International Differences in the Location and Use of Arteriovenous Accesses Created for Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Pisoni, Ronald L.; Zepel, Lindsay; Fluck, Richard; Lok, Charmaine E.; Kawanishi, Hideki; Süleymanlar, Gültekin; Wasse, Haimanot; Tentori, Francesca; Zee, Jarcy; Li, Yun; Schaubel, Douglas E.; Burke, Steven K.; Robinson, Bruce M.

doi:10.1053/j.ajkd.2017.09.012

Cited by 132 publications

(141 citation statements)

References 22 publications

(25 reference statements)

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“…Finally, there are country differences in anatomic location of AV accesses. Upper arm accesses are now more common than forearm AVFs in the US , and are more likely to be placed in the lower arm in Japan . The reason this matters is that Japanese guidelines recommend that the flow rate of AVF should be maintained from 500 to 1000 mL/min , while European guidelines have somewhat higher values .…”

Section: Access To Transplant and Modality Usementioning

confidence: 99%

Long‐Term Survival for Hemodialysis Patients Differ in Japan Versus Europe and the USA. What Might the Reasons Be?

et al. 2018

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Section: Access To Transplant and Modality Usementioning

confidence: 99%

Long‐Term Survival for Hemodialysis Patients Differ in Japan Versus Europe and the USA. What Might the Reasons Be?

et al. 2018

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“…Indeed, there was a significant difference in patency rates between upper and forearm AV accesses, with 1-year patency of 74% versus 58%, respectively. This trend is echoed by others 18,[28][29][30][31] and has contributed in the shift from forearm to upper-arm AV accesses predominantly in the US 32 . Patients with previous failed AV access are susceptible to future AV access failure and this is conceivably related to the presence of pre-existing risk factors for failure or the occurrence of maladaptive vascular remodelling and neointimal hyperplasia following creation of the previous failed AV access 33 .Brachial-cephalic AV accesses had better patency rates compared to brachial-basilic and this is opposed to previous studies which have shown less primary failures for basilic vein AV accesses and similar cumulative access survival [34][35][36] .…”

Section: Discussionmentioning

confidence: 71%

A national study of autogenous arteriovenous access use and patency in a contemporary hemodialysis population

Stoumpos

Traynor

Metcalfe

et al. 2019

Journal of Vascular Surgery

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Objective:The predicted outcomes of autogenous arteriovenous (AV) hemodialysis access creation are predominantly based on historical data; however both the hemodialysis population and clinical practices have changed significantly over the last decade. This study examined contemporary AV access clinical use and patencies. Methods:A multi-centre observational cohort study was performed of all new AV accesses created in Scotland in 2015. The primary endpoint was efficacy assessed by successful AV access use for a minimum of 30 days and primary, primary-assisted, and secondary patency at 1 year. Data obtained included all interventions to maintain or restore patency. Predictors of patency loss including demographics, comorbid conditions, dialysis status, AV access location, duplex surveillance, procedures, prior access, and antiplatelets were assessed.Kaplan-Meier and competing risks analyses were performed to estimate the probability of AV access failure. All patients were followed-up for at least 1 year, or had a censoring event.Results: A total of 582 AV accesses were created in 537 patients (mean age 60 [SD 14] years; 60% men; 42% with diabetes) in nine adult renal centres. Mean follow-up was 11.8 (SD 7.6) months. By the end of the follow-up, 322 (55.3%) AV accesses were successfully used for dialysis. At 1 year, 48% (95% CI 44-52) of AV accesses had primary patency, 67% (95% CI 63-71) had primary-assisted patency, and 69% (95% CI 65-73) had secondary patency. The leading cause of primary patency loss was primary failure (30%). An average of 0.48 interventions per patient-year was required to maintain patency. On multivariable analysis, patency was better for an upper compared to forearm AV access (1-year secondary patency of upper vs. forearm AV accesses 74% vs. 58%, respectively). The cumulative hazard and incident functions for AV access failure were 31% (95% CI 27-35) and 23% (95% CI 20-27) at 1 year, respectively. Conclusions:Despite advances in recent years with pre-operative vessel assessment and surveillance, patency rates have not improved with primary failure remaining the major

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“…However, no post-placement outcomes other than maturation were evaluated and the study did not include AVG placements. We found that AVG also required a median length of 53 days between access placement and first use for hemodialysis, which was longer than the Dialysis Outcomes and Practice Patterns Study reported median time to first use of 29 days, although the present cohort may contain more elderly patients which may account for a longer maturation time [20]. In our dataset, time to first use may be slightly skewed due to CROWNWeb reporting only once per month on any given day.…”

Section: Doi: 101159/000495355mentioning

confidence: 62%

Clinical Outcomes of Arteriovenous Access in Incident Hemodialysis Patients with Medicare Coverage, 2012–2014

et al. 2019

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Background: Chronic hemodialysis requires a mode of vascular access through an arteriovenous fistula (AVF), a prosthetic arteriovenous graft (AVG), or a central venous catheter (CVC). AVF is recommended over AVG or CVC due to increased patency and decreased intervention rates for those that mature. AVG are preferred over CVC due to decreased infection and mortality risk. The aims of this study were to evaluate the lifespan of AVF and AVG in maturation, sustained access use, and abandonment. Methods: The United States Renal Data System (USRDS), Medicare claims, and CROWNWeb were used to identify access placements. Patients with a first end-stage renal disease (ESRD) service from January 1, 2012 to June 30, 2014 with continuous coverage with Medicare as primary payer and ≥1 AVF or AVG placed after ESRD onset were included. Maturation was defined as the first use of the access for hemodialysis recorded in CROWNWeb. Sustained access use was defined as 3 consecutive months of use without catheter placement or replacement. Accesses that were never used at any time post-placement were considered abandoned. Results: The cohort included 38,035 AVF placements and 12,789 AVG placements. Sixty-nine percent of AVF and 72% of AVG matured. Fifty-two percent of AVF and 51% of AVG achieved sustained access use. One quarter of AVF and 14% of AVG were abandoned without use as recorded in CROWNWeb. Conclusion: Although considered the gold standard for vascular access, only half of AVF and AVG placements achieved sustained access use. The USRDS database has inherent limitations but provides useful clinical insight into maturation, sustained use, and abandonment.

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International Differences in the Location and Use of Arteriovenous Accesses Created for Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Cited by 132 publications

References 22 publications

Long‐Term Survival for Hemodialysis Patients Differ in Japan Versus Europe and the USA. What Might the Reasons Be?

Long‐Term Survival for Hemodialysis Patients Differ in Japan Versus Europe and the USA. What Might the Reasons Be?

A national study of autogenous arteriovenous access use and patency in a contemporary hemodialysis population

Clinical Outcomes of Arteriovenous Access in Incident Hemodialysis Patients with Medicare Coverage, 2012–2014

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