Correlates of Vascular Access Occlusion in Hemodialysis

Goldwasser, Philip; Avram, Morrell M.; Collier, James; Michel, Marie-Alex; Gusik, Sara-Ann; Mittman, Neal

doi:10.1016/s0272-6386(12)80672-x

Cited by 48 publications

(32 citation statements)

References 44 publications

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“…20 -22 We did not show a significant association of sex, current smoking, or diabetes mellitus on the relative rates of access thrombosis, consistent with several previous studies. 11,[23][24][25][26] Interestingly, for patients with fistulas, older age was associated with lower rates of fistula thrombosis (15% lower rate per 10-year increment in age); we observed no association of age with graft thrombosis. These results contrast with those reported by Saran et al, who showed that older age was associated with a decreased risk of graft, but not fistula thrombosis.…”

Section: Discussionmentioning

confidence: 74%

“…CLINICAL EPIDEMIOLOGY www.jasn.org are associated with a higher rate of access thrombosis, regardless of baseline access type, which is consistent with previous studies. 10,11 Lower BP may lead to decreased access blood flow, which has been shown to independently predict subsequent access thrombosis. 5 Moreover, achievement of the current recommended target BP is associated with higher rates of intradialytic hypotension.…”

Section: Discussionmentioning

confidence: 99%

“…These results contrast with those reported by Saran et al, who showed that older age was associated with a decreased risk of graft, but not fistula thrombosis. 25 Overall, the relation of age with vascular access failure has been mixed, with some studies showing a detrimental association of older age 24,27 and several others showing no significant relation of age 11,23,28,29 with access failure. One reason for the differences may be that most of the other studies were performed in incident hemodialysis patients and examined only time to the first access failure, whereas our analysis compared rates of access thrombosis in prevalent patients followed over several years.…”

Section: Discussionmentioning

confidence: 99%

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Intradialytic Hypotension and Vascular Access Thrombosis

Chang¹,

Paik²,

Greene³

et al. 2011

Journal of the American Society of Nephrology

181

156

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Identifying potential modifiable risk factors to reduce the incidence of vascular access thrombosis in hemodialysis could reduce considerable morbidity and health care costs. We analyzed data from a subset of 1426 HEMO study subjects to determine whether more frequent intradialytic hypotension and/or lower predialysis systolic BP were associated with higher rates of vascular access thrombosis. Our primary outcome measure was episodes of vascular access thrombosis occurring within a given 6-month period during HEMO study follow-up. There were 2005 total episodes of vascular access thrombosis during a median 3.1 years of follow-up. The relative rate of thrombosis of native arteriovenous fistulas for the highest quartile of intradialytic hypotension was approximately twice that of the lowest quartile, independent of predialysis systolic BP and other covariates. There was no significant association of intradialytic hypotension with prosthetic arteriovenous graft thrombosis after multivariable adjustment. Higher predialysis systolic BP was associated with a lower rate of fistula and graft thrombosis, independent of intradialytic hypotension and other covariates. In conclusion, more frequent episodes of intradialytic hypotension and lower predialysis systolic BP associate with increased rates of vascular access thrombosis. These results underscore the importance of including vascular access patency in future studies of BP management in hemodialysis.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intradialytic Hypotension and Vascular Access Thrombosis

Chang¹,

Paik²,

Greene³

et al. 2011

Journal of the American Society of Nephrology

181

156

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“…2,12 However, the role of hyperinsulinism or insulin resistance, which is important in intimal hyperplasia or injury, has not been investigated.…”

Section: Discussionmentioning

confidence: 99%

“…This suggests that there are additional predisposing factors that are still undiscovered. [1][2][3] We may propose hyperinsulinism as a risk factor for vascular access dysfunction by the way of its damage to the endothelium. Endothelial dysfunction may lead to vascular access dysfunction by the different mechanisms.…”

Section: Introductionmentioning

confidence: 99%

A novel factor for primary arteriovenous fistula failure: hyperinsulinism

Akın

Özmen

Kaya³

2016

Renal Failure

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Introduction: Dysfunction of vascular access is an important reason of morbidity for dialysis patients and it is a major factor affecting the economical burden of hemodialysis. The preferred type of vascular access is creation of an arteriovenous fistula (AVF). However, the problem of fistula maturation rate is still a challenge. Herein, we tried to search the role of hyperinsulinism and insulin resistance as a new predictor of primary AVF failure (pAVFF) that may be a cause of intimal damage. Methods: We included 119 patients (73 male and 46 female) with a diagnosis of end-stage renal disease (ESRD) who had undergone an AVF operation by a vascular surgeon. The AVF was examined for presence of thrill on the first postoperative day. A successful cannulation with two fistula needles with a blood flow of 250 mL/min for at least one complete dialysis session, after 4 weeks of AVF surgery was defined as functioning access. Insulin resistance in our patients was determined by the standard homeostasis model assessment (homa-IR). A logistic-regression analysis was performed to investigate the independent factors related with pAVFF. Findings: Detection of pAVFF occurred in 27 (22.7%) patients. The presence of thrill, amount of daily proteinuria, insulin levels, homa-IR, and serum albumin levels were found to be significantly different between patients with fistula failure and those without pAVFF. The logistic-regression analysis of preoperative factors revealed the following OR (odds ratio) and 95% CI values: homa-IR 1.205 (1.063-1.366) (p ¼ 0.004), serum albumin 0.398 (0.178-0.892) (p ¼ 0.025), and the amount of daily proteinuria 1.307 (1.012-1.688) (p ¼ 0.041). Even after addition of the presence of postoperative thrill on AVF, which was a postoperative strong clinical factor to the analysis, mean homa-IR and mean serum albumin continued to be independent predictors of pAVFF. Discussion: Insulin resistance or hyperinsulinism may be a significant cause of pAVFF, which emphasizes the role of endothelium in fistula dysfunction.

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