Effect of Clopidogrel on Early Failure of Arteriovenous Fistulas for Hemodialysis

Dember, Laura M.; Beck, Gerald J.; Allon, Michael; Delmez, James A.; Dixon, Bradley S.; Greenberg, Arthur; Himmelfarb, Jonathan; Vázquez, Miguel A.; Gassman, Jennifer; Greene, Tom; Radeva, Milena; Braden, Gregory; İkizler, T. Alp; Rocco, Michael V.; Davidson, Ingemar; Kaufman, James S.; Meyers, Catherine M.; Kusek, John W.; Feldman, Harold I.

doi:10.1001/jama.299.18.2164

Cited by 726 publications

(559 citation statements)

References 18 publications

Supporting

Mentioning

526

Contrasting

Unclassified

Order By: Relevance

“…The fistula maturation failure rate of 61% in patients who went on to get thigh grafts is similar to rates of 50 to 60% reported by others (2,3). In the setting of this longitudinal study, the high fistula maturation failure rate draws attention to patients who may not be candidates for fistula placement and/or successful maturation.…”

Section: Discussionsupporting

confidence: 81%

“…Toward this end, the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines and the Fistula First initiative have emphasized the use of autogenous fistulas as the access of choice (1). Unfortunately, Ͼ50% of all fistulas fail to mature (2,3), and many patients are not candidates for fistula placement. As a result, 28% of hemodialysis patients in the United States undergo dialysis with synthetic grafts (4).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Thigh Grafts Contribute Significantly to Patients' Time on Dialysis

Ram

Sachdeva

Caldito

et al. 2010

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives: Thigh grafts are placed in hemodialysis patients who have exhausted all arm access sites. The goal of this study was to compare the survival, complication rates, and overall contribution of thigh grafts with arm grafts and fistulas in patients with at least one functional thigh graft during their dialysis history.Design, setting, participants, & measurements: This longitudinal review of a prospectively acquired clinical database included 85 thigh graft recipients. The rates of survival, thrombosis, infection, and other complications were determined for a total of 268 fistulas, arm grafts, and thigh grafts placed in these patients.Results: In this patient subset, thigh graft primary failure rate was lower than arm grafts and fistulas (3 versus 13 and 61%, respectively). Excluding primary failures, thigh grafts survived longer than both arm grafts and mature fistulas (53 versus 14 and 32%, at 3 years; 47 versus 3 and 11% at 5 years). Thigh grafts had a lower thrombosis rate than arm grafts (0.543 versus 1.457/patient-year) but similar rates of loss as a result of infection and surgical revision. In patients with previous arm accesses, thigh grafts contributed 51% of total dialysis time compared with 38 and 11% for arm grafts and fistulas.Conclusions: Thigh grafts provide long-term, thrombosis-and infection-free dialysis access for patients with exhausted arm access sites. The decision for thigh graft placement should, therefore, be made as soon as there is evidence for unavailability of arm access sites so that catheter use can be minimized.

show abstract

Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

Thigh Grafts Contribute Significantly to Patients' Time on Dialysis

Ram

Sachdeva

Caldito

et al. 2010

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…These patients with hypercoagulable states or combined thrombophilia should be preoperatively identified to tailor antithrombotic therapy and intensify surveillance, especially during the first, most vulnerable months after surgery. However, the optimal prophylaxis for access thrombosis and stenosis is not settled despite extensive efforts (29)(30)(31)(32)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

