Influência do diabetes mellitus sobre a perviedade da fístula arteriovenosa para hemodiálise

Cruz, Renan Nunes da; Retzlaff, Giuliano; Gomes, Ricardo Zanetti; Reche, Péricles Martim

doi:10.1590/1677-5449.0008

Cited by 6 publications

(6 citation statements)

References 22 publications

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“…13 Diabetes has been associated with poor AVF results, and lower blood flow, probably due to its influence on accelerating atherosclerosis progression on distal arteries. 8 , 22 , 25 In our series, these factors had no significant influence on AVF outcome.…”

Section: Discussionmentioning

confidence: 47%

“…In the literature, female gender, increasing age, and diabetes mellitus are related to poor results. 6 , 8 , 23 , 24 Jemcov et al found that females had smaller arteries and that radial-cephalic AVF took longer to mature in women, but they had higher venous access flow compared to men. 13 Diabetes has been associated with poor AVF results, and lower blood flow, probably due to its influence on accelerating atherosclerosis progression on distal arteries.…”

Section: Discussionmentioning

confidence: 99%

“…4 Over the years, technical aspects of arteriovenous fistulas (AVF) have been reported that make long-term HD feasible, depending on inherent patient characteristics. 5 - 8…”

Section: Introductionmentioning

confidence: 99%

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Influence of intraoperative findings on immediate flow through radial-cephalic arteriovenous wrist fistulas for hemodialysis access

et al. 2018

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Background Adequate flow through a newly created arteriovenous fistula depends on multiple characteristics of the vessels and patient comorbidities. Several studies have related preoperative findings to failure, but few have analyzed the influence of intraoperative findings. Objectives To evaluate the predictive value of intraoperative findings on the immediate outcome of radial-cephalic arteriovenous wrist fistulas (RCAVF) by collecting data that are easily measured intraoperatively. Methods We designed a cross-sectional study, in which a single surgeon performed 101 RCAVF in 100 patients at a single center. We analyzed the immediate postoperative flow, assessed by thrill intensity immediately after fistula creation, against patient demographics and intraoperative data. The following variables were analyzed: age, sex, comorbidities, length of vein visible at preoperative examination, macroscopic arterial calcification, maximum vein diameter, and length of stenosis-free vein, measured by cannulation with a urethral catheter during the procedure. The chi-square test was used both to eliminate possible bias introduced by side of venous access (left or right), and to determine predictive values of immediate thrill. Results Side of access was not associated with any significant differences in variables. Absence of macroscopic arterial calcification, successful venous catheterization using a 6 French catheter or larger, and ability to advance it more than 10 centimeters along the lumen of the proximal vein were correlated with adequate immediate postoperative thrill (p = 0.004, p < 0.001, and p = 0.005, respectively). Conclusions In this series of 101 RCAVF, both the diameter of the catheter and its progress through the proximal vein and also absence of arterial calcification had positive predictive value for achieving adequate immediate thrill after vascular access construction.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

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Influence of intraoperative findings on immediate flow through radial-cephalic arteriovenous wrist fistulas for hemodialysis access

et al. 2018

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“…Previous clinical studies have demonstrated that the presence of diabetes increases the risk of AVF failure [11,[28][29][30][31]. Park et al [28] identified in the Cox proportional hazard model analysis that diabetes is an independent risk factor of primary patency (HR: 2.008, p = 0.043) in a cohort of 383 autogenous AVF.…”

Section: Discussionmentioning

confidence: 99%

Elevated Leukocyte Glucose Index Is Associated with Long-Term Arteriovenous Fistula Failure in Dialysis Patients

