Gender differences in vascular access in hemodialysis patients in the United States: Developing strategies for improving access outcome

Marcus, Richard J.; Marcus, Dawn A.; Sureshkumar, Kalathil K; Hussain, Sultana Monira; McGill, Rita L.

doi:10.1016/s1550-8579(07)80040-4

Cited by 45 publications

(39 citation statements)

References 32 publications

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“…Our study confirms findings by other investigators that women are underrepresented among hemodialysis patients with AV fistulas (8,9). This difference may be attributable to smaller vascular diameter and higher rates of early primary fistula failure among female patients (10). Albumin and hemoglobin are also reported to be lower in women at dialysis initiation (11).…”

Section: Discussionsupporting

confidence: 91%

Meeting KDOQI Guideline Goals at Hemodialysis Initiation and Survival during the First Year

Slinin

Guo

Gilbertson

et al. 2010

Clinical Journal of the American Society of Nephrology

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Results: At dialysis initiation, 59%, 31%, 9%, and 1.6% of patients met zero, one, two, or three guideline goals, respectively (total n ‫؍‬ 192,307). After multivariate adjustment, mortality hazard ratios (95% confidence intervals) were 0.81 (0.80 to 0.83) for patients who met one, 0.53 (0.51 to 0.56) for patients who met two, and 0.34 (0.30 to 0.39) for patients who met three guideline goals, compared with patients who met none. Meeting each individual goal was also associated with lower mortality.Conclusions: These findings suggest a graded association between meeting a greater number of evidence-based guideline goals at dialysis initiation and lower risk of death during the first year on dialysis.

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Section: Discussionsupporting

confidence: 91%

Meeting KDOQI Guideline Goals at Hemodialysis Initiation and Survival during the First Year

Slinin

Guo

Gilbertson

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…The AVF maturation and patency rates are lower in female than in male haemodialysed patients [2, 3, 34]. The origin of gender differences has not been yet elucidated.…”

Section: Discussionmentioning

confidence: 99%

“…Then, theoretically, there could be differences in the carotid-brachial pathway stiffness between patients with arteriovenous fistulae (AVF) in the upper arm and those with vascular access in the forearm; with high stiffness reduction when the AVF is constructed in the upper arm. In addition, taking into account the gender dependence of arterial stiffness variations and vascular access performance [2, 3], it would be important to explore possible vascular biomechanical differences between male and female CHP. Findings regarding gender-associated differences in arterial response to vascular access construction could contribute to understand gender differences in the AVF patency rates [2, 3].…”

Section: Introductionmentioning

confidence: 99%

Vascular Accesses for Haemodialysis in the Upper Arm Cause Greater Reduction in the Carotid-Brachial Stiffness than Those in the Forearm: Study of Gender Differences

Bia

Cabrera-Fischer

Galli

et al. 2012

International Journal of Nephrology

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Purpose. To evaluate in chronically haemodialysed patients (CHPs), if: (1) the vascular access (VA) position (upper arm or forearm) is associated with differential changes in upper limb arterial stiffness; (2) differences in arterial stiffness exist between genders associated with the VA; (3) the vascular substitute (VS) of choice, in biomechanical terms, depends on the previous VA location and CHP gender. Methods. 38 CHPs (18 males; VA in upper arm: 18) were studied. Left and right carotid-brachial pulse wave velocity (PWVc-b) was measured. In in vitro studies, PWV was obtained in ePTFE prostheses and in several arterial and venous homografts obtained from donors. The biomechanical mismatch (BM) between CHP native vessel (NV) and VS was calculated. Results/Conclusions. PWVc-b in upper limbs with VA was lower than in the intact contralateral limbs (P < 0.05), and differences were higher (P < 0.05) when the VA was performed in the upper arm. Differences between PWVc-b in upper limbs with VA (in the upper arm) with respect to intact upper limbs were higher (P < 0.05) in males. Independently of the region in which the VA was performed, the homograft that ensured the minimal BM was the brachial artery. The BM was highly dependent on gender and the location in the upper limb in which the VA was performed.

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“…In addition, when venipunctures are inevitable, it would seem prudent to allow the veins of the dominant hand to be used first before those of the nondominant hand. Underutilization of AV fistulas in women is due to vascular anatomical differences between the sexes (20,21). Noninvasive preoperative screening for appropriate sites and evaluation of blood flow may result in better access outcome and patency.…”

Section: Futurementioning

confidence: 99%

Vascular Access: Past, Present, and Future

Lew

Ing

2008

Int J Artif Organs

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Gender differences in vascular access in hemodialysis patients in the United States: Developing strategies for improving access outcome

Cited by 45 publications

References 32 publications

Meeting KDOQI Guideline Goals at Hemodialysis Initiation and Survival during the First Year

Meeting KDOQI Guideline Goals at Hemodialysis Initiation and Survival during the First Year

Vascular Accesses for Haemodialysis in the Upper Arm Cause Greater Reduction in the Carotid-Brachial Stiffness than Those in the Forearm: Study of Gender Differences

Vascular Access: Past, Present, and Future

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