Risk Factors Associated with Patency Loss of Hemodialysis Vascular Access within 6 Months

Monroy-Cuadros, Mauricio; Yılmaz, Serdar; Salazar-Bañuelos, Anastasio; Doig, Christopher J.

doi:10.2215/cjn.09441209

Cited by 115 publications

(104 citation statements)

References 22 publications

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“…General risk factors for access failure include female sex, diabetes, and history of access dysfunction (21)(22)(23)(24)(25)(26). In this study, diabetes was associated only with the impaired functional primary patency of AVF.…”

Section: Discussionmentioning

confidence: 55%

Thrombophilia and Arteriovenous Fistula Survival in ESRD

Salmela

Hartman²,

Peltonen³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The role of thrombophilia in failing arteriovenous fistula (AVF) among patients with ESRD undergoing hemodialysis is not established. This study aimed to assess whether AVF primary patency is associated with thrombophilia and coagulation abnormalities.Design, setting, participants, & measurements This observational study screened 219 patients between 2002 and 2004 for thrombophilia before AVF surgery. Thrombophilia included factor V Leiden and prothrombin G20210A mutations, protein C and antithrombin activities, and protein S. Coagulation abnormalities included high factor VIII:C, homocysteine, fibrinogen, and D-dimer levels; presence of antiphospholipid antibodies; and short thrombin time. We reviewed patient charts for comorbid conditions, AVF maturation and interventions, kidney transplantation, and patient survival (mean follow-up duration, 3.6 [range, 2.3-5.8] years). Primary patency from the AVF placement and functional primary patency from the first AVF cannulation were analyzed with Kaplan-Meier and Cox proportional hazards models.Results Thrombophilia was present in 9% of the patients, and coagulation abnormalities occurred in 77%. One-year primary patency was 68%; 46% of the AVF failures occurred before the initiation of hemodialysis. Female sex (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.7-4.1) and thrombophilia (HR, 2.2; 95% CI, 1.2-4.2) were independent risk factors for loss of primary patency. Thrombophilia mutations or low antithrombin level (HR, 3.8), female sex (HR, 2.5), and diabetes (HR, 1.9) were associated with shortened functional primary patency of AVF.Conclusions Against the background of frequent coagulation abnormalities, thrombophilia and female sex predispose patients with ESRD to access failure, mostly due to thrombosis or stenosis.

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Section: Discussionmentioning

confidence: 55%

Thrombophilia and Arteriovenous Fistula Survival in ESRD

Salmela

Hartman²,

Peltonen³

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…The connection between artery diameter and blood inflow rate was emphasized by a number of studies [42,46,47]. However, we did not included artery diameter and arterial blood flow in our study due to the unavailability of retrospective data.…”

Section: Discussionmentioning

confidence: 99%

Development of prognostic model for fistula maturation in patients with advanced renal failure

et al. 2018

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Background: This study aimed to explore the role of patient's characteristic and haematological factors as predictive on the maturation of arteriovenous fistulae in patients who underwent vascular access surgery at the Royal Infirmary of Edinburgh. Methods: Retrospective data from 300 patients who had undergone fistula creation between February 2007 and October 2010 was examined. A predictive logistic regression model was developed using the backward stepwise procedure. Model performance, discrimination and calibration, was assessed using the receiver operating characteristics (ROC) curve and Hosmer and Lemeshow goodness of fit test. Results: Three variables were identified which independently influenced fistula maturation. Males were twice as likely to undergo fistula maturation, compared to that of females (odds ratio (OR) 0.514; 95% confidence interval (CI) 0.308-0.857), patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula (OR 3.140; 95% CI 1.596-6.177) and a pre-operative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation compared to a vein size less than 2.5 mm (OR 4.532; 95% CI 2.063-9.958). The model for fistula maturation had fair discrimination as indicated by the area under the ROC curve (0.68; 95% CI 0.615-0. 738) but good calibration indicated by Hosmer and Lemeshow test (p = 0.79). Conclusion: Gender, PVD and vein size are independent predictors of arteriovenous fistula maturation. The clinical utility of these risk equation in the maturation of arteriovenous fistulae requires further validation in the newly treated patients.

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“…2,9 Multiple studies show that older patients, women, and patients with vascular disease or vascular disease risk factors are at greatest risk of having an AV fistula fail to mature, potentially leaving them dependent on CVCs for vascular access. [10][11][12] Accordingly, it is possible that these patients may benefit from initial AV graft placement because of higher rates of primary maturation. 13,14 Many prior studies exploring vascular access choice have not assessed the effect of vascular access failure and more importantly, have not fully considered how patient characteristics affect both access failure and mortality.…”

mentioning

confidence: 99%

Vascular Access Choice in Incident Hemodialysis Patients

Drew¹,

Lok

Cohen

et al. 2015

Journal of the American Society of Nephrology

123

115

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Hemodialysis vascular access recommendations promote arteriovenous (AV) fistulas first; however, it may not be the best approach for all hemodialysis patients, because likelihood of successful fistula placement, procedure-related and subsequent costs, and patient survival modify the optimal access choice. We performed a decision analysis evaluating AV fistula, AV graft, and central venous catheter (CVC) strategies for patients initiating hemodialysis with a CVC, a scenario occurring in over 70% of United States dialysis patients. A decision tree model was constructed to reflect progression from hemodialysis initiation. Patients were classified into one of three vascular access choices: maintain CVC, attempt fistula, or attempt graft. We explicitly modeled probabilities of primary and secondary patency for each access type, with success modified by age, sex, and diabetes. Access-specific mortality was incorporated using preexisting cohort data, including terms for age, sex, and diabetes. Costs were ascertained from the 2010 USRDS report and Medicare for procedure costs. An AV fistula attempt strategy was found to be superior to AV grafts and CVCs in regard to mortality and cost for the majority of patient characteristic combinations, especially younger men without diabetes. Women with diabetes and elderly men with diabetes had similar outcomes, regardless of access type. Overall, the advantages of an AV fistula attempt strategy lessened considerably among older patients, particularly women with diabetes, reflecting the effect of lower AV fistula success rates and lower life expectancy. These results suggest that vascular access-related outcomes may be optimized by considering individual patient characteristics.

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Risk Factors Associated with Patency Loss of Hemodialysis Vascular Access within 6 Months

Cited by 115 publications

References 22 publications

Thrombophilia and Arteriovenous Fistula Survival in ESRD

Thrombophilia and Arteriovenous Fistula Survival in ESRD

Development of prognostic model for fistula maturation in patients with advanced renal failure

Vascular Access Choice in Incident Hemodialysis Patients

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