Effects of Heparin on Early Patency of Arteriovenous Fistula in Angioaccess Surgery of Patients with End-Stage Renal Disease

Background: Arteriovenous fistula (AVF) is now the optimal method of obtaining vascular access for dialysis. Measures such as systemic anticoagulation have been proposed as means of increasing patency rates but enough evidence does not exist to support their application. We aimed to evaluate the efficacy of preoperative heparin injection on patency of AVF during the first 24 hours after surgery and to determine whether such measure can be used to prevent early thrombosis of the vascular access.Methods: The study was carried out on 150 patients admitted to Shohada-e-Tajrish hospital for permanent vascular access placement during 2011-2012. 75 patients were randomly assigned to receive 100 units/kg of heparin intraoperatively and at 24 hours post-surgery AVF patency rate was assessed and compared to the control group. Results: All the 75 patients who had received heparin intraoperatively had a patent arteriovenous fistula 24 hours post-surgery which showed a statistically significant difference compared to the control group among which only 69 (92%) patients had a functioning AV fistula (p-value= 0.028).Conclusions: Our results show that systemic anticoagulation with heparin can be considered as an effective option in preventing vascular access failure. However, considering the contradictory data on the usefulness of heparin injection, larger trials are needed to evaluate efficacy and adverse effects of systemic intraoperative anticoagulation in End-Stage Renal Disease (ESRD) patients before qualifying it as a method of increasing AVF patency in these patients

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Raloxifene in the Treatment of Osteoporosis in Postmenopausal Women with End-Stage Renal Disease: A Systematic Review and Meta-Analysis

Hormone and Metabolic Research ◽

10.1055/a-1655-4362 ◽

2021 ◽

Vol 53 (11) ◽

pp. 730-737

Author(s):

Hao-Yang Ma ◽

Shuang Chen ◽

Ling-Ling Lu ◽

Wei Gong ◽

Ai-Hua Zhang

Keyword(s):

Lumbar Spine ◽

Renal Disease ◽

Postmenopausal Women ◽

End Stage Renal Disease ◽

Control Group ◽

Mineral Density ◽

Treatment Of Osteoporosis ◽

Significant Difference ◽

Stage Renal Disease ◽

End Stage

AbstractAs a selective estrogen receptor modulator (SERM), raloxifene is used in healthy postmenopausal women to prevent bone loss and reduce fractures. However, the benefit of raloxifene is uncertain in the treatment of osteoporosis among patients with end-stage renal disease (ESRD) or those who require maintenance dialysis. We assessed the safety and efficacy of raloxifene in this particular population. Studies were selected from PubMed, Springer, CNKI (Chinese National Knowledge Infrastructure) and Wanfang Database. Randomized controlled trials (RCTs) and prospective studies with control/placebo groups were included. Five studies were included with a total of 244 participants (121 patients in the raloxifene group and 123 patients in the placebo/control group). The median duration of treatment was 12 months. The incidence rate of side effects of raloxifene was 0/121 (0%). There was a significant improvement of lumbar spine bone mineral density (BMD) levels in the raloxifene group compared with the placebo group (MD: 33.88, 95% CI: 10.93, 56.84, p=0.004). There was no significant difference concerning the improvement of femoral neck BMD (MD: 8.42, 95% CI: –10.21, 27.04, p=0.38), intact parathyroid hormone (iPTH) (MD: –12.62, 95% CI: –35.36, 10.13, p=0.28), calcium (MD: -0.08, 95% CI: –0.61, 0.44, p=0.76), phosphorus (MD: 0.18, 95% CI: –0.12, 0.48, p=0.23) or bone alkaline phosphatase (BAP) (MD: –4.33, 95% CI: –14.44, 5.79, p=0.40). Raloxifene seems to be effective in improving the lumbar spine BMD in postmenopausal women with ESRD. More large RCTs are necessary to evaluate the long-term safety of raloxifene in uremic patients.