Thrombophilia and Arteriovenous Fistula Survival in ESRD

Salmela

Hartman²,

Peltonen³

et al. 2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryBackground and objectives The role of thrombophilia in failing arteriovenous fistula (AVF) among patients with ESRD undergoing hemodialysis is not established. This study aimed to assess whether AVF primary patency is associated with thrombophilia and coagulation abnormalities.Design, setting, participants, & measurements This observational study screened 219 patients between 2002 and 2004 for thrombophilia before AVF surgery. Thrombophilia included factor V Leiden and prothrombin G20210A mutations, protein C and antithrombin activities, and protein S. Coagulation abnormalities included high factor VIII:C, homocysteine, fibrinogen, and D-dimer levels; presence of antiphospholipid antibodies; and short thrombin time. We reviewed patient charts for comorbid conditions, AVF maturation and interventions, kidney transplantation, and patient survival (mean follow-up duration, 3.6 [range, 2.3-5.8] years). Primary patency from the AVF placement and functional primary patency from the first AVF cannulation were analyzed with Kaplan-Meier and Cox proportional hazards models.Results Thrombophilia was present in 9% of the patients, and coagulation abnormalities occurred in 77%. One-year primary patency was 68%; 46% of the AVF failures occurred before the initiation of hemodialysis. Female sex (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.7-4.1) and thrombophilia (HR, 2.2; 95% CI, 1.2-4.2) were independent risk factors for loss of primary patency. Thrombophilia mutations or low antithrombin level (HR, 3.8), female sex (HR, 2.5), and diabetes (HR, 1.9) were associated with shortened functional primary patency of AVF.Conclusions Against the background of frequent coagulation abnormalities, thrombophilia and female sex predispose patients with ESRD to access failure, mostly due to thrombosis or stenosis.

show abstract

“…The conditions concerning the decision made at each sampling event, whether there is a positive or a negative outcome, or whether further data need to be collected, are based on rules which change dynamically according to the data. Where regular data and safety monitoring of clinical trials is required by independent boards, interim analyses from each sampling event provide the opportunity to assess participants for adverse effects as well as monitor for efficacy or futility of treatment (e.g., Aberle et al (2011) and Dember et al (2008)). Any number of such interim analyses can be carried out (up to the total number of participants) at any point during the data collection.…”

Section: Introductionmentioning

confidence: 99%

Sequential sampling: a novel method in farm animal welfare assessment

Heath

Main

Mullan

et al. 2016

animal

View full text Add to dashboard Cite

Lameness in dairy cows is an important welfare issue. As part of a welfare assessment, herd level lameness prevalence can be estimated from scoring a sample of animals, where higher levels of accuracy are associated with larger sample sizes. As the financial cost is related to the number of cows sampled, smaller samples are preferred. Sequential sampling schemes have been used for informing decision making in clinical trials. Sequential sampling involves taking samples in stages, where sampling can stop early depending on the estimated lameness prevalence. When welfare assessment is used for a pass/fail decision, a similar approach could be applied to reduce the overall sample size. The sampling schemes proposed here apply the principles of sequential sampling within a diagnostic testing framework. This study develops three sequential sampling schemes of increasing complexity to classify 80 fully assessed UK dairy farms, each with known lameness prevalence. Using the Welfare Quality herd-size-based sampling scheme, the first 'basic' scheme involves two sampling events. At the first sampling event half the Welfare Quality sample size is drawn, and then depending on the outcome, sampling either stops or is continued and the same number of animals is sampled again. In the second 'cautious' scheme, an adaptation is made to ensure that correctly classifying a farm as 'bad' is done with greater certainty. The third scheme is the only scheme to go beyond lameness as a binary measure and investigates the potential for increasing accuracy by incorporating the number of severely lame cows into the decision. The three schemes are evaluated with respect to accuracy and average sample size by running 100 000 simulations for each scheme, and a comparison is made with the fixed size Welfare Quality herd-size-based sampling scheme. All three schemes performed almost as well as the fixed size scheme but with much smaller average sample sizes. For the third scheme, an overall association between lameness prevalence and the proportion of lame cows that were severely lame on a farm was found. However, as this association was found to not be consistent across all farms, the sampling scheme did not prove to be as useful as expected. The preferred scheme was therefore the 'cautious' scheme for which a sampling protocol has also been developed.

show abstract

Effect of Clopidogrel on Early Failure of Arteriovenous Fistulas for Hemodialysis

Cited by 726 publications

References 18 publications

Thigh Grafts Contribute Significantly to Patients' Time on Dialysis

Thigh Grafts Contribute Significantly to Patients' Time on Dialysis

Thrombophilia and Arteriovenous Fistula Survival in ESRD

Sequential sampling: a novel method in farm animal welfare assessment

Contact Info

Product

Resources

About