the lower arteriovenous fistula primary failure rates were. Conclusions In this study, we observed a lower rate of fistula patency in patients with a low level of education. Hence, we are of the opinion that the trainings delivered on arteriovenous fistula care in dialysis centers are required to be shaped in accordance with educational levels of patients.

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.

Sign in / Sign up

Export Citation Format

Share Document