A call to optimize haemodialysis vascular access care in healthcare disrupted by COVID-19 pandemic

Basile, Carlo; Lomonte, Carlo; Combe, Christian; Covic, Adrian; Kirmizis, Dimitrios; Liakopoulos, Vassilios; Mitra, Sandip

doi:10.1007/s40620-021-01002-4

Cited by 7 publications

(9 citation statements)

References 14 publications

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“…Noticing the major drawbacks of disrupted vascular access for hemodialysis requiring patients Basile et al advocated for an overall optimization in care of definitive access. 20 Knowing that the overall salvage rate of AVF might have changed throughout the pandemic generates a series of unresolved questions beyond the scope of this study. Further studies about AVF thrombosis surveillance, diagnosis, and treatment in COVID-19 patients would be helpful to fully understand the implications of this disease.…”

Section: Discussionmentioning

confidence: 97%

Implications of COVID-19 Infection on Arteriovenous Fistula Thrombosis

Franco-Mesa

Walters

Shah

et al. 2023

Vasc Endovascular Surg

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Objective: This study aims to identify and analyze implications of COVID‐19 positivity on AVF occlusion, subsequent treatment patterns, and ESRD patient outcomes. Our aim is to provide a quantitative context for vascular access surgeons in order to optimize surgical decision making and minimize patient morbidity. Methods: The de-identified national TriNetX database was queried to extracted all adult patients who had a known AVF between January 1, 2020 and December 31, 2021. From this cohort individuals who also were diagnosed with COVID‐19 prior to creation of their AVF were identified. Cohorts were propensity score matched according to age at AVF surgery, gender, ethnicity, diabetes mellitus, nicotine dependence, tobacco use, use of anticoagulant medications, and use of platelet aggregation inhibitors, hypertensive diseases, hyperlipidemia, and prothrombotic states. Results: After propensity score matching there were 5170 patients; 2585 patients in each group. The total patient population had 3023 (58.5%) males and 2147 (41.5%) females. The overall rate of thrombosis of AV fistulas was 300 (11.6%) in the cohort with COVID‐19 and 256 (9.9%) in the control group (OR 1.199, CI 1.005-1.43, P =.0453). Open revisions of AVF with thrombectomy were significantly higher in the COVID‐19 cohort compared to the non-COVID‐19 group (1.5% vs .5% P = .0002, OR 3.199, CI 1.668-6.136). Regarding the time from AVF creation to intervention, the median days for open thrombectomy in COVID-19 patients was 72 vs 105 days in controls. For endovascular thrombectomy, the median was 175 vs 168 days for the COVID-19 and control cohorts respectively. Conclusion: As for this study, there were significant differences in rates of thrombosis and open revisions of recent created AVF, however endovascular interventions remained remarkably low. As noted in this study, the persistent prothrombotic state of patients with a history of COVID‐19 may persist beyond the acute infectious period of the disease.

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Section: Discussionmentioning

confidence: 97%

Implications of COVID-19 Infection on Arteriovenous Fistula Thrombosis

Franco-Mesa

Walters

Shah

et al. 2023

Vasc Endovascular Surg

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“…This could have a detrimental impact on dialysis patients’ outcomes in the near future and needs to be addressed urgently. Keeping the use of CVCs to a minimum, with the goal of creating the; right access, in the right patient, at the right time, for the right reasons; is mandatory [ 20 , 23 ]. In our study, any significant increase in CVC-related hospitalizations and complications during the 15 months of follow-up was observed.…”

Section: Discussionmentioning

confidence: 99%

“…The COVID pandemic has resulted in a major disruption in the healthcare system that has affected several medical and surgical specialties [ 4 , 5 ]. In an effort to address the burden of COVID disease and the demand for healthcare resources, elective procedures were deferred or suspended [ 6 ]. European and American vascular societies in the era of the COVID pandemic have recommended classifying operations into urgent, emergent and elective based on the nature of their pathology [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres

Jiménez

Delgado

Pereira

et al. 2022

Clinical Kidney Journal

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Background The COVID pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies has proposed deferring the creation of an elective vascular access (VA) (autologous or prosthetic arteriovenous fistula (AVF or AVG) in incident patients on hemodialysis (HD) in the era of a COVID pandemic. The aim of this study is to examine the impact of COVID pandemic on VA creation and the CVC-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of 3 different regions. Methods We compared retrospectively two periods of time: the pre-COVID (January 1th 2019-March 11th 2020) and the COVID era (March 12th 2020-June 30th 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centers. The variables analyzed were: type of VA (central venous catheter-CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC-HD sessions that did not reach the goal of KT(KT> 45) as marker of HD adequacy. Results 1791 VA for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during COVID period compared to those who did not were significantly younger and a significant decrease of surgical activity to create AVFs and AVGs in older HD patients (> 75 and > 85 years) was observed in COVID period compared to Pre-COVID period. There was a significant increase in CVC placement (from 59.7% to 69.5%) (p<0.001) from the pre-COVID to the COVID time-period. During COVID pandemic a significantly higher number of patients started HD through a CVC (80.3% vs. 69.1%, p<0.001) The percentage of CVC in prevalent HD patients has not decreased 19 months after the start of the pandemic (414 CVC/1058 prevalent patients (39.4%). No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In COVID period a significant increase in catheter replacement and in the percentage of HD session that not reach the HD dose objective (KT> 45) was observed. Conclusions COVID has presented a public health system crisis that has influenced VA for HD with an increase of CVC relative to AVF. A decrease in HD session that not reach the HD dose objective was observed in COVID period compared to preCOVID period.

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“…En un estudio realizado en Hubei, la provincia China más afectada por el coronavirus (24), los CVC incidentes durante la primera ola de la pandemia aumentaron del 50 al 92 %, debido posiblemente a la escasez de recursos sanitarios.…”

Section: Discussionunclassified

“…Estas medidas coincidieron con la propuesta de preservar la realización de FAV y evitar en la medida de lo posible los CVC durante la pandemia del grupo europeo de diálisis (EUDIAL) recientemente publicadas y que se contraponen a las recomendaciones iniciales de la Sociedad Americana de cirugía (24).…”

Section: Discussionunclassified