Arteriovenous Fistula Maturation in Prevalent Hemodialysis Patients in the United States: A National Study

Woodside, Kenneth J.; Bell, Sarah; Mukhopadhyay, Purna; Repeck, Kaitlyn; Robinson, Ian; Eckard, Ashley; Dasmunshi, Sudipta; Plattner, Brett; Pearson, Jeffrey; Schaubel, Douglas E.; Pisoni, Ronald L.; Saran, Rajiv

doi:10.1053/j.ajkd.2017.11.020

Cited by 122 publications

(120 citation statements)

References 57 publications

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“…The respective numbers after 2 months were 98% (Japan), 79% (Europe), and 36% (US). In a recent study from the United States, Woodside et al [5] used CrownWeb data to characterize time to the first use of newly created AVF as surrogate for successful AVF maturation. The authors identified 45,087 new AVFs that were placed in 39,820 prevalent HD patients in 2013.…”

Section: Discussionmentioning

confidence: 99%

“…An AVF is favored due to its advantage over CVC usage with respect to sur- vival outcomes, hospitalization rates, and cost to the healthcare system [1][2][3][4]. Notwithstanding this evidence, most US incident patients start HD using a CVC [5][6][7][8]. Even though the use of AVF has notably improved in prevalent patients, the initiation of HD with an AVF continues to be low.…”

Section: Introductionmentioning

confidence: 99%

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Tracking Arteriovenous Fistula Maturation: A Novel Approach

et al. 2018

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Background: The time between the creation of an arteriovenous fistula (AVF) and its successful use is significantly longer in hemodialysis (HD) patients in the United States compared to those in other countries, and there is an urgent need to reduce the residence time of central-venous catheters (CVC). Methods: Successful AVF creation and maturation results in typical hemodynamic changes, such as an increase in cardiac output and upper body blood flow (UBBF). In patients with CVC as vascular access, we measured once per minute intradialytic central-venous oxygen saturation (ScvO₂) and hemoglobin levels simultaneously using the Crit-Line Monitor. Under conditions of stable upper body oxygen consumption and arterial oxygen saturation, ScvO₂ and hemoglobin concentration allows the calculation of estimated UBBF (eUBBF). In a quality improvement project, we used ScvO₂ and eUBBF to track the hemodynamic changes accompanying AVF maturation. Results: Out of 11 patients (9 incident to HD, 1 female, age 61 ± 13 years), AVF maturation was successful in 9. In 1 patient, the AVF did not mature. One patient died from sudden cardiac death with a maturing AVF. In the 9 patients with successful AVF maturation, ScvO₂ increased from 60.9 ± 2.7% prior to AVF creation to 73.4 ± 3.6% a week after AVF creation (19.6 ± 6.3% increase). eUBBF increased from 1.3 ± 0.3 to 2.2 ± 0.6 L/min (62.7 ± 37.5% increase); no material ScvO₂ or eUBBF changes occurred in the other 2 patients. Conclusion: Our results indicate the potential utility of ScvO₂ and eUBBF to track the hemodynamic response to AVF maturation. To what extent these insights translate into shortening of the time between AVF creation and successful cannulation warrants further investigations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tracking Arteriovenous Fistula Maturation: A Novel Approach

et al. 2018

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“…Additionally, the median time to maturation was 114 days, while the ADR reported a median time to maturation of 111 days [1]. A recent analysis of prevalent HD patients in USRDS with a new AVF observed a median time to maturation of 111 days with 36.2% of AVF having no evidence of use in CROWNWeb [19]. However, no post-placement outcomes other than maturation were evaluated and the study did not include AVG placements.…”

Section: Doi: 101159/000495355mentioning

confidence: 99%

“…Patients initiating dialysis with a mature or maturing AVF or AVG may be clinically and demographically different from patients initiating dialysis with a catheter alone, which may impact placement-related outcomes such as maturation and abandonment [19,23]. To evaluate whether patients with a mature or maturing AVF or AVG at first dialysis were different than patients initiating dialysis with a catheter alone, demographic and clinical characteristics were stratified by access at first dialysis (online Suppl.…”

