The Impact of Comorbidity Burden on The Association between Vascular Access Type and Clinical Outcomes among Elderly Patients Undergoing Hemodialysis

Jhee, Jong Hyun; Hwang, Sang Youn; Song, Jang-Ho; Lee, Seoung Woo

doi:10.1038/s41598-019-54191-1

Cited by 14 publications

(18 citation statements)

References 40 publications

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“…25,26 To balance these two outcomes, it is important to implement better methods to maintain AVF to support more frequent hemodialysis. Consistent with our findings, CCI has been reported to be a risk factor for thrombosis and/or stenosis, 27,28 which causes VA failure and is related to increased mortality and hospitalization of hemodialysis patients. 29 Therefore, nurses should pay attention to the assessment of CCI to provide targeted protective measures for the patient's AVF care to reduce the incidence of thrombosis and stenosis.…”

Section: Discussionsupporting

confidence: 91%

It is time to implement prepump arterial pressure monitoring during hemodialysis: A retrospective multicenter study

Sun

Lan³

et al. 2020

J Vasc Access

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Introduction: Prepump arterial pressure (Pa) indicates the ease or difficulty with which the blood pump can draw blood from vascular access (inflow) during hemodialysis. The absolute prepump arterial pressure to blood pump speed (Qb) ratio (|Pa/Qb|) may reflect the dysfunction of other vascular accesses. There is no consensus on the impact of |Pa/Qb| on arteriovenous fistula dysfunction. This study aimed to demonstrate the impact of |Pa/Qb| on arteriovenous fistula dysfunction. Methods: In this retrospective analysis, 490 hemodialysis patients with arteriovenous fistula from three hospitals were enrolled. Data were extracted from the I-Diapro database and hospital case systems. The absolute values for |Pa/Qb| and other data collected in the first month of enrollment were used to predict arteriovenous fistula dysfunction and determine the |Pa/Qb| cutoff value. Based on this value, patients were grouped, and 1-year arteriovenous fistula function was analyzed. Patients were followed until arteriovenous fistula dysfunction, until access type replacement, or for 12 months. Results: The area under the receiver operating characteristic curve for fistula dysfunction over 1 year was 0.65, with an optimal |Pa/Qb| value, sensitivity, and specificity of 0.499, 60.7%, and 72.6%, respectively. |Pa/Qb| > 0.499 was associated with earlier intervention (317.37 ± 7.68 vs 345.96 ± 3.64 days), lower survival ( p < 0.001), and a 3.26-fold greater risk of arteriovenous fistula dysfunction ( p < 0.001) than |Pa/Qb| ⩽ 0.499. Conclusions: |Pa/Qb| was an independent risk factor for arteriovenous fistula dysfunction. Nurses should emphasize |Pa/Qb| monitoring and properly set blood pump speed according to this ratio to protect arteriovenous fistula function. |Pa/Qb| > 0.499 might be a predictive measure of arteriovenous fistula dysfunction.

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Section: Discussionsupporting

confidence: 91%

It is time to implement prepump arterial pressure monitoring during hemodialysis: A retrospective multicenter study

Sun

Lan³

et al. 2020

J Vasc Access

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“…31,32 The use of vascular graft worsens patient prognosis; in this sense, Jhee et al reported that the use of vascular graft showed a higher risk of all-cause mortality than AVF in patients with higher comorbidity (HR 1.3; CI of 95% 1.02-1.75, p = 0.004). 33 The AVFs are used less frequently among elderly patients than among younger patients. 34 Robinson et al showed that almost a quarter of older adults with incident ESKD and a central venous catheter as primary access were not referred for AV access placement due to medical reasons.…”

Section: Discussionmentioning

confidence: 99%

Mortality in elderly patients starting hemodialysis program

Toapanta

Comas

Román

et al. 2022

Seminars in Dialysis

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Background: The incidence of older patients over 80 years old with chronic kidney disease who start hemodialysis (HD) program has been increasing in the last decade. Methods: We aimed to identify risk factors for morbidity and mortality in patients older than 80 years with end‐stage renal disease who started HD. We conducted a retrospective observational study of the Catalan Renal registry (RMRC). Results: A total of 2833 patients equal or older than 80 years (of 15,137) who started HD between 2002 and 2019 from the RMRC were included in the study. In this group, the first dialysis was performed through an arteriovenous fistula in 44%, percutaneous catheter in 28.2%, and tunneled catheter in 26.6%. Conventional dialysis was used in 65.7% and online HD in 34.3%. The most frequent cause of death was cardiac disease (21.8%), followed by social problems (20.4%) and infections (15.9%). Overall survival in older HD during the first year was 84% versus 91% in younger than 80 years (p < 0.001). Cox regression analysis identified the start of HD in the period 2002–2010, chronic obstructive pulmonary disease (COPD), and the onset of HD through vascular graft depicted as risk factors for first‐year mortality after dialysis initiation in patients older than 80 years with end‐stage renal disease who started HD. Conclusions: In conclusion, patients older than 80 years who started HD program had higher mortality, especially those who presented exacerbation of kidney disease, those with COPD, and those who started with a vascular graft.

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“…The risk for HD catheter dysfunction at 1 year was estimated at 15% [28]. Hospitalization rates due to access malfunction were higher among patients with tunneled catheters than among those with fistulas [29,30]. Dysfunction of a tunneled catheter can be due to thrombosis, fibrin sheath formation, stenosis, kinking, or malposition of the catheter [19].…”

Section: Discussionmentioning

confidence: 99%

A New Procedure for Guidewire Exchange of Tunneled Hemodialysis Catheters in Chronic Hemodialysis Patients: A Pilot Study

et al. 2022

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Introduction: Different techniques of guidewire exchange of tunneled catheters for hemodialysis (HD) have been reported. This study was carried out to assess the feasibility of a new procedure in chronic HD patients who needed catheter exchange because of mechanical dysfunction. Methods: The guidewire exchange method was based on the creation of a new exit site and a new subcutaneous tunnel while using the same venous insertion site. This was a retrospective study of exchanged tunneled catheters because of mechanical complications in patients on chronic HD between June 1, 2015, and December 31, 2019. The feasibility of the procedure was defined by successful exchange and catheter patency at 6 months. Catheter survival and immediate complications were reported. Results: A total of 49 procedures were performed in 34 HD patients. There was no catheter insertion failure. At 6 months, 6 catheters have lost their patency because of a mechanical complication. Thus, the success rate of the procedure was 43/49 (87.8%). Catheter survival censored on death, transplantation, or vascular access creation was 97.8% at 90 days, 86.2% at 180 days, and 74.5% at 1 year. The median catheter survival was 10.2 months. Among the 49 procedures, there were 9 hematomas at the insertion site that did not require surgical intervention. Discussion/Conlusion: Our study shows that guidewire exchange of a tunneled HD catheter by creating a new exit site and a new subcutaneous tunnel by using the same venous access is a newer method in chronic HD patients. This procedure should not be used in patients with coagulation issues. Additional studies are needed to compare the different methods of HD catheter exchange.

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The Impact of Comorbidity Burden on The Association between Vascular Access Type and Clinical Outcomes among Elderly Patients Undergoing Hemodialysis

Cited by 14 publications

References 40 publications

It is time to implement prepump arterial pressure monitoring during hemodialysis: A retrospective multicenter study

It is time to implement prepump arterial pressure monitoring during hemodialysis: A retrospective multicenter study

Mortality in elderly patients starting hemodialysis program

A New Procedure for Guidewire Exchange of Tunneled Hemodialysis Catheters in Chronic Hemodialysis Patients: A Pilot Study

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