Use of vascular access for haemodialysis in Europe: a report from the ERA-EDTA Registry

Noordzij, Marlies; Jager, Kitty J.; Veer, Sabine N van der; Kramar, Reinhard; Collart, Frédéric; Heaf, James; Stojceva-Taneva, Olivera; Leivestad, Torbjørn; Buturović‐Ponikvar, Jadranka; Sánchez, Manuel Benítez; Moreso, Fransesc; Prütz, Karl-Göran; Severn, Alison; Wanner, Christoph; Vanholder, Raymond; Ravani, Pietro

doi:10.1093/ndt/gfu253

Cited by 90 publications

(77 citation statements)

References 19 publications

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“…The rate of fistula thrombosis (0.085 per py) was far below the NKF-KDOQI goal (0.250 per py) [4] . Additionally, compared to recent epidemiological data [9,[21][22][23], we found low catheter utilization: 68.6% of patients receiving a fistula or graft initiated HD with a mature VA and only 12.6% of prevalent patients used a tunneled catheter.…”

Section: Discussionmentioning

confidence: 42%

“…Substantial comorbidities, older age and female gender are 118 recognized risk factors of primary fistula failure [11,12,15,18] . Grafts were used by 15.7% of our prevalent patients, which is about twice the average observed in Europe [21][22][23] , and those who received a graft were more likely to be older, of the female gender and affected by cerebrovascular disease. A selective graft use in such patients may have contributed to reduce the number of primary fistula failures, catheter utilization and access-morbidity, while still affording an adequate cumulative access survival.…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, catheters are still widely used despite a higher risk of infection, hospitalization and mortality [1,2,19,20] . Approximately 80% of North American patients [9] and onehalf or more European patients [21][22][23] are catheter dependent at HD initiation. Among prevalent patients, this percentage accounts for 20% in the United States [9] and for 20-35% in Europe, where an increasing catheter utilization has been described in some countries, such as Italy [21][22][23] .…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Vascular Access Care and Surgery Managed by Interventional Nephrologists: A Twelve-Year Experience

Fumagalli

Pietro²,

Migliori³

et al. 2016

Blood Purif

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Background: Optimizing vascular access outcomes is still a challenge, since 30-60% of arteriovenous fistulas fail or do not mature and catheters are widely used in contemporary patients. Methods: This study reports on strategies and outcomes in a single center in which access planning, surgery and maintenance are managed by a team of nephrologists. We retrospectively analyzed 305 fistulas and 61 grafts created in 270 consecutive patients between 2002 and 2013. Results: The percentage of patients receiving a fistula or graft who initiated hemodialysis with a mature access was 68.6%. Among prevalent patients, 71.7% used a fistula, 15.7% a graft and 12.6% a catheter. Rates of primary failure and revision before cannulation were 14.4 and 1.6% for fistulas vs. 4.9 and 3.3% for grafts. After maturation, complications (1.040 vs. 0.188 per patient-year (py)) and interventions (0.743 vs. 0.066 per py) were greater for grafts than for fistulas (p < 0.001). Secondary patency did not significantly differ between grafts and fistulas (median survival 34.8 vs. 57.3 months, p = 0.36), unless primary failures were excluded from Kaplan-Meier analysis (median survival 34.9 vs. 70.9 months, p = 0.03). Conclusions: High fistula prevalence, low access-related morbidity and catheter dependence were achieved using individualized strategies, including mid-forearm or perforating vein fistula creation and selective graft placement in high risk patients. Direct involvement of nephrologists throughout all steps of access care can improve access outcomes, by promoting a patient-centered approach.

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Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of Vascular Access Care and Surgery Managed by Interventional Nephrologists: A Twelve-Year Experience

Fumagalli

Pietro²,

Migliori³

et al. 2016

Blood Purif

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“…Unplanned patients will tend to obtain in-centre HD as a default dialysis option [3], reflected in high usage (up to 80%) of central venous catheter (CVC) [2]. In Europe there is a challenging trend of decreasing use of arteriovenous fistula, AVF (42% in 2005 and 32% in 2009), while CVC use increased from 58% to 68% [4]. …”