Section: Doi: 101159/000495355mentioning

confidence: 99%

Clinical Outcomes of Arteriovenous Access in Incident Hemodialysis Patients with Medicare Coverage, 2012–2014

et al. 2019

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Background: Chronic hemodialysis requires a mode of vascular access through an arteriovenous fistula (AVF), a prosthetic arteriovenous graft (AVG), or a central venous catheter (CVC). AVF is recommended over AVG or CVC due to increased patency and decreased intervention rates for those that mature. AVG are preferred over CVC due to decreased infection and mortality risk. The aims of this study were to evaluate the lifespan of AVF and AVG in maturation, sustained access use, and abandonment. Methods: The United States Renal Data System (USRDS), Medicare claims, and CROWNWeb were used to identify access placements. Patients with a first end-stage renal disease (ESRD) service from January 1, 2012 to June 30, 2014 with continuous coverage with Medicare as primary payer and ≥1 AVF or AVG placed after ESRD onset were included. Maturation was defined as the first use of the access for hemodialysis recorded in CROWNWeb. Sustained access use was defined as 3 consecutive months of use without catheter placement or replacement. Accesses that were never used at any time post-placement were considered abandoned. Results: The cohort included 38,035 AVF placements and 12,789 AVG placements. Sixty-nine percent of AVF and 72% of AVG matured. Fifty-two percent of AVF and 51% of AVG achieved sustained access use. One quarter of AVF and 14% of AVG were abandoned without use as recorded in CROWNWeb. Conclusion: Although considered the gold standard for vascular access, only half of AVF and AVG placements achieved sustained access use. The USRDS database has inherent limitations but provides useful clinical insight into maturation, sustained use, and abandonment.

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“…Also, access failure remained a common reason for hospitalization of end‐stage renal disease (ESRD) patients, the exact opposite of the intended goal . Another obscure factor recently identified is the disparity in fistula maturation rate across ESRD networks, indicating a need for additional study of the provider, practice, and regional factors that explain AVF maturation …”

Section: Failure Of Various Access Types To Meet Reliable Access Expementioning

confidence: 99%

How arteriovenous grafts could help to optimize vascular access management

Besarab

Kumbar

2018

Seminars in Dialysis

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A one-size-fits-all approach to vascular access for dialysis may be prejudicial. Arteriovenous fistulae (AVF) have high primary failure, failure to mature rate, and late-stage complications making them unsuitable choice for many patients. Aging of population with chronic kidney disease (CKD) coupled with venous injury during CKD stages depletes suitable superficial veins for AVF creation. The National Institutes of Health consortium demonstrated the difficulty in attaining a functional AVF in hemodialysis patients. Recognition of flaws in AVF and the quest to reduce catheter use bring to the fore the benefits of arteriovenous grafts (AVG). Advances in catheter technologies, flow, care, and antibiotic locks have resulted in significant improvement in catheter-related infections. However, widespread recognition of catheter-related complications like central vein stenosis, metastatic infections, and exhaustion of venous access sites preclude their being a viable alternative to AVF, furthering the need to explore AVG as a substitute. Placement of "early cannulation" AVG is a catheter sparing option in patients who are likely to have inadequate fistula maturation. Advances in biohybrid technology and tissue-engineered grafts are providing a robust opportunity to develop biocompatible graft materials with minimal tissue reactivity and thrombogenicity. Xenografts (bovine carotid artery grafts) are proving to be comparable and, in many cases, better than conventional polytetrafluoroethylene material. Older age, dialysis dependence, and smaller vein size are related to the appropriateness of AVG creation. An individualized approach in selecting optimal upper extremity vascular access option using patient-specific factors while incorporating the benefits of an AVG would greatly aid in achieving low catheter usage in the dialysis population.

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Arteriovenous Fistula Maturation in Prevalent Hemodialysis Patients in the United States: A National Study

Cited by 122 publications

References 57 publications

Tracking Arteriovenous Fistula Maturation: A Novel Approach

Tracking Arteriovenous Fistula Maturation: A Novel Approach

Clinical Outcomes of Arteriovenous Access in Incident Hemodialysis Patients with Medicare Coverage, 2012–2014

How arteriovenous grafts could help to optimize vascular access management

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