EBPG on Vascular Access

Tordoir, Jan H.M.; Canaud, Bernard; Haage, Patrick; Könner, Klaus; Başçı, Alı; Fouque, Denis; Kooman, Jeroen P.; Martín‐Malo, Alejandro; Pedrini, Luciano A.; Pizzarelli, Francesco; Tattersall, James; Vennegoor, Marianne; Wanner, Christoph; Wee, Piet ter; Vanholder, Raymond

doi:10.1093/ndt/gfm021

Cited by 595 publications

(662 citation statements)

References 290 publications

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“…This predictive model seems to be reasonably accurate, because the corresponding likelihoods of starting hemodialysis after AVF creation in this study were 74% (182 of 246) and 81% (118 of 145) in patients with eGFRs,20 and ,15 ml/min per 1.73 m 2 , respectively. Vascular access guidelines promulgated by different national societies have proposed various eGFR thresholds for referral of a patient with CKD to the surgeon for access creation (10)(11)(12). Unfortunately, these guidelines are opinion based, and their validity has not been subjected to empirical evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison, the Canadian Society of Nephrology recommends placement of the AVF when eGFR is between 15 and 20 ml/min per 1.73 m 2 (10), the Japanese Society for Dialysis Therapy recommends AVF placement when the creatinine clearance is between 10 and 20 ml/min or serum creatinine is between 6 and 8 mg/dl (11), and the European Best Practices Guidelines recommend vascular access placement when the eGFR reaches ,30 ml/min per 1.73 m 2 (12). Because these national guidelines are not on the basis of clinical evidence and because none of them incorporate clinical patient characteristics, the optimal timing of predialysis vascular access placement remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Initiation for Predialysis Arteriovenous Fistula

Al-Balas¹,

Lee

Young

et al. 2016

CJASN

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Background and objectives The optimal timing of predialysis arteriovenous fistula surgery remains uncertain. We evaluated factors associated with hemodialysis initiation in patients undergoing predialysis arteriovenous fistula surgery and derived a model to predict future initiation of dialysis.Design, setting, participants, & measurements Our study retrospectively identified 308 patients undergoing predialysis arteriovenous fistula creation at a large medical center in 2006-2012 to determine whether they initiated hemodialysis. Multiple variable logistic regression analyzed which demographic and clinical factors predicted initiation of dialysis within 2 years of arteriovenous fistula surgery. A receiver operating characteristic area under the curve was used to quantify the predictive value of preoperative factors on the likelihood of initiating hemodialysis within 2 years.Results Overall, hemodialysis was initiated within 6 months, 1 year, and 2 years in 119 (39%), 175 (57%), and 211 (68%) patients, respectively. Using multiple variable logistic regression, four factors were associated with hemodialysis initiation at 2 years: eGFR at access surgery (odds ratio, 0.45; 95% confidence interval, 0.31 to 0.64 per 5 ml/min per 1.73 m 2 ; P,0.001), diabetes (odds ratio, 2.51; 95% confidence interval, 1.22 to 5.15; P=0.003), GFR trajectory (odds ratio, 1.54; 95% confidence interval, 1.09 to 2.17 per 3 ml/min per 1.73 m 2 per year; P=0.01), and spot urine protein-to-creatinine ratio (odds ratio, 1.39; 95% confidence interval, 1.14 to 1.71 per 1 U; P,0.001). eGFR alone had a moderate predictive value for dialysis initiation (area under the curve =0.69; 95% confidence interval, 0.63 to 0.76; P,0.001), whereas the full model had a higher predictive value (area under the curve =0.83; 95% confidence interval, 0.77 to 0.88; P,0.001).Conclusions The likelihood of initiating hemodialysis within 2 years of predialysis arteriovenous fistula surgery is associated with eGFR at access surgery, diabetes, GFR trajectory, and magnitude of proteinuria. The combined use of all four variables improves the ability to predict future hemodialysis compared with the use of eGFR alone.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors of Initiation for Predialysis Arteriovenous Fistula

Al-Balas¹,

Lee

Young

et al. 2016

CJASN

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“…2 However, shortand long-term AVF dysfunctions, including inadequate increase in blood flow volume (BFV) after surgery (nonmaturation), vein thrombotic occlusion, ischemic circulation in the distal arm and in the hand (steal syndrome), and massive increase in VA BFV with risk of cardiac failure, are among the major causes of morbidity and hospitalization in HD patients. 3,4 Indeed AVF primary patency at 2 years after surgery was recently estimated to be B50% [5][6][7] and even lower in the United States.…”

mentioning

confidence: 99%

Validation of a patient-specific hemodynamic computational model for surgical planning of vascular access in hemodialysis patients

Caroli

Manini

Antiga³

et al. 2013

Kidney International

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“…Since its introduction in clinical practice, native arteriovenous fistula (AVF) has proven to be the safest and most durable vascular access for hemodialysis and, accordingly, it is recommended by international guidelines as the vascular access of choice in most patients with end-stage renal disease (ESRD) who are candidates for hemodialysis [1][2][3]. The absence or relative impoverishment of superficial vessels is frequently the main barrier to achieving this target in patients, who are increasingly of older age and affected by comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Venous Window Needle Guide for deep vessels and difficult arteriovenous fistula cannulation

et al. 2016

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The Venous Window Needle Guide (VWINGTM) has recently been proposed for patients with difficult arteriovenous fistula (AVF) access for hemodialysis due to deep vessels or other cannulation-related problems. This totally subcutaneous titanium device is sutured onto the upper wall of the matured fistula and may facilitate cannulation by the button-hole technique. We describe our initial experience with nine implants in six patients with a cumulative followup of 83 months, and make some experience-based technical suggestions for implant and surveillance radiological imaging. The indication for implantation was deep vessel, previous failure of cannulation or unsuitable site for direct cannulation. No infectious complications were observed during follow-up and proper blood flow was constantly achieved. Some difficulties were occasionally encountered with regard to cannulation; nonetheless, patient satisfaction was not significantly affected. VWING seems to be an interesting option in some patients provided that surgical implantation is carefully carried out and preventive measures against infections are strictly observed.

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EBPG on Vascular Access

Cited by 595 publications

References 290 publications

Predictors of Initiation for Predialysis Arteriovenous Fistula

Predictors of Initiation for Predialysis Arteriovenous Fistula

Validation of a patient-specific hemodynamic computational model for surgical planning of vascular access in hemodialysis patients

Venous Window Needle Guide for deep vessels and difficult arteriovenous fistula cannulation

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