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.

scholarly journals P1348EFFECT OF CILOSTAZOL ON ARTERIOVENOUS FISTULA IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
JAE WAN JEON ◽  
Young Rok Ham ◽  
Haeri Kim ◽  
Wonjung Choi ◽  
Ki Ryang Na ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Vascular Complications ◽  
Hemodialysis Patients ◽  
Transluminal Angioplasty ◽  
Control Group ◽  
Fistula Surgery ◽  
Significant Difference ◽  
And Control ◽  
Percutaneous Transluminal

Abstract Background and Aims Permanent vascular access is important in patients requiring hemodialysis. However, among patients requiring hemodialysis, even if arteriovenous fistula surgery is performed, many are unable to undergo hemodialysis with vascular access due to maturation failure. Method Using 194 patients who underwent arteriovenous fistula surgery, a cilostazol group (n = 107) and a control group (n = 87) were compared and analyzed for the occurrence of vascular complications. Results In the cilostazol group, there were less vascular complications (36.4% vs. 52.9%; p = 0.022), especially maturation failure (2.8% vs. 11.5%; p = 0.016). However, there was no significant difference between the cilostazol group and control group regarding percutaneous transluminal angioplasty (PTA) requirement nor frequency and interval to PTA after vascular surgery. The frequency of reoperations due to vascular injury after the start of hemodialysis after maturation was also significantly lower in the cilostazol group. Conclusion These results suggest that vascular access patients may benefit from postoperative cilostazol therapy.

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.

scholarly journals The management of vascular access in hemodialysis patients during the coronavirus disease 2019 epidemic: A multicenter cross-sectional study

2020 ◽  
pp. 112972982093748
Author(s):  
Jia Shi ◽  
Jian-Jun Yan ◽  
Jian Chen ◽  
Qing-Hong Zhang ◽  
Yi Yang ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Sectional Study ◽  
Epidemic Disease ◽  
Cross Sectional ◽  
Flow Reduction ◽  
Arteriovenous Access ◽  
Access Complications

Background: Coronavirus disease 2019 is an epidemic disease throughout the world. The management of vascular access during the epidemic is currently unknown. Methods: In this multicenter cross-sectional study, we collected vascular access data from hemodialysis patients treated at 44 hospitals in Hubei from 22 January to 10 March 2020. We estimated the management of vascular access during the coronavirus disease 2019 outbreak. Results: Of the 9231 hemodialysis patients included, 5387 patients (58.4%) were men and 2959 patients (32.1%) were older than 65 years. Arteriovenous fistula was the predominant type of vascular access, accounting for 76.5%; 496 patients (5.4%) developed vascular access complications; catheter flow reduction was the most common vascular access complication, and stenosis was the predominant complication among those with arteriovenous access. Overall, 280 vascular access sites were placed in patients newly diagnosed with uremia, of whom 260 (92.8%) underwent catheter insertion; 149 rescue procedures were carried out to treat the vascular access complications, which consisted of 132 catheters, 7 percutaneous transluminal angioplasties, 6 arteriovenous fistula repairs, and 4 arteriovenous fistulas. Occlusion of the arteriovenous access had the highest rescue rate (92.7%), while many other vascular access complications remained untreated; 69 and 142 patients were diagnosed with confirmed and suspected coronavirus disease 2019, respectively. A total of 146 patients died, of whom 29 patients (19.9%) died due to vascular access complications. Conclusion: Catheter flow reduction and stenosis of arteriovenous access were the major vascular access complications. Most of the vascular access sites established were catheters, and many of the vascular access complications remained untreated.

Variations in the Circulating Heparin Levels During Maintenance Hemodialysis in End Stage Renal Disease Patients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3412-3412
Author(s):  
Vinod Bansal ◽  
Kristiyana Kaneva ◽  
Debra Hoppensteadt ◽  
Josephine Cunanan ◽  
Jawed Fareed
Keyword(s):  
Thrombin Generation ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Functional Assay ◽  
Dialysis Unit ◽  
Blood Samples ◽  
Patient Consent ◽  
Significant Difference ◽  
Circulating Levels ◽  
Maintenance Hemodialysis Patients