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Current state of vascular access in Singapore

The Journal of Vascular Access ◽

10.1177/1129729819878595 ◽

2019 ◽

Vol 21 (5) ◽

pp. 582-588 ◽

Cited By ~ 2

Author(s):

Suh Chien Pang ◽

Ru Yu Tan ◽

Jia Liang Kwek ◽

Kian Guan Lee ◽

Marjorie Wai Yin Foo ◽

...

Keyword(s):

Renal Disease ◽

Arteriovenous Fistula ◽

Vascular Access ◽

End Stage Renal Disease ◽

Shared Responsibility ◽

Arteriovenous Graft ◽

Access Management ◽

Current State ◽

Stage Renal Disease ◽

End Stage

This article described the current state of vascular access management for patients with end-stage renal disease in Singapore. Over the past 10 years, there has been a change in the demographics of end-stage renal disease patients. Aging population and the increase in prevalence of diabetes mellitus has led to the acceleration of chronic kidney disease and increase in incidence and prevalence of end-stage renal disease. Vascular access care has, therefore, been more complicated, with the physical, psychological, and social challenges that occur with increased frequency in elderly patients and patients with multiple co-morbidities. Arteriovenous fistula and arteriovenous graft are created by vascular surgeons, while maintenance of patency of vascular access through endovascular intervention has been a shared responsibility between surgeons, interventional radiologists, and interventional nephrologists. Pre-emptive access creation among end-stage renal disease patients has been low, with up to 80% of new end-stage renal disease patients being commenced on hemodialysis via a dialysis catheter. Access creation is exclusively performed by a dedicated vascular surgeon with arteriovenous fistula success rate up to 78%. The primary and cumulative patency rates of arteriovenous fistula and arteriovenous graft were consistent with the results from many international centers. Vascular access surveillance is not universally practiced in all dialysis centers due to its controversies, in addition to the cost and the limited availability of equipment for surveillance. Timely permanent access placement, with reduced dependence on dialysis catheters, and improved vascular access surveillance are the main areas for potential intervention to improve vascular access management.

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Effects of Kidney Transplantation on Cognitive Performance in a Pediatric Population

PEDIATRICS ◽

10.1542/peds.74.2.273 ◽

1984 ◽

Vol 74 (2) ◽

pp. 273-278 ◽

Cited By ~ 1

Author(s):

Robert S. Fennell ◽

Wiley C. Rasbury ◽

Eileen B. Fennell ◽

Mary K. Morris

Keyword(s):

Kidney Transplantation ◽

Renal Disease ◽

Cognitive Performance ◽

End Stage Renal Disease ◽

Pediatric Population ◽

Control Group ◽

Memory And Attention ◽

Significant Difference ◽

Stage Renal Disease ◽

End Stage

The cognitive functioning of 20 children and adolescents with end-stage renal disease was assessed 1 to 3 weeks prior to the onset of hemodialysis, and at 1 month and 1 year after successful kidney transplantation, and results were compared with those of a matched control group. A battery of intelligence, achievement, problem solving, learning, memory, and attention tasks were administered. Both groups had significantly improved scores over time on most measures. The group with renal disease exhibited significantly greater improvement than the control group from initial testing to 1 month after transplantation on the performance IQ and full-scale IQ as well as in mathematics achievement. This significant difference was not maintained, however, at 1 year after transplantation. Cognitive performance was less impaired the later the onset of renal failure or the fewer the years in end-stage renal disease. BUN nitrogen, serum creatinine levels, and BP did not consistently correlate with any of the cognitive or academic achievement measures.

