Blood Access Complications and Longevity with Frequent (Daily) Hemodialysis and with Routine Hemodialysis

Twardowski, Zbylut J.

doi:10.1046/j.1525-139x.1999.99078.x

Cited by 16 publications

(8 citation statements)

References 29 publications

(17 reference statements)

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“…A review of the literature on blood access problems published a few years ago concluded that frequent hemodialyses were not detrimental to primary fistula longevity and complication rates [62]. This review confirms these conclusions and extends them with results regarding AV bridge grafts.…”

Section: Discussionsupporting

confidence: 74%

Blood access in daily hemodialysis

Twardowski

2004

Hemodialysis International

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Frequent dialyses are sometimes perceived as increasing the risk of blood access malfunction and decreased longevity. This review of the literature, however, indicates that the failure rates and overall fistula survival appear to be better with more frequent dialyses than with routine dialysis frequency, although the reasons for this phenomenon are not clear. One of the possible explanations is that frequent dialyses are associated with fewer intradialytic hypotensive episodes, which are very detrimental to the blood access. Another possible explanation is the generally lower blood flow used with more frequent hemodialyses, particularly long nocturnal hemodialysis. Finally, a decreased clotting tendency and decreased rates of hematoma formation at the puncture sites are additional possible explanations. Complication rates with bridge grafts are not higher with more frequent compared to routine thrice-weekly hemodialysis sessions. No such comparative data are available, however, for central-vein catheters. This lack of comparisons seems to stem from the intuitive assumption by nephrologists that hemodialyses that are more frequent should not adversely impact catheter complication rates and survival. No data at all are available on the use of the Dialock(R) hemodialysis system (Biolink Corp., Norwell, MA, USA) and LifeSite hemodialysis access system (Vasca, Inc., Tewksbury, MA, USA), two newer forms of hybrid access in patients undergoing frequent hemodialyses. Current evidence shows that the perceived risk of blood access malfunction and decreased longevity when patients undergo more frequent hemodialysis is not supported by the current literature.

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Section: Discussionsupporting

confidence: 74%

Blood access in daily hemodialysis

Twardowski

2004

Hemodialysis International

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“…Significant reductions in uremia-related symptoms such as pruritus, general fatigue, and postdialysis fatigue were observed in the present study. In our series and in the other reported studies, short daily HD was not associated with complications related to frequent use of vascular access, nor was it detrimental to primary fistula longevity [26]. We therefore suggest that frequent use (six times weekly) of the vascular access creates no obvious problems in comparison to conventional use (three times weekly).…”

Section: Discussionsupporting

confidence: 61%

Prolonged Protective Effect of Short Daily Hemodialysis against Dialysis-Induced Hypotension

Okada

Abe

Hagi

et al. 2005

Kidney Blood Press Res

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Background/Aims: Short daily hemodialysis (HD) has a protective effect against dialysis-induced hypotension (DIH). We examined whether this effect extends beyond the treatment period. Methods: We analyzed clinical variables in 6 patients (5 with diabetes mellitus) who underwent conventional hemodialysis (CHD) for 4 h three times weekly for 12 weeks; then short daily HD for 2 h six times weekly for 12 weeks, and then 12 more weeks of CHD. All patients had been given vasopressors for severe DIH. Results: The severe DIH disappeared during the short daily HD. There were significant decreases in body weight (BW), cardiothoracic ratio (CTR), blood pressure (BP), normal saline solution (NSS) amount (62.8 ± 26.4 vs. 9.8 ± 7.4 ml/session, p < 0.05), frequency (0.60 ± 0.26 vs. 0.10 ± 0.07 infusions/session, p < 0.05) and postdialysis atrial natriuretic peptide (ANP) (176.8 ± 56.4 vs. 104.8 ± 42.3 pg/ml, p < 0.05). Weekly ultrafiltration volume (6.3 ± 0.9 vs. 7.9 ± 0.7 l, p < 0.05) was significantly higher during the short daily HD period than during the first CHD period. The vasopressor treatment was therefore stopped or reduced in all patients during the short daily HD period. Because DIH recurred in the second CHD period despite a significant increase in BP, the vasopressor treatment was resumed in 5 patients. BW, CTR, NSS infusion amount and frequency, or postdialysis ANP did not differ significantly between the short daily HD and second CHD periods. Conclusions: The protective effect of short daily HD against DIH lasted more than 12 weeks after the treatment ended. We therefore conclude that temporary short daily HD is useful for preventing DIH.

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“…From then on, the new interest in the buttonhole technique resulted in its development and improvement. [6][7][8][9] The wider use of the buttonhole technique allowed the recognition of some fundamental aspects for its success, the most important of which seems to be the track formation by a single professional skilled in AVF cannulation. The technique has been boosted with the introduction of blunt needles.…”

Section: Discussionmentioning

confidence: 99%

Punção da fístula arteriovenosa com a técnica em casa de botão com agulha romba

Castro¹,

Silva²,

Souza³

et al. 2010

J. Bras. Nefrol.

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Introduction: Cannulation of arteriovenous fistula (AVF) may be performed by the following techniques: area puncture, rope ladder, or buttonhole. The ideal technique has not yet been established. Objective: To assess the complications and difficulties of introducing the buttonhole (BH) technique for cannulation of AVF created with a native vein in a dialysis unit. Methods: Sixteen patients (mean age, 57 ± 14 years) undergoing hemodialysis for 63 ± 38 months were changed to BH AVF cannulation. In the phase of track formation cannulations were performed with sharp needles and, in the maintenance phase, with blunt needles. In both phases, patients were assessed for pain intensity on a 0 to 10 scale. Results: The number of HD sessions required for the track formation was 9.5 ± 1.5 and the number of sessions during the maintenance phase was 29.7 ± 0.8 per patient. During the 152 HD for the track formation, no significant complications occurred. During the 475 HD sessions using the BH technique and a blunt needle, the complications were as follows: resistance to cannulation (7.6%); cannulation using a sharp needle due to cannulator choice (5.7%); change from a blunt to a sharp needle during cannulation (4.2%); and local bleeding (0.8%). One patient required antibiotic therapy. The median pain intensity reported by the patients was four during the track formation, and two during cannulation with a blunt needle. The Kt/V values before and after changing the cannulation technique did not differ (1.48 ± 0.27 and 1.48 ± 0.23). Conclusion:The introduction of the BH technique with a blunt needle is technically easy, has few complications, reduces pain, and does not induce change in dialysis dose.

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Blood Access Complications and Longevity with Frequent (Daily) Hemodialysis and with Routine Hemodialysis

Cited by 16 publications

References 29 publications

Blood access in daily hemodialysis

Blood access in daily hemodialysis

Prolonged Protective Effect of Short Daily Hemodialysis against Dialysis-Induced Hypotension

Punção da fístula arteriovenosa com a técnica em casa de botão com agulha romba

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