Abstract Abstract 3412 Introduction: Unfractionated heparin has remained the anticoagulant of choice for hemodialysis patients. The anticoagulation facilitates blood flow through the dialysis circuit and assures the patency of the dialysis membrane. Wide variations in the heparinization responses have been observed in patients undergoing this procedure. The purpose of this investigation was to measure circulating heparin levels in patients prior to and after hemodialysis. Methods: This study included 119 ESRD patients undergoing maintenance hemodialysis after appropriate IRB approval and patient consent. For the 3–4 hour hemodialysis duration, a heparin loading dose of 1000 Units followed by two additional dosages of 500 Units/hour were administered. Citrated blood samples were collected prior to and immediately after the dialysis session. The blood samples were centrifuged for 15 minutes at 3000 g at 4°C and platelet poor plasma (PPP) was extracted. Citrated plasma was frozen at −70°C and analyzed utilizing such clot based methods as Activated Partial Thromboplastin Time (APTT), Heptest and Prothrombinase Induced Clotting Time (PiCT). Circulating Anti-Xa levels were measured using a chromogenic substrate method. Thromboplastin induced thrombin generation was also measured using a fluorogenic substrate method, Thrombin Generation Assay (TGA). The Antithrombin (AT) levels in each of these patients were also measured using a functional assay. The circulating levels of heparin were determined using a calibration curve constructed from the heparin used in the dialysis unit. Results were computed for the individual tests and heparin concentrations were obtained using the assay based calibration procedures. Results: In the clot based assays such as APTT and Heptest, no significant differences between pre and post plasma samples were noted. The circulating levels of heparin were from 0 to 1.08 U/ml with a mean of 0.07 ± 0.11 for the APTT and a range of 0 to 1.98 for the Heptest with a mean of 0.09 ± 0.26 U/ml. In the PiCT test the range was from 14.0 to 300 seconds for the pre dialysis samples with a mean of 32.0 ± 38.2, whereas for the post samples the range was from 15.2 to 110 with a mean of 29.6 ± 14.0. For the Anti-Xa levels the % inhibition for the two groups was similar. The circulating Anti-Xa levels in the pre dialysis samples ranged from 0 to 0.77 with a mean of 0.10 ± 0.14, whereas the post level ranged from 0 to 0.51 with a mean of 0.13 ± 0.11. For the thrombin generation, the % inhibition levels ranged from 0 to 100% pre dialysis with a mean of 34.2 ± 34% and ranged 0 to 100% post dialysis with a mean of 44.5 ± 34.4%. The Antithrombin levels ranged from 28 to 130% with a mean of 86.6 ± 19.5% in the pre dialysis samples. There was no significant difference between pre and post dialysis samples using APTT, Heptest and PiCT, whereas the Thrombin generation and Anti-Xa resulted in a statistically significant p value < 0.05 when comparing the two groups. Conclusion: Wide variations in circulating heparin levels are noted in maintenance hemodialysis patients at pre dialysis and post dialysis time periods. Some patients exhibit higher levels of heparin due to a vascular access flush. These results also suggest that the use of heparin in maintenance hemodialysis patients in repeated regimen results in a steady state hypocoagulation as evidenced by the inhibition of thrombin generation, circulating Anti-Xa level and the prolongation of various clotting times. Disclosures: No relevant conflicts of interest to declare.

Enhanced Training in Vascular Access Creation Predicts Arteriovenous Fistula Placement and Patency in Hemodialysis Patients

2008 ◽  
Vol 247 (5) ◽  
pp. 885-891 ◽  
Author(s):  
Rajiv Saran ◽  
Stacey J. Elder ◽  
David A. Goodkin ◽  
Takashi Akiba ◽  
Jean Ethier ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Hemodialysis Patients

scholarly journals Aortic Arch Calcification as a Predictor of Repeated Arteriovenous Fistula Failure within 1-Year in Hemodialysis Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-9
Author(s):  
Yit-Sheung Yap ◽  
Kai-Ting Ting ◽  
Wen-Che Chi ◽  
Cheng-Hao Lin ◽  
Yi-Chun Liu ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Arteriovenous Fistula ◽  
Aortic Arch ◽  
Serum Albumin Level ◽  
Binary Logistic Regression ◽  
Hemodialysis Patients ◽  
Albumin Level ◽  
Binary Logistic Regression Analysis ◽  
The Impact ◽  
Aortic Arch Calcification

Objectives. The aim of the study was to identify the factors associated with repeated arteriovenous fistula (AVF) failure within 1-year, especially the impact of aortic arch calcification (AAC) on patency of AVF.Materials and Methods. We retrospectively assessed chest radiography in hemodialysis patients who had undergone initial AVF. The extent of AAC was categorized into four grades (0–3). The association between AAC grade, other clinical variables, and repeated failure of AVF was then analyzed by binary logistic regression analysis.Results. This study included 284 patients (158 males, mean age61.7±13.1years). Patients with higher AAC grade were older, had more frequently diabetes mellitus and cardiovascular disease, had lower diastolic blood pressure, and had higher corrected calcium and lower intact parathyroid hormone levels. In multivariate analysis, the presence of higher AAC grade (odds ratio (95% confidence interval): 2.98 (1.43–6.23);p=0.004), lower mean corrected calcium (p=0.017), and mean serum albumin level (p=0.008) were associated with repeated failure of AVF.Conclusions. The presence of higher AAC grade, lower mean corrected calcium and mean serum albumin level were independently associated with repeated AVF failure within 1 year in hemodialysis patients.