Mureșan,

Florea,

Arbănași

et al. 2024

JCM

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(1) Background: Arteriovenous fistula (AVF) is the preferred type of vascular access for dialysis in patients with end-stage kidney disease (ESKD). However, the primary patency of AVF at one year is under 70% due to several risk factors and comorbidities. Leukocyte glucose index (LGI), a new biomarker based on blood leukocytes and glucose values, has been found to be associated with poor outcomes in cardiovascular disease. The aim of this study is to analyze the impact of LGI on the long-term primary patency of AVF following dialysis initiation. (2) Methods: We conducted a retrospective observational study in which we initially enrolled 158 patients with ESKD admitted to the Vascular Surgery Department of the Emergency County Hospital of Targu Mures, Romania, to surgically create an AVF for dialysis between January 2020 and July 2023. The primary endpoint was AVF failure, defined as the impossibility of performing a chronic dialysis session due to severe restenosis or AVF thrombosis. After follow-up, we categorized patients into two groups based on their AVF status: “functional AVF” for those with a permeable AVF and “AVF failure” for those with vascular access dysfunction. (3) Results: Patients with AVF failure had a higher prevalence of atrial fibrillation (p = 0.013) and diabetes (p = 0.028), as well as a higher LGI value (1.12 vs. 0.79, p < 0.001). At ROC analysis, LGI had the strongest association with the outcome, with an AUC of 0.729, and an optimal cut-off value of 0.95 (72.4% sensitivity and 68% specificity). In Kaplan–Meier survival analyses, patients in the highest tertile (T3) of LGI had a significantly higher incidence of AVF failure compared to those in tertile 1 (p = 0.019). Moreover, we found that patients with higher baseline LGI values had a significantly higher risk of AVF failure during follow-up (HR: 1.48, p = 0.003). The association is independent of age and sex (HR: 1.65, p = 0.001), cardiovascular risk factors (HR: 1.63, p = 0.012), and pre-operative vascular mapping determinations (HR: 3.49, p = 0.037). (4) Conclusions: In conclusion, high preoperative values of LGI are positively associated with long-term AVF failure. The prognostic role of the biomarker was independent of age, sex, cardiovascular risk factors, and pre-operative vascular mapping determinations.

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“…Logo, é importante que esse acesso seja calibroso e tenha bom fluxo de sangue, permitindo a saída e o retorno sanguíneo entre o aparelho e o organismo, e que a FAV permita sessão dialítica por horas e tolere a punção frequente. Ressalta-se que este acesso é um recurso terapêutico utilizado pelos pacientes com IRC por toda a vida ou até que eles sejam submetidos a um transplante renal com resultados satisfatórios (DA CRUZ et al, 2015;FERNANDES et al, 2018).…”

Section: Discussionunclassified

Fístula Arteriovenosa Na Insuficiência Renal Crônica: cuidados e complicações

Magalhães

Silva

Brant

2020

BJHR

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A insuficiência renal crônica, em estágios avançados, é tratada por terapia renal substitutiva. A hemodiálise, enquanto tipo mais utilizado, necessita de um acesso vascular com bom fluxo sanguíneo. Dessa forma, a fístula arteriovenosa (FAV) é a modalidade de acesso venoso com mais benefícios. Diante disso, o presente estudo objetivou caracterizar as medidas de cuidado necessárias, por parte dos pacientes e dos profissionais de saúde, durante o período de maturação e de uso de FAV, bem como as complicações advindas do incorreto manejo desse acesso vascular. Como metodologia, foi adotada uma revisão de literatura das bases de dados BVS, EBSCO e Scielo, sendo selecionados 11 artigos. Evidenciou-se que, após confecção da FAV, o período de maturação é importante para dilatação da artéria e aumento da espessura da parede venosa, o que permite aumento do fluxo sanguíneo e da resistência da parede venosa. A partir desse período, são importantes as medidas de cuidado visando a diminuição de complicações e a durabilidade da FAV. Essas medidas são representadas pela proteção contra traumatismos e grandes esforços, não dormir sobre o membro utilizado, não realizar curativos circulares; evitar aferição de pressão arterial, retirada de sangue e infusão de medicamentos na FAV. Como complicações associadas ao manejo incorreto desse acesso vascular, têm-se a trombose, a infecção, o fenômeno de roubo e a hipertensão venosa, principalmente. Conclui-se que os benefícios advindos da utilização de FAV estão intrinsecamente relacionados às medidas de cuidado, o que ressalta a importância do correto manejo do acesso vascular por parte dos profissionais e dos pacientes.

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Influência do diabetes mellitus sobre a perviedade da fístula arteriovenosa para hemodiálise

Cited by 6 publications

References 22 publications

Influence of intraoperative findings on immediate flow through radial-cephalic arteriovenous wrist fistulas for hemodialysis access

Influence of intraoperative findings on immediate flow through radial-cephalic arteriovenous wrist fistulas for hemodialysis access

Elevated Leukocyte Glucose Index Is Associated with Long-Term Arteriovenous Fistula Failure in Dialysis Patients

Fístula Arteriovenosa Na Insuficiência Renal Crônica: cuidados e complicações

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