A Survey of Vascular Access for Haemodialysis in The Netherlands

Abstract

After nearly 30 years of access surgery for haemodialysis, a survey of vascular access in a large population seemed relevant in order to analyse the state of the art. On 1 January 1988, 2195 patients in 52 centres in The Netherlands (population 14,714,900) were on long-term haemodialysis and 588 on continuous ambulant peritoneal dialysis (CAPD) for renal insufficiency. A questionnaire was mailed out, to which there was 100% response. Of all the patients on long-term haemodialysis, 70% had a Cimino fistula, 22% a graft fistula, and 6% a more proximal arm fistula. The remaining 2% had a Scribner shunt. Of all the graft fistulae, the expanded polytetrafluoroethylene (ePTFE) graft was the one most used (58%), followed by the homologous vein graft (25%), the autologous vein graft (13%), and those made of other materials (4%). Preference for acute access was recorded; catheterisation of the subclavian vein was used almost exclusively in 17 centres, while in 24 centres it was chosen in more than 50% of the cases. The femoral vein was almost always the choice for acute access in 6 centres and it was selected in more than 50% of the cases in 17 centres. Another alternative, the Scribner shunt, was applied in selected cases in 22 of the 52 centres. Percutaneous transluminal angioplasty (PTA), as a method for treating stenoses in vessels used for vascular access, was applied routinely in 5 centres and occasionally in 19 centres.

Subtotal parathyroidectomy for secondary renal hyperparathyroidism: a 20-year surgical outcome study

“…In the present material, in 86.8 % patients the lesions developed in the presence of the above underlying diseases and only in less than 5 % (4.1 %), diabetic nephropathy was responsible for renal failure. The above data approximate findings from the literature; where at present, diabetic nephropathy accounts for a low percentage of causes of CRF; what is an evidence of progress having occurred over the years in proper management of diabetic patients [11–13, 20, 21]. …”

“…Such a situation may pose an additional threat to the cardiac muscle and the entire circulatory system [6–10]. According to the data from the literature on the subject, between 15 % and approximately 40 % of patients require dialysis therapy and its duration is often positively correlated with the insensitive to conservative therapy nodular (monoclonal) type of parathyroid proliferation [11–13]. In such cases, a factor that plays a decisive role in the therapeutic success is a properly planned and executed surgical procedure, which—through interrupting autonomous PTH release allows for a possibility of regulating the level of phosphates and calcium as well as provides creates favorable conditions for a kidney transplant [14].…”

Influence of Surgeons’ Specialty on the Selection of Vascular Access for Hemodialysis Treatment

“…This goal has been surpassed in almost all European countries. In a survey performed in The Netherlands [2], among 52 centers, 76% of the patients on long-term hemodialysis had autologous AV fistulae. The Catalan Renal Registry [3] also revealed that in 85% of 3,073 hemodialyzed patients an AV fistula was used.…”

Accelerated increase of arteriovenous fistula use in haemodialysis centres: results of the multicentre CIMINO initiative

“…Since the late 1980s AVFs have been used by 60-65% of the haemodialysis patients in the Netherlands [7,8]. Moreover, a national survey we held in 2002-03 displayed not only an unchanged percentage of AVF use (59%), but also a great range in both type of vascular access use (AVFs: 31-91% and grafts: 3-57%) and anatomical location.…”