Dialysis Access, Infections, and Hospitalisations in Unplanned Dialysis Start Patients: Results from the Options Study

Machowska, Anna; Alscher, Mark Dominik; Vanga, Satyanarayana Reddy; Koch, Michael; Aarup, Michael; Qureshi, Abdul Rashid; Lindholm, Bengt; Rutherford, Peter

doi:10.5301/ijao.5000557

Cited by 8 publications

(8 citation statements)

References 22 publications

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“…In Prol group, six patients had thrombotic events resulting in vascular access failure. On the contrary, no thrombotic events were recorded in the The International Journal of Artificial Organs 43 (1) Max group, while intra-operative and post-operative complications such as significant bleeding hyperflow shunt and steal phenomenon were not observed in both groups. Doppler ultrasound data of the two groups are shown in Table 2.…”

Section: Resultsmentioning

confidence: 74%

“…AVFs have fewer incidence of complications (such as infection and stenosis), higher patency rates, and longer patient survival compared to arteriovenous graft or central venous catheters. 1 According to National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (NKF KDOQI) guidelines, the ultrasound features of AVF maturation are defined by the “the Rule of 6”: flow > 600 mL/min, AVF located less than 6 mm from the skin surface, and vein diameter > 6 mm. 2,3 Causes of AVF non-maturation are still a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of hemodynamic impact of absorbable sutures in native arteriovenous fistulas: A retrospective study

Occhionorelli

Fabbian

Battaglia³

et al. 2019

Int J Artif Organs

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One of the major causes of arteriovenous fistula failure is the venous stenosis due to aggressive neointimal hyperplasia. The aim of the study was to assess the arteriovenous fistula maturation comparing absorbable sutures and non-absorbable ones in native vessels. Surgeries performed during a period of 24 months by a single team of expert surgeons were evaluated. Surgeries that met the inclusion criteria, namely, age ⩾ 18 years and radio-cephalic arteriovenous fistula, were considered. According to type of suture, patients were classified as Max group (absorbable suture) and Prol group (non-absorbable). Data pertaining to 70 patients were collected; 51% were men and the mean age was 73 ± 12 years. In Max group, an increasing blood flow was observed during the first 4 weeks without post-operative complications. In Prol group, six patients had thrombosis that resulted in vascular access failure. After the first week, the duplex Doppler ultrasound of both groups showed a regular arteriovenous fistula maturation, with an increase of blood flow rate. Although pre-operative post-tourniquet mean vein diameters of Max group were not adequate, the mean vein diameter and mean blood flow rate increased after 4 weeks, respectively. On the contrary, in Prol group, mean vein diameters and blood flow rate decreased. The maturation of arteriovenous fistula and its functional performance were not altered by the type of suture (absorbable/non-absorbable). Absorbable sutures were associated with good results considering arteriovenous fistula maturation.

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Section: Resultsmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Evaluation of hemodynamic impact of absorbable sutures in native arteriovenous fistulas: A retrospective study

Occhionorelli

Fabbian

Battaglia³

et al. 2019

Int J Artif Organs

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“…Eligible studies included incident chronic dialysis patients (n = 42) 2-4,6,8,9,13-48 and patients with CKD known to nephrology (n = 6). 5,49-53 Study designs included retrospective cohort studies (n = 27), 2,3,5,6,14-16,19-24,26,28,31-36,38,47…”

Section: Resultsmentioning

confidence: 99%

“…13 No randomized control trials were found in the search. The majority of studies were conducted in Europe (n = 26; 22 unique cohorts) 2,8,9,15-19,22-25,29,30,33,36,40-43,45-48,50,51 ; 11 studies were conducted in North America 3-6,14,21,26,28,31,52,53 (Canada, n = 9; 8 unique cohorts). Study cohort sizes ranged from 43 to 45 785 persons.…”

Section: Resultsmentioning

confidence: 99%

Risk Factors for Unplanned Dialysis Initiation: A Systematic Review of the Literature