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Effect of local papaverine on arteriovenous fistula maturation in patients with end-stage renal disease

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0170 ◽

2019 ◽

Vol 41 (2) ◽

pp. 185-192 ◽

Cited By ~ 1

Author(s):

Reza Manani ◽

Gholamreza Kazemzadeh ◽

Ali Saberi ◽

Fatemeh Sadeghipour ◽

Asghar Rahmani

Keyword(s):

Renal Disease ◽

Arteriovenous Fistula ◽

End Stage Renal Disease ◽

Control Group ◽

Case Group ◽

Maturation Time ◽

Stage Renal Disease ◽

End Stage ◽

And Control ◽

Fistula Maturation

Abstract Background: Arteriovenous fistula (AVF) maturation is one of the main concerns in patients with end-stage renal disease (ESRD) and finding a strategy for increasing success rate and accelerating fistula maturation is valuable. The aim of this study was to evaluate the effects of papaverine injection on AVF maturation and success rate. Method: This study was a randomized clinical trial that involved 110 patients with ESRD that were referred for AVF construction. Patients were allocated in papaverine group and control group with block randomization according to age and sex. In the case group, papaverine (0.1 or 0.2 cc) was injected locally within the subadventitia of artery and vein after proximal and distal control during AVF construction and in the control group, AVF construction was done routinely without papaverine injection. Results: Maturation time in case and control groups was 37.94 ± 11.49 and 44.23 ± 9.57 days, respectively (p=0.004). Hematoma was not seen in the case group but occurred in one patient in the control group. One patient of the case group developed venous hypertension. Four functional fistulas, 1 (1.8%) in the case group and 3 (5.5%) in the control group, failed to mature (p=0.618). Maturation rate did not differ between the two groups statistically (p=0.101). Conclusion: Local papaverine injection increased vessel diameter and blood flow, increasing shearing stress in both arterial and venous segment of recently created AVF. In this way, papaverine probably can decrease AVF maturation time without an increase in complications.

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American Association of Kidney Patients survey of patient preferences for hemodialysis vascular access

The Journal of Vascular Access ◽

10.1177/1129729819870962 ◽

2019 ◽

Vol 21 (2) ◽

pp. 230-236

Author(s):

Saravanan Balamuthusamy ◽

Larry E Miller ◽

Diana Clynes ◽

Erin Kahle ◽

Richard A Knight ◽

...

Keyword(s):

Central Venous Catheter ◽

Renal Disease ◽

Arteriovenous Fistula ◽

Vascular Access ◽

End Stage Renal Disease ◽

American Association ◽

Venous Catheter ◽

Central Venous ◽

Stage Renal Disease ◽

End Stage

Objectives: To determine the vascular access modalities used for hemodialysis, the reasons for choosing them, and determinants of satisfaction with vascular access among patients with end-stage renal disease. Methods: The American Association of Kidney Patients Center for Patient Research and Education used the American Association of Kidney Patients patient engagement database to identify eligible adult hemodialysis patients. Participants completed an online survey consisting of 34 demographic, medical history, and hemodialysis history questions to determine which vascular access modalities were preferred and the reasons for these preferences. Results: Among 150 respondents (mean age 54 years, 53% females), hemodialysis was most frequently initiated with central venous catheter (64%) while the most common currently used vascular access was arteriovenous fistula (66%). Most (86%) patients previously received an arteriovenous fistula, among whom 77% currently used the arteriovenous fistula for vascular access. Older patients and males were more likely to initiate hemodialysis with an arteriovenous fistula. The factors most frequently reported as important in influencing the selection of vascular access modality included infection risk (87%), physician recommendation (84%), vascular access durability (78%), risk of complications involving surgery (76%), and impact on daily activities (73%); these factors were influenced by patient age, sex, and race. Satisfaction with current vascular access was 90% with arteriovenous fistula, 79% with arteriovenous graft, and 67% with central venous catheter. Conclusion: Most end-stage renal disease patients continue to initiate hemodialysis with central venous catheter despite being associated with the lowest satisfaction rates. While arteriovenous fistula was associated with the highest satisfaction rate, there are significant barriers to adoption that vary based on patient demographics and perception of procedure invasiveness.

