Influence of Vascular Access Type on Outcome Measures in Patients on Maintenance Hemodialysis

Chand, Deepa H.; Teo, Boon Wee; Fatica, Richard; Brier, Michael E.

doi:10.1159/000113525

Cited by 22 publications

(14 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Erythropoietin usage for each access type was derived from the literature (20) and associated costs were identified from CMS data (19). Blood stream infection-related costs were calculated assuming 60% of events would require inpatient admission and 40% outpatient therapy alone (21).…”

Section: Transition Probabilities Utilities and Costsmentioning

confidence: 99%

See 1 more Smart Citation

Choice of Vascular Access among Incident Hemodialysis Patients

Hou¹,

Lacson²,

Wang³

et al. 2010

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives: Arteriovenous fistulas (AVFs) are widely accepted as the preferred hemodialysis vascular access type. However, supporting data have failed to consider morbidity and mortality incurred during failed creation attempts and may therefore overstate potential advantages. This study compares survival, quality-adjusted survival, and costs among incident hemodialysis patients after attempted placement of AVFs or arteiovenous grafts (AVGs).Design, setting, participants, & measurements: Analogous Markov models were created, one each for AVF and AVG. Patients entered consideration at the time of first access creation, contemporaneous with dialysis initiation. Subsequent outcomes were determined probabilistically; transition probabilities, utilities, and costs were gathered from published sources. To ensure comparability between AVFs and AVGs, the timing and likelihood of access maturation were measured in a contemporary cohort of incident hemodialysis patients.Results: Mean (SD) overall survival was 39.2 (0.8) and 36.7 (1.0) months for AVFs and AVGs, respectively: difference (95% confidence interval [CI]) 2.6 (1.8, 3.3) months. Quality-adjusted survival was 36.1 (0.8) and 32.5 (0.9) quality-adjusted life months (QALMs) for AVFs and AVGs, respectively: difference (95% CI) 3.6 (2.8, 4.3) QALMs. The incremental costeffectiveness ratio (95% CI) for AVFs relative to AVGs was $446 (؊6023, 6994) per quality-adjusted life year saved.Conclusions: AVFs are associated with greater overall and quality-adjusted survival than AVGs. Observed differences were much less pronounced than might be expected from existing literature, suggesting that prospective identification of patients at high risk for AVF maturational failure might enable improvements in health outcomes via individualization of access planning.

show abstract

Section: Transition Probabilities Utilities and Costsmentioning

confidence: 99%

“…c Estimated based on mean erythropoietin usage of 227.24, 242.19, and 277.80 units/kg per week among patients with AVFs (20), AVGs, and catheters respectively, at a cost of $9.54/1000 units (19).…”

Section: Crossover Modelmentioning

confidence: 99%

Choice of Vascular Access among Incident Hemodialysis Patients

Hou¹,

Lacson²,

Wang³

et al. 2010

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…The presence of a catheter was associated with a significantly smaller birth weight before year-adjustment but failed to reach statistical significance after year-adjustment. Fistulas are associated with fewer infectious complications [20], compared to catheter and an increased achieved dialysis dose [21], the 2 factors that should be associated with a better fetal outcome.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes in French Hemodialysis Patients

Normand¹,

Xu²,

Panaye³

et al. 2018

Am J Nephrol

View full text Add to dashboard Cite

Background: Pregnancy in hemodialysis (HD) women is a rare event and often associated with maternal and fetal complications. Scarcity of available data from large cohorts impedes fair medical counseling. Methods: This is a descriptive, retrospective, multi-centric study. Pregnant women on HD during the period from 1985 to 2015 in France were included. The primary outcome was a living infant discharged from hospital, while secondary outcomes included gestational age and birth weight. Results: We identified 100 pregnancies in 84 women on HD, from 41 centers. Chronic HD was initiated during pregnancy for 17.7% (14/79) of patients explaining a 19.8% prevalence of catheter (19/96) and a preserved residual diuresis for 50% of pregnancy (43/86). Seventy-six (89.4%) women performed daily dialysis during the third trimester (6 times per week). Our primary outcome was met for 78% of newborns with a mean gestational age of 33.2 ± 3.9 weeks and a mean birth weight of 1,719 ± 730 g. Conclusions: Our study is one of the largest series of pregnancies in HD patients. Despite recent progresses, these pregnancies remain at high risk, reinforcing the need for an early nephrologist-obstetrician skilled team co-management.

show abstract

“…Kaysen (2009) indicates that the type of vascular access used in dialysis, the insertion of the catheters, biofilm on catheters, bacterial components present in dialysate, and water supply can all be sources of inflammation (Kaysen, 2009). Markers of inflammation associated with vascular access alone include albumin (Chand, Teo, Fatica, & Brier, 2008;Wystrychowski et al, 2009), CRP (Costa et al, 2008;Movilli et al, 2006;Sachdeva, Kovalchuk, Bitzer, & Mokrzycki, 2009), and IL-6 (Costa, et al, 2008;Sachdeva, et al, 2009). As Kaysen (2009) points out, the type of vascular access in HP is associated with mortality (Xue, Dahl, Ebben, & Collins, 2003).…”

Section: Causes Of Inflammation In Hemodialysis Patientsmentioning

confidence: 99%