Section: Introductionmentioning

confidence: 99%

Offering Patients Therapy Options in Unplanned Start (OPTiONS): Implementation of an educational program is feasible and effective

et al. 2017

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BackgroundPatients with unplanned dialysis start (UPS) have worse clinical outcomes than non-UPS patients, and receive peritoneal dialysis (PD) less frequently. In the OPTiONS study of UPS patients, an educational programme (UPS-EP) aiming at improving care of UPS patients by facilitating care pathways and enabling informed choice of dialysis modality was implemented. We here report on impact of UPS-EP on modality choice and clinical outcomes in UPS patients.MethodsThis non-interventional, prospective, multi-center, observational study included 270 UPS patients from 26 centers in 6 European countries (Austria, Germany, Denmark, France, United Kingdom and Sweden) who prior to inclusion presented acutely, or were being followed by nephrologists but required urgent dialysis commencement by an acutely placed CVC or PD catheter. Effects of UPS-EP on choice and final decision of dialysis therapy and outcomes within 12 months of follow up were analysed.ResultsAmong 270 UPS patients who had an unplanned start to dialysis, 214 were able to receive and 203 complete UPS-EP while 56 patients - who were older (p = 0.01) and had higher Charlson comorbidity index (CCI; p < 0.01) - did not receive UPS-EP. Among 177 patients who chose dialysis modality after UPS-EP, 103 (58%) chose PD (but only 86% of them received PD) and 74 (42%) chose HD (95% received HD). Logistic regression analysis showed that diabetes 1.88 (1.05 – 3.37) and receiving UPS-EP, OR = 4.74 (CI, 2.05 – 10.98) predicted receipt of PD. Patients choosing PD had higher CCI (p = 0.01), higher prevalence of congestive heart failure (p < 0.01) and myocardial infarction (p = 0.02), and were more likely in-patients (p = 0.02) or referred from primary care (p = 0.02). One year survival did not differ significantly between PD and HD patients. Peritonitis and bacteraemia rates were better than international guideline standards.ConclusionsUPS-EP predicted patient use of PD but 14% of those choosing PD after UPS-EP still did not receive the modality they preferred. Patient survival in patients choosing and/or receiving PD was similar to HD despite age and comorbidity disadvantages of the PD groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0419-z) contains supplementary material, which is available to authorized users.

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“…[4][5][6] However, despite some variance between several countries in the reported use of CVC, its frequent use remains an important problem, particularly among patients newly started to hemodialysis. 7,8 On the other hand, use of catheters is associated with increased morbidity and mortality rates in hemodialysis patients. [9][10][11] From a clinical viewpoint, major catheter-related issues are represented by catheter infections and catheter dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Catheter-related atrial thrombus: tip of the iceberg?

et al. 2015

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Although guidelines recommend catheters as a last resort for establishing a vascular access in patients undergoing dialysis, they continue to be used widely for this purpose. Catheter-related atrial thrombus (CRAT) is rarely reported in this group of patients, and it can lead to serious complications. The aim of this study was to determine the incidence of CRAT in patients undergoing hemodialysis with permanent-tunneled catheters. A total of 50 patients undergoing hemodialysis with permanent catheters were included in this study. The diagnosis of CRAT was based on transthoracic echocardiography findings. Thrombus was present in nine patients (18%) and related to the tip of the catheter in all cases. Except for one patient with two foci of thrombus, all patients had a single focus. There were no significant associations between the development of thrombus and the duration of catheter use or the location of the catheter. Furthermore, catheter-related atrial thrombus did not appear to have a significant effect on mortality. The asymptomatic character of CRAT can be responsible for the low reporting rates, and its exact role in increased mortality and morbidity related with catheter use remains unknown. While planning management strategies, information on different options for vascular access routes and possible catheter-related complications should be provided to all patients who will undergo dialysis, together with a discussion involving other replacement alternatives for end-stage renal disease.

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Use of vascular access for haemodialysis in Europe: a report from the ERA-EDTA Registry

Cited by 90 publications

References 19 publications

Outcomes of Vascular Access Care and Surgery Managed by Interventional Nephrologists: A Twelve-Year Experience

Outcomes of Vascular Access Care and Surgery Managed by Interventional Nephrologists: A Twelve-Year Experience

Offering Patients Therapy Options in Unplanned Start (OPTiONS): Implementation of an educational program is feasible and effective

Catheter-related atrial thrombus: tip of the iceberg?

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