Hassan

Akbari

Brown

et al. 2019

Can J Kidney Health Dis

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Background:Unplanned dialysis initiation is common in patients with chronic kidney disease (CKD).Objective:To determine common definitions and patient risk factors for unplanned dialysis.Design:Systematic review.Setting:MEDLINE, EMBASE, and the Cochrane Library were searched from inception to February 2018.Patients:Studies that included incident chronic dialysis patients or patients with CKD that cited a definition or examined risk factors for unplanned dialysis were included.Measurements:Definitions and criteria for unplanned dialysis reported across studies. Patient characteristics associated with unplanned dialysis.Methods:Two reviewers independently extracted data using a standardized data abstraction form and assessed study quality using a modified New Castle Ottawa Scale.Results:From 2797 citations, 48 met eligibility criteria. Reported definitions for unplanned dialysis were variable. Most publications cited dialysis initiation under emergency conditions and/or with a central venous catheter. The association of patient characteristics with unplanned dialysis was reported in 26 studies, 18 were retrospective and 21 included incident dialysis patients. The most common risk factors in univariate analyses were (number of studies) increased age (n = 7), cause of kidney disease (n = 6), presence of cardiovascular disease (n = 7), lower serum hemoglobin (n = 9), lower serum albumin (n = 10), higher serum phosphate (n = 6), higher serum creatinine or lower estimated glomerular filtration rate (eGFR) at dialysis initiation (n = 7), late referral (n = 5), lack of dialysis education (n = 6), and lack of follow-up in a predialysis clinic prior to dialysis initiation (n = 5). A minority of studies performed multivariable analyses (n = 10); the most common risk factors were increased age (n = 4), increased comorbidity score (n = 3), late referral (n = 5), and lower eGFR at dialysis initiation (n = 3).Limitations:Comparison of results across studies was limited by inconsistent definitions for unplanned dialysis. High-quality data on patient risk factors for unplanned dialysis are lacking.Conclusions:Well-designed prospective studies to determine modifiable risk factors are needed. The lack of a consensus definition for unplanned dialysis makes research and quality improvement initiatives in this area more challenging.

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“…Volume overload and hyperkalaemia are other factors (Brown et al 2015) and acute kidney injury is another (Arrameddy et al 2014). HD is the most common form of dialysis in patients initiating unplanned dialysis (Mendelssohn et al 2011;Brown et al 2015), and the majority, remain on in-centre HD (Machowska et al 2017). Patients who initiate dialysis unplanned have a worse clinical and psychological status, longer hospitalisation and poorer outcomes both in the short and long term (Brown et al 2015) and a higher risk for complications such as infections due to the use of CVC (Miller et al 2016).…”

Section: Literature Reviewmentioning

confidence: 99%

Patients' experiences of initiating unplanned haemodialysis

Nilsson

2019

Journal of Renal Care

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SUMMARY Background Many patients with end stage kidney disease initiate dialysis in an unplanned fashion and as a result experience increased morbidity, mortality and make greater demands on health care resources. To deliver care appropriate to the needs of these patients it is imperative to gain insight into the perspective of each individual. Aim To describe the meaning of the phenomenon “initiating haemodialysis in an unplanned fashion” experienced by the participants. Design The study used a lifeworld perspective with a descriptive phenomenological approach. Participants Five patients (M 4, F 1), with experiences of the phenomenon were recruited from two dialysis units in southern Sweden. Approach Individual in‐depth interviews were undertaken, recorded and transcribed. The texts were analysed according to Giorgi's (2009) method. Findings The essence of the phenomenon was described as a life situation characterised by a rapid decline in health and kidney function leading to unplanned initiation of haemodialysis, which resulted in not really being able to understand what had happened. The sudden initiation of haemodialysis affected each patient in various ways and gave rise to thoughts of life's meaning. Support from others, acceptance and inner strength were helpful. Patients wished for more in‐depth conversations with health care professionals. Conclusion Psychological support is critical. Health care professionals need to have the time and the necessary skills in communication and empathetic listening to understand the psychological trauma each patient goes through in the unplanned setting.

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Dialysis Access, Infections, and Hospitalisations in Unplanned Dialysis Start Patients: Results from the Options Study

Cited by 8 publications

References 22 publications

Evaluation of hemodynamic impact of absorbable sutures in native arteriovenous fistulas: A retrospective study

Evaluation of hemodynamic impact of absorbable sutures in native arteriovenous fistulas: A retrospective study

Risk Factors for Unplanned Dialysis Initiation: A Systematic Review of the Literature

Patients' experiences of initiating unplanned haemodialysis

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