Tunneled Catheters in Hemodialysis Patients: Reasons and Subsequent Outcomes

Lee, Timmy; Barker, Jill; Allon, Michael

doi:10.1053/j.ajkd.2005.05.024

Cited by 221 publications

(166 citation statements)

References 18 publications

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“…These observations suggest that processes of care are more important than patient characteristics in determining whether the AVF is ready to use at dialysis initiation. In this regard, a previous publication from our center highlighted the complexity of and long delays in achieving this goal (23).…”

Section: Discussionmentioning

confidence: 99%

Predictors of Initiation for Predialysis Arteriovenous Fistula

Al-Balas¹,

Lee

Young

et al. 2016

CJASN

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Background and objectives The optimal timing of predialysis arteriovenous fistula surgery remains uncertain. We evaluated factors associated with hemodialysis initiation in patients undergoing predialysis arteriovenous fistula surgery and derived a model to predict future initiation of dialysis.Design, setting, participants, & measurements Our study retrospectively identified 308 patients undergoing predialysis arteriovenous fistula creation at a large medical center in 2006-2012 to determine whether they initiated hemodialysis. Multiple variable logistic regression analyzed which demographic and clinical factors predicted initiation of dialysis within 2 years of arteriovenous fistula surgery. A receiver operating characteristic area under the curve was used to quantify the predictive value of preoperative factors on the likelihood of initiating hemodialysis within 2 years.Results Overall, hemodialysis was initiated within 6 months, 1 year, and 2 years in 119 (39%), 175 (57%), and 211 (68%) patients, respectively. Using multiple variable logistic regression, four factors were associated with hemodialysis initiation at 2 years: eGFR at access surgery (odds ratio, 0.45; 95% confidence interval, 0.31 to 0.64 per 5 ml/min per 1.73 m 2 ; P,0.001), diabetes (odds ratio, 2.51; 95% confidence interval, 1.22 to 5.15; P=0.003), GFR trajectory (odds ratio, 1.54; 95% confidence interval, 1.09 to 2.17 per 3 ml/min per 1.73 m 2 per year; P=0.01), and spot urine protein-to-creatinine ratio (odds ratio, 1.39; 95% confidence interval, 1.14 to 1.71 per 1 U; P,0.001). eGFR alone had a moderate predictive value for dialysis initiation (area under the curve =0.69; 95% confidence interval, 0.63 to 0.76; P,0.001), whereas the full model had a higher predictive value (area under the curve =0.83; 95% confidence interval, 0.77 to 0.88; P,0.001).Conclusions The likelihood of initiating hemodialysis within 2 years of predialysis arteriovenous fistula surgery is associated with eGFR at access surgery, diabetes, GFR trajectory, and magnitude of proteinuria. The combined use of all four variables improves the ability to predict future hemodialysis compared with the use of eGFR alone.

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Section: Discussionmentioning

confidence: 99%

Predictors of Initiation for Predialysis Arteriovenous Fistula

Al-Balas¹,

Lee

Young

et al. 2016

CJASN

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“…Surgeons and nephrologists are reluctant to place thigh grafts in these patients, opting instead for tunneled central venous catheters. The latter are recognized to be inferior to any type of vascular access because of higher rates of infection, lower blood flows resulting in inadequate dialysis, and greater risk for development of central vein stenosis and thrombosis (20,21). After repeated insertion and removal of central vein catheters in the neck, venous stenosis ensues, forcing the interventionalist to access the femoral veins.…”

Section: Discussionmentioning

confidence: 99%

Thigh Grafts Contribute Significantly to Patients' Time on Dialysis

Ram

Sachdeva

Caldito

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Thigh grafts are placed in hemodialysis patients who have exhausted all arm access sites. The goal of this study was to compare the survival, complication rates, and overall contribution of thigh grafts with arm grafts and fistulas in patients with at least one functional thigh graft during their dialysis history.Design, setting, participants, & measurements: This longitudinal review of a prospectively acquired clinical database included 85 thigh graft recipients. The rates of survival, thrombosis, infection, and other complications were determined for a total of 268 fistulas, arm grafts, and thigh grafts placed in these patients.Results: In this patient subset, thigh graft primary failure rate was lower than arm grafts and fistulas (3 versus 13 and 61%, respectively). Excluding primary failures, thigh grafts survived longer than both arm grafts and mature fistulas (53 versus 14 and 32%, at 3 years; 47 versus 3 and 11% at 5 years). Thigh grafts had a lower thrombosis rate than arm grafts (0.543 versus 1.457/patient-year) but similar rates of loss as a result of infection and surgical revision. In patients with previous arm accesses, thigh grafts contributed 51% of total dialysis time compared with 38 and 11% for arm grafts and fistulas.Conclusions: Thigh grafts provide long-term, thrombosis-and infection-free dialysis access for patients with exhausted arm access sites. The decision for thigh graft placement should, therefore, be made as soon as there is evidence for unavailability of arm access sites so that catheter use can be minimized.

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“…The longer a CVC is in place, the less likely a patient will agree to AVF creation or use. One study that evaluated reasons for CVC use found that only duration of CVC dependence was associated with future access use (56).…”

Section: Impact On Esrd Indicatorsmentioning

confidence: 99%

“…This is also a reasonable approach in late-referral patients to avoid the risk for initiating HD with a CVC. The chances of having an AVF placed once a CVC has been in place for Ͼ6 mo is low (56), and the risk for death in the first year with exclusive CVC use is Ͼ50% (62).…”

Section: Selectively Use Grafts: They Do Have a Placementioning

confidence: 99%