Is the Fistula First Approach still valid?

Franco, Ricardo Portiolli

doi:10.1590/2175-8239-jbn-2020-u001

Cited by 8 publications

(5 citation statements)

References 28 publications

(36 reference statements)

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“…Atualmente, apesar de se conhecer as vantagens de iniciar a HD em uso da FAV, devido às peculiaridades de cada paciente deve-se avaliar as características em conjunto antes da escolha do acesso vascular. Alguns aspectos como idade, sexo, expectativa de vida e comorbidades, devem fazer parte da análise pré-procedimento, já que podem afetar negativamente a permeabilidade da FAV a longo prazo (Vassalotti et al, 2021;Serqueira et al, 2017;Franco, 2021).…”

Section: Introductionunclassified

Acessos vasculares para hemodiálise: análise de dados da clínica Diaverum em Sergipe

Brito

Figueiredo²,

Santos³

et al. 2022

RSD

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Pacientes com insuficiência renal aguda ou em estágio terminal da doença renal crônica necessitam de terapia de substituição renal que pode ser realizada por diálise peritoneal, hemodiálise (HD) ou transplante renal. O acesso venoso é essencial para a hemodiálise e pode ser realizado por Cateteres Venosos Centrais (CVC), arterialização de uma veia nativa ou pela interposição de um enxerto. Diversas comorbidades como diabetes, doença arterial periférica, obesidade e outras interferem negativamente nosucesso do acesso vascular, em especial na fístula arteriovenosa nativa. O uso prévio de CVC está associado ao insucesso da confecção de uma FAV. Quando a HD é a opção, a criação de uma FAV deve ser o mais breve possível, sendo raras as exceções. Desse modo, o trabalho tem como objetivo avaliar as variáveis epidemiológicas e clínicas dos pacientes submetidos à confecção de fístula arteriovenosa na instituição Diaverum, no estado de Sergipe, e analisar comparativamente os acessos vasculares temporários e permanentes . Como resultados pudemos observar a maior taxa de pacientes que iniciaram a hemodiálise por CVC e desses foi observado uma maior taxa de complicações. Além dissdo também pode-se notar que nos pacientes que iniciaram o tratamento com a FAV, houve uma duração da fístula a longo prazo maior do que os que iniciaram com cateter. Com tais resultados, pudemos concluir que todo acesso vascular no paciente que possui DRC avançada e em pacientes que já realizam hemodiálise deve levar em consideração vários fatores, e não so a praticidade de implantação devido as consequencias que ele pode acarretar em um outro acesso no futuro.

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Section: Introductionunclassified

Acessos vasculares para hemodiálise: análise de dados da clínica Diaverum em Sergipe

Brito

Figueiredo²,

Santos³

et al. 2022

RSD

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“…In the article: Is the fistula first approach still valid? 4 , we note that in Table 2, the author was based on figure 1.5 from Kdoqi 2019 5 . Therefore, there is a difference between the contents.…”

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confidence: 99%

“…If we analyze the vast majority of Brazilian patients, the estimated dialysis time is more than one year. Thus, if we were to use the data from Franco 4 , we would have a inadequate indication for arteriovenous graft. Similar consideration can be made if we assume that patients with multiple comorbidities, who are older and contraindicated for transplantation, are likely to dialyze longer than young patients who do not have multiple comorbidities and are suitable for kidney transplantation.…”

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confidence: 99%

“…Similar consideration can be made if we assume that patients with multiple comorbidities, who are older and contraindicated for transplantation, are likely to dialyze longer than young patients who do not have multiple comorbidities and are suitable for kidney transplantation. Thus, the patients who would benefit most from prostheses would be contraindicated for the procedure, according to Franco 4 . This is a very important issue that has implications for clinical practice.…”

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confidence: 99%

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Is the fistula first approach still valid?

Santos

2022

Braz. J. Nephrol.

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“…Recently, we published an update regarding the concepts of the Fistula First Initiative and the latest evidence and guidelines on the indications of arteriovenous grafts (AVG) and fistulas (AVF) for hemodialysis (HD) vascular access 1 . The article was commented on in a letter to the editor by De Castro-Santos, who discussed the indication of AVG in patients with anticipated short duration on HD.…”

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confidence: 99%

Reply to Letter to the Editor

Franco

2022

Braz. J. Nephrol.

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Recently, we published an update regarding the concepts of the Fistula First Initiative and the latest evidence and guidelines on the indications of arteriovenous grafts (AVG) and fistulas (AVF) for hemodialysis (HD) vascular access 1 . The article was commented on in a letter to the editor by De Castro-Santos, who discussed the indication of AVG in patients with anticipated short duration on HD. De Castro-Santos addressed two points. First, he noted a difference in content between our manuscript and the KDOQI 2019 guidelines 2 and stated: "In the article of the Brazilian Journal of Nephrology, the author considers indication of graft for patients with the probability of hemodialysis for less than one year. In the original document, the recommendation is for patients with survival time less than one year." Second, he argues that Table 2 in our article is suggesting AVG for patients with an HD expectancy of more than one year.We sincerely thank De Castro-Santos for his careful and critical reading of our paper, as it led us to find a diagraming error in the Portuguese version of the article. In this version, the signs for greater than (>) and less than (<) were reversed in the head row, causing the table columns to go against the KDOQI guidelines 2 . The second point is thus explained by this error and I apologize for not noticing this during the revisions.The English version is correct, and Table 2 of the article states that for patients with HD expectancy of less than one year and a non-urgent start of HD, a forearm AVG or a brachiocephalic AVF (with a high likelihood of unassisted maturation) could be considered as the first choice. The table is an attempt to summarize Figures 1.2 and 1.3 and statement 3.1 B of the Guidelines (page S45) and present them in a more visual fashion.The literal transcription of statement 3.1 B of the guideline is: "B) A patient's ESKD Life-Plan includes an anticipated limited duration (e.g., <1 year) on HD:-Forearm loop AVG or brachiocephalic AVF (with high likelihood of unassisted maturation)-Upper arm AVG". Therefore, the choice between AVG and AVF lies with the surgeon, if both have the same chance of unassisted maturation.We agree with the first point made by De Castro-Santos that there is an important conceptual difference between "survival time less than one year" and "HD expectancy less than one year", but as shown above, the table reproduced the terms of the guideline statement. We also agree with De Castro-Santos that "survival time" is a more appropriate interpretation of the guideline than "HD expectancy". In our article, we try to make this clear: "In patients with an estimated survival of less than one year, the latest guidelines consider AVG or AVF with a high chance of maturation (i.e., brachiocephalic) as the first choice."

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Is the Fistula First Approach still valid?

Cited by 8 publications

References 28 publications

Acessos vasculares para hemodiálise: análise de dados da clínica Diaverum em Sergipe

Acessos vasculares para hemodiálise: análise de dados da clínica Diaverum em Sergipe

Is the fistula first approach still valid?

Reply to Letter to the Editor

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