Evaluation of variables associated with the patency of arteriovenous fistulas for hemodialysis created by a nephrologist

Abstract

Evaluation of variables associated with the patency of arteriovenous fistulas for hemodialysis created by a nephrologistAvaliação de variáveis associadas à permeabilidade de fístulas arteriovenosas criadas por um nefrologista para fins de hemodiálise Introdução: A fístula arteriovenosa (FAV) é considerada o acesso vascular padrão ouro para hemodiálise crônica, e sua falha prediz taxas mais altas de morbimortalidade. Objetivos: 1) Avaliar a taxa de sucesso da FAV criada por um nefrologista e 2) identificar variáveis clínicas, laboratoriais e demográficas que influenciam a patência da FAV. Métodos: Estudo de coorte retrospectivo de 101 pacientes com doença renal crônica, totalizando 159 FAVs criados por um nefrologista entre junho de 2010 e junho de 2013. Resultados: Das FAVs criadas, 124 (78%) apresentaram patência imediata e 110 (62,9%) apresentaram patência tardia. A hemoglobina (10-12 g/dL) foi a única variável relacionada à patência tardia da FAV (p = 0,05). A pressão arterial elevada no momento da cirurgia foi associada a um menor número de procedimentos por paciente (p = 0,001). A FAV proximal ocorreu com maior frequência em pacientes com dois acessos confeccionados (p = 0,03). A taxa de sucesso da FAV foi semelhante à relatada anteriormente na literatura. Conclusão: O nível de hemoglobina no intervalo recomendado tem um impacto favorável na perviedade tardia da FAV e pressão arterial elevada durante a cirurgia no menor número de acessos vasculares por paciente. A alta taxa de sucesso indica que ela pode ser feita por nefrologistas treinados. ResumoPalavras-chave: Fístula Arteriovenosa; Diálise Renal; Insuficiência Renal Crôni-ca; Grau de Desobstrução Vascular. Introduction: Arteriovenous fistula (AVF)is considered the gold standard vascular access for chronic hemodialysis, and its failure predicts higher morbidity and mortality rates. Objective: 1) To evaluate the success rate of AVF created by a nephrologist and 2) to identify clinical, laboratory, and demographic variables that influence AVF patency. Methods: A retrospective cohort study of 101 patients with chronic kidney disease for a total of 159 AVF created by a nephrologist between June 2010 and June 2013. Results: Of the AVFs created, 124 (78%) displayed immediate patency and 110 (62.9%) displayed late patency. Hemoglobin (10-12 g/dL) was the only variable related to late AVF patency (p = 0.05). An elevated blood pressure at time of surgery was associated with a lower number of procedures per patient (p = 0.001). Proximal AVF occurred more frequently in patients with dual access (p = 0.03). The AVF success rate was similar to those previously reported in the literature. Conclusion: Hemoglobin level in the recommended range has a favorable impact on late AVF patency and elevated blood pressure during surgery on the lower number of vascular accesses per patient. The high success rate indicates that it can be placed by trained nephrologists. AbstRAct

Arteriovenous Fistula Creation by Nephrologist: A Single Centre Experience

“…The baseline parameters like age, gender, diabetes and hypertension were similar to other studies. 3,9,10 The primary patency rates was 77% in our experience which was similar to other Indian experience published by plastic surgeon 11 as well as other international studies by nephrologists. 9,[12][13][14] All of 17 patients already on HD could be switched to AVF from nontunneled catheter at 4-5 weeks with adequate pump speed (300 ml/min).We followed them only for two weeks after first cannulation, no one had secondary failure/ complications in this period.…”

“…4,15 Four out of eight females had primary failure but it may be due to smaller arterial size in females, as many studies have proven that gender doesn't affect the outcome. 3,16 We found normotension (systolic < 120 mmHg) to be strongly associated with AVF failure as low blood flow is predisposing factor for AVF failure as in HEMO study. 17 As expected similar to other studies failure was significantly associated with lesser arterial diameter 9,10,12,13,18 , the minimum diameter on which AVF was successfully created was 1.5 mm, we didn't attempt AVF creation if cephalic vein diameter after proximal compression of arm was less than 2 mm.…”

Are There Differences in Arteriovenous Fistulae Created for Hemodialysis between Nephrologists and Vascular Surgeons?

“…Vernaglione et al [16] found that arteriovenous fistulae may function poorly in women, with a failure rate of 50%. Inequality of gender distribution in published studies limits assessment of the possible influence of gender on the functioning of the arteriovenous fistula, which is why any correlation between gender and vascular access function remains controversial [17]. The proportion of women in our study groups was similar (Table 2).…”

“…Experience shows that this should be considered favorably. García-Trío et al [18] found no difference in the rate of functioning of the arteriovenous fistula, whether created by vascular surgeons or by nephrologists [17]. Therefore, nephrologists in many dialysis centers in Europe have begun to conduct this procedure [19].…”

Avaliação clínica da maturação da fístula arteriovenosa para hemodiálise: revisão de escopo

“…Contudo, a maioria indicou avaliação da maturação dentro de quatro até seis semanas. (10,14,15,26,31,35,37,43,52) Ainda foram verificados estudos apontando tempos superiores a seis semanas: entre quatro e oito semanas; (56,57) dentro de dois meses após o procedimento; (40) até dois a três meses; (33) dentro de quatro meses; (29) em seis meses; (54) e outro que recomendou realizar a avaliação em duas semanas, seis semanas, três meses, seis meses e 12 meses do período pós-operatório. (53) Dentre as técnicas de avaliação clínica, 23 estudos (60,5%) recomendaram o exame físico e 15 (39,5%) a combinação anamnese e exame físico.…”