scholarly journals A Comparative Study on the Effects of Acupressure at SP6 and ST36 Acupoints on the Pain Caused by Fistula Needle Placement in Hemodialysis Patients

2021 ◽  
Vol 10 (4) ◽  
pp. 354-367
Author(s):  
Tahereh Baloochi Beydokhti ◽  
Keyword(s):  
Arteriovenous Fistula ◽  
Hemodialysis Patients ◽  
Control Group ◽  
Needle Placement ◽  
Chi Square ◽  
Double Blind ◽  
Significant Difference ◽  
Chi Square Test ◽  
Vas Scores ◽  
And Control

Objective: Hemodialysis is one of the most common treatment methods in kidney patients. To do this, repeated insertion of the needle into the vessel is necessary. Patients treated with hemodialysis are exposed to stress and pain caused by perforation of their arteriovenous fistula about 300 times a year. More than 1/5 of hemodialysis patients express this pain as unbearable. This study aims to evaluate the effect of acupressure at SP6 and ST36 acupoints on the pain caused by fistula needle placement in hemodialysis patients. Methods: This study is a double-blind randomized clinical trial conducted in 2016 on 90 hemodialysis patients with arteriovenous fistula in Mashhad, Iran. They were randomly divided into three groups of SP6, ST36, and control. Data were collected after obtaining a written informed consent by a demographic form and the Visual Analog Scale (VAS). Data analysis was performed in SPSS v.16 software by using Kolmogorov-Smirnov test, Kruskal-Wallis test, one-way ANOVA, paired t-test, and Chi-square test. Results: There was a statistically significant difference between VAS scores after the intervention in all three group (P<0.001). The Mean±SD VAS scores before the intervention in SP6, ST36, control groups were 54.47±18.93, 51.5±22.83, 46.6±17.73, respectively which changed to 45.63±20.53, 40.2±20.01, and 51.87±19.05 after the intervention, indicating that acupressure at SP6 and ST36 acupoints reduced pain in patients, while the pain increased in the control group. Conclusion: Acupressure at SP6 and ST36 acupoints is an effective method in relieving pain caused by the insertion of a needle into the arteriovenous fistula in hemodialysis patients.

Effects of N-acetylcysteine on arterial neo-intimal hyperplasia in rat model of arteriovenous fistula

2018 ◽  
Vol 20 (2) ◽  
pp. 190-194
Author(s):  
Amirmohsen Jalaeefar ◽  
Arash Mohammadi Tofigh ◽  
Atoosa Gharib ◽  
Mohsen Khandaghy ◽  
Mohammad Reza Rahimi
Keyword(s):  
Arteriovenous Fistula ◽  
Rat Model ◽  
Intimal Hyperplasia ◽  
Intima Media Thickness ◽  
Hemodialysis Patients ◽  
Control Group ◽  
Clinical Issue ◽  
Significant Difference ◽  
Hematoxylin And Eosin ◽  
The Mean

Introduction: Arteriovenous fistula is the best choice for vascular access in hemodialysis patients. However, arteriovenous fistula dysfunction is a major clinical issue. The most common cause of arteriovenous fistula failure is intimal hyperplasia. In this study, we have investigated the effect of N-acetylcysteine on neo-intimal hyperplasia after arteriovenous fistula creation in rats. Methods: This study was conducted in 24 rats which were randomly divided into two groups: control and N-acetylcysteine groups. An end-to-side anastomosis was made between the femoral artery and vein. The control group received distilled water intraperitoneally while the animals in N-acetylcysteine group received 300 mg/kg/day of N-acetylcysteine via the same route. After 28 days, the thickness of intima and media was measured using hematoxylin and eosin. Results: There was no significant difference between the two groups regarding age ( p = 0.6) and weight ( p = 0.1). The mean intima thickness in N-acetylcysteine group was significantly less than control group (17 ± 20 and 119 ± 46 µm, respectively; p < 0.001). The mean intima/media thickness in the N-acetylcysteine group was significantly less than control group (0.5 ± 0.63 vs 2.05 ± 1.17 µm; p < 0.001). Conclusion: N-acetylcysteine is effective in inhibiting neo-intimal hyperplasia in a rat model of arteriovenous fistula.

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.

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