Factors affecting fistula failure in patients on chronic hemodialysis: a population–based case–control study

Abstract

BackgroundWith advancement of hemodialysis (HD) technique, late fistula failure (LFF) remains a problem significantly affecting life quality of patients. We attempt to identify factors affecting LFF in patients on chronic HD in Taiwan from the National Health Insurance Research Database.MethodsThis case–control study enrolled patients over 18 years old and who received regular HD for more than 3 months. LFF was defined as the first fistula failure episode beyond 3 months of chronic HD. We analyzed characteristics, comorbidities and medicine and investigated the association factors of LFF by logistic regression model. A trend test was conducted for risk in different provider levels. Sensitivity tests were conducted to test consistency.ResultsOf 1558 patients recruited, 772 (49.6%) were identified as LFF cases and 786 were identified as controls. The data showed that patients with diabetes mellitus (DM) had 42% increased rate of LFF. Patients receiving more than 10 HD sessions per month had a 90% increased rate of LFF; patients receiving chronic HD in private clinics had a 49% reduction rate of LFF. There were no significant differences in age, dialysis frequency, and comorbidities among different provider levels. There was a significant trend of risk reduction of the event from medical centers, regional hospitals, district hospitals, to private clinics. The sensitivity tests revealed similar results.ConclusionsThe factors associated with LFF include DM and receiving more HD sessions; on the contrary, receiving HD in private clinics is associated with less risk of LFF.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-1010-6) contains supplementary material, which is available to authorized users.

Effects of cardiovascular medications on primary patency of hemodialysis arteriovenous fistula

“…The present study contained 45% of patients with DM and 79% patients with hypertension, which was similar with the hemodialysis population reported in several previous studies 30 , 31 . In these studies, DM had been shown to be associated with a higher risk of AVF failure, which may be explained by increased thrombogenicity due to hyperglycemia 5 , 31 . On the contrary, another study showed that diabetes status was not associated with long-term AVF patency, which was in accordance with the findings in our study 32 .…”

Elevated Platelet Galectin-3 and Rho-Associated Protein Kinase Activity Are Associated with Hemodialysis Arteriovenous Shunt Dysfunction among Subjects with Diabetes Mellitus

“…However, limited studies were designed to focus on the role of galectin-3 in hemodialytic patients. Vascular access dysfunction was critical point for hemodialytic patients, and diabetes affected the risk of shunt failure [34]. In addition to traditional medications for potential risk factors, current literature reported that drug-eluting balloon for recurrent AV shunt stenosis seemed to be a safe and beneficial therapy [35].…”

Outcomes of post-operative duplex ultrasound following arteriovenous fistula formation: A pragmatic single-centre experience

“…Relevant clinical variables, namely past medical history (ischaemic heart disease, diabetes, previously failure vascular access attempt), medication history (antiplatelet and anticoagulant use at index) and HbA1c (immediately prior to index) were also recorded. 14 Data on subsequent interventions were also collected from electronic hospital records and recorded on a standardised form. Each patient was followed-up until access failure, renal transplant, death or 1st June 2018 (whichever sooner).…”