Background and Aims Clinical practice guidelines recommend an arteriovenous fistula (AVF) as the ideal vascular access for hemodialysis. Autologous AVFs have higher primary, assisted primary and overall survival, associated with lower morbidity and mortality compared to prosthetic AVFs. However, primary failure of AVFs function is not uncommon, above all due to the vascular pathology of patients on hemodialysis (HD). We determined the survival rates in a series of vascular accesses created in a high-resolution hospital. Method Cross-sectional study; We include all AVFs performed during the last 20 years. Demographic variables (age, sex), etiology of CKD and associated comorbidity were collected. We determine the primary, assisted and global survival times. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and are compared using the Chi2 test. Quantitative variables are expressed as mean ± standard deviation and the Mann Whitney Student-T/U was used to compare them. We performed a kaplan-Meier analysis determining primary, assisted and overall survival. Statistical significance for a value of p <0.05. Results 622 AVFs performed in 482 patients were reviewed. 86.8% were autologous. The mean age was 65.4±14 years; 66.6% were male. The most frequent etiologies of CKD were diabetic nephropathy (30.2%), unknown (18%), and glomerulonephritis (16.6%). 91.2% had arterial hypertension (HBP) and diabetes mellitus (DM) 47.9%. 48.7% received antiplatelet therapy and 15.6% anticoagulation prior to the creation of the AVF. 27% presented primary failure. In the survival analysis using the Kaplan Meier test, the mean time to perform angioplasty in dysfunctional AVFs was 14.6±1.37 months and to perform a thrombectomy 17.6±1.31 months. The overall survival of AVFs was 41.9±2 months. When assessing the type of AVF, we observed a longer survival for autologous (31.5±1.8) vs prosthetic (21.8±3.6) (p = 0.03 log Rank 4.73). Conclusion In our study, autologous AVFs have better survival compared to prosthetic ones. Of the AVFs created, primary survival at one year (requiring angioplasty) was 64%, assisted primary survival (requiring thrombectomy) was 42%, and overall survival 24%.
Background and Aims The population with chronic kidney disease (CKD) presents an increased risk of infection by hepatitis B virus (HBV). Usually, the protective immunological response rate (considering HBV titer > 10 mIU/mL) is 90–95% after the 4th dose of vaccine; In CKD the immune response is lower and correlates with the degree of CKD. In dialysis, this response is variable, less than 50% with three-dose regimens and higher with four doses. Cardiovascular risk factors have been implicated in the response rate to vaccination. The objective of this work is to analyze the efficacy of the HBV vaccine in hemodialysis patients and to identify cardiovascular factors as predictors of response. Method Retrospective observational study. We evaluated the response to a 4-dose vaccination protocol (0-1-2-6 months), determining the levels of HBVA 3 months after the last dose. Demographic variables (age, sex), associated comorbidity, etiology of CKD, among others, were collected. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and have been compared using the Chi2 test. The quantitative variables are expressed as mean +/- standard deviation and the T-student was used to compare them. Statistical significance for a value of p <0.05. Results 89 patients were included; 68.5% are male, with an average age of 65 years. 85.4% had arterial hypertension, and 39.3 were diabetic, the most frequent cause of CKD being renal vascular disease (20.8%), diabetic nephropathy (26.4%) and interstitial (9%). The immune response to HBV vaccination was 79.2%. When making statistical comparisons between the qualitative variables, we have not observed differences between serological response and DM or sex; We did find a trend towards significance when comparing the serological response with the variable HT and etiology of CKD (polycystic kidney disease), pNS. The comparison of means between quantitative variables when performing the Student's T-test did not show differences for any of the study variables. Conclusion In our center, HBV vaccination on dialysis achieves a response rate of 79.2%. HT may condition the immune response to vaccination in HD patients, although significance was not reached. Hereditary pathology has been the one that has shown the best serological response with respect to the rest of etiologies, perhaps associated with greater residual renal function.
78 patients in PD were retrospectively analyzed in 2 time ranges. Pre CV19 (Nov 19 to March 20, 5 months) and During CV19 (April 20 to August 20, 5 months). We compared the results of both. The clinical results analyzed in Table 1. Statistical analysis with Chi square and T Student. Average age 51.5 years. During CV19, on-site attentions were significantly reduced, increasing telemetric attentions. Blood pressure, diuresis, edema, UF rate, Hemoglobin, phosphorus, iPTH, Kt/V, Albumin, EPO dosage, hospitalization rate, weight, remained very similar in both periods. 3 patient had Peritonitis in preCV19 period, compared with 4 in CV19 period. 4 patients tested positive for SARS COV2 (5.1%) all community and family acquired, 1 died. Lower rate of ES infection and a higher rate of other complications during CV19 (transient hypotension/hypertension, UF transient failure, all telemetrically well managed) were detected. Conclusions: Telemetric model of care allows adequate control of patients. The clinical measured parameters, did not suffer changes, remaining stable, comparing the two periods, with on-site compared with telemetric controls. It was observed that 5% suffered CV19. 1 died. Complication rates were similar. The number of patients developed peritonitis and hospitalization rates were no statistically different. The telemetric control model has no clinical differences with on-site results. It could be maintained in the future, combined with on-site attentions, especially in the remote patient.
Conclusions: AVF procedure has been deferred in many centers in India due to limited staff, fear of COVID related dissemination of infection to staff and patient. An 88% success rate at 1-month of follow up is encouraging to perform this AVF surgery while maintaining standard universal COVID precautions.
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