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Arteriovenous fistulas for hemodialysis: Brief review and current problems

The Journal of Vascular Access ◽

10.1177/11297298211007720 ◽

2021 ◽

pp. 112972982110077

Author(s):

John J Manov ◽

Prasoon P Mohan ◽

Roberto Vazquez-Padron

Keyword(s):

Renal Disease ◽

Arteriovenous Fistula ◽

Vascular Access ◽

End Stage Renal Disease ◽

State Of The Art ◽

Arteriovenous Fistulas ◽

Number Of Patients ◽

Stage Renal Disease ◽

End Stage

The number of people worldwide living with end-stage renal disease is increasing. Arteriovenous fistulas are the preferred method of vascular access in patients who will require hemodialysis. As the number of patients with arteriovenous fistulas grows, the role of physicians who intervene who maintain and salvage these fistulas will grow in importance. This review aims to familiarize practitioners with the rationale for arteriovenous fistula creation, the detection of fistula dysfunction, and the state of the art on fistula maintenance and preservation. Current controversies are briefly reviewed.

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Comparative Study of Autologous Radiocephalic and Brachiocephalic Arteriovenous Fistula in Patients with End Stage Renal Disease

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v18i1.35206 ◽

2020 ◽

Vol 18 (1) ◽

pp. 78-81

Author(s):

Deepak Thapa Magar ◽

Kiran Shrestha ◽

Dinesh Chapagain ◽

Kumar Shrestha ◽

Sara Thapa

Keyword(s):

Renal Disease ◽

Arteriovenous Fistula ◽

Failure Rate ◽

Vascular Access ◽

End Stage Renal Disease ◽

Patency Rate ◽

Av Fistula ◽

Number Of Patients ◽

Stage Renal Disease ◽

End Stage

Introduction: End-stage renal disease requires treatment with dialysis or renal transplantation. For the dialysis, autologous radiocephalic (RC) or brachiocephalic (BC) arteriovenous fistula (AVF) is the better option for vascular access for hemodialysis. Aims: The aim of this study is to find out the outcome between RC AVF and BC AVF. Methods: This is the retrospective study, conducted for the period of 24 months from September 2017 to September 2019 in the department of Cardiothoracic and Vascular Surgery of Bir Hospital, Nepal. RC and BC AVF were created for the assess of hemodialysis. Outcome and different complications were taken into consideration. Results: The total number of patients included in this study was 400. The overall failure rate of autologous AV fistula was 12.75%. Out of these, the failure rate was more in RC AV fistula group, 34 (17%) than in BC AV fistula group, 17 (8.5%). The most common complication was bleeding in both groups having an overall rate of 39 (9.75%). The limb edema was more common in BC AV fistula group 16 (8.0%) then in RC AV fistula group 7(3.5%). The overall infection rate was 4.5%. Overall patency rate was 87.25%. Conclusion: Autologous RC AVF and BC AVF are the choices for vascular access for hemodialysis in patients with end-stage renal disease. BC AVF has a better patency rate than RC AVF but with the slight higher risk of complications.

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Hemodynamic and Biologic Determinates of Arteriovenous Fistula Outcomes in Renal Failure Patients

BioMed Research International ◽

10.1155/2015/171674 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 16

Author(s):

Mary Hammes

Keyword(s):

Renal Failure ◽

Renal Disease ◽

Arteriovenous Fistula ◽

Success Rate ◽

Vascular Access ◽

End Stage Renal Disease ◽

Neointimal Hyperplasia ◽

Venous Stenosis ◽

Stage Renal Disease ◽

End Stage

The outcome of patients with end-stage renal disease on hemodialysis depends on a functioning vascular access. Although a variety of access options are available, the arteriovenous fistula remains the best vascular access. Unfortunately the success rate of mature fistula use remains poor. The creation of an arteriovenous fistula is followed by altered hemodynamic and biological changes that may result in neointimal hyperplasia and eventual venous stenosis. This review provides an overview of these changes and the needed research to provide a long lasting vascular access and hence improve outcomes for patients with end-stage renal disease.

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