Long-Term Survival of Vascular Accesses in a Large Chronic Hemodialysis Population

Chazan, Joseph A.; London, Marilyn R.; Pono, Lucille

doi:10.1159/000188461

Cited by 98 publications

(45 citation statements)

References 4 publications

(6 reference statements)

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“…2 The arteriovenous fistula (AVF) is still considered the best access for hemodialysis (HD) because of low complication rate, superior access survival, and decreased mortality when compared with either arteriovenous grafts or central venous dialysis catheters. [3][4][5][6][7] Because AVF requires fewer angiographic procedures and revisions, use of an AVF can also reduce the cost of vascular access-related care up to fivefold, 8,9 and multiple sources suggest that use of an AVF is cost-effective when compared with other vascular accesses. 10,11 Ideally, the AVF is placed and ready to use at the initiation of HD, but this process is highly dependent on predialysis nephrology care.…”

mentioning

confidence: 99%

Arteriovenous Fistulas among Incident Hemodialysis Patients in Department of Defense and Veterans Affairs Facilities

Hurst

Abbott

Raj

et al. 2010

Journal of the American Society of Nephrology

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A higher proportion of patients initiate hemodialysis (HD) with an arteriovenous fistula (AVF) in countries with universal health care systems compared with the United States. Because federally sponsored national health care organizations in the United States, such as the Department of Veterans Affairs (DVA) and the Department of Defense (DoD), are similar to a universal health care model, we studied AVF use within these organizations. We used the US Renal Data System database to perform a cross-sectional analysis of patients who initiated HD between 2005 and 2006. Patients who received predialysis nephrology care had 10-fold greater odds of initiating dialysis with an AVF (adjusted odds ratio [aOR] 10.3; 95% confidence interval [CI] 9.6 to 11.1). DVA/DoD insurance also independently associated with initiating HD with an AVF (aOR 1.4; 95% CI 1.2 to 1.5). Fewer patients initiated HD at a DoD facility, but these patients were also approximately twice as likely to use an AVF (aOR 2.3; 95% CI 1.2 to 4.6). In conclusion, patients in DVA/DoD systems are significantly more likely to use an AVF at initiation of HD than patients with other insurance types, including Medicare. Further study of these federal systems may identify practices that could improve processes of care across health care systems to increase the number of patients who initiate HD with an AVF.

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confidence: 99%

Arteriovenous Fistulas among Incident Hemodialysis Patients in Department of Defense and Veterans Affairs Facilities

Hurst

Abbott

Raj

et al. 2010

Journal of the American Society of Nephrology

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“…Access complications account for 30% of hemodialysis patient hospital admissions (1), and it has been estimated that 14% of total Medicare end-stage renal disease (ESRD) expenditures relate to the treatment of complications of vascular access (2). Mechanical malfunction of access due to thrombosis accounts for much of this morbidity and resource utilization; prevention and treatment of thrombosis is consequently of major clinical and economic importance.…”

mentioning

confidence: 99%

Low-Intensity Warfarin Is Ineffective for the Prevention of PTFE Graft Failure in Patients on Hemodialysis

Crowther¹,

Clase²,

Margetts³

et al. 2002

Journal of the American Society of Nephrology

171

131

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Abstract. Polytetrafluoroethylene (PTFE) dialysis grafts in patients with end-stage renal disease (ESRD) are prone to thrombotic failure. The objective of this multicenter, randomized, double-blind, placebo-controlled clinical trial was to determine if warfarin reduces the risk of failure of PTFE dialysis grafts. Patients with ESRD and newly placed PTFE grafts were studied at community and academic dialysis centers in Southwestern Ontario. Patients were allocated to receive warfarin or matching placebo, with the warfarin administered to achieve a target INR of 1.4 to 1.9. Time to graft failure was the main outcome measure. A total of 107 patients (56 allocated to warfarin) were randomized. The time-to-event analysis revealed no significant difference in the likelihood of graft survival between the two groups (odds ratio, 1.76 in favor of placebo; 95% confidence interval, 0.72 to 4

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“…The stenosis rate in the early phase is found to be higher in fistulas performed at the snuff box level than with fistulas performed at either the wrist or more proximal levels. The rate of thrombosis formation varies between 4% and 18% per year (15)(16)(17)(18). The follow-up period was 4 months in our patients, and fistula failure due to thrombosis developed in ten (27.7%) of our patients.…”

Section: Discussionmentioning

confidence: 73%

“…Arteriovenous fistula is functional in 73-93% of patients after the first AV fistula operation (15)(16)(17)(18). The complication rate is 20% (10% wound, 8% ischemia) in patients undergoing AV fistula operation, since 24% of these patients need repeated intervention (3,19).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Risk Factors for Arteriovenous Fistula Failure in Patients Undergoing Hemodialysis

Sarı¹,

Taşkapan²,

Sigirci³

et al. 2016

Erciyes Med J

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Objective: The aim of the present study is to evaluate the relationship between demographic characteristics, hematological and biochemical parameters, and elements of the coagulation system that may predispose a person to thrombosis or to anatomical and functional parameters in Doppler ultrasonography scanning and the maturation and adequacy of arteriovenous fistulas. Materials and Methods:Overall, 36 patients who underwent a native arteriovenous fistula operation were included. Biochemical parameters, hematological parameters, the coagulation system, and a Doppler ultrasonography evaluation were performed before an arteriovenous fistula operation on day 1 after the fistula operation and at the time point when the arteriovenous fistula became dysfunctional.Results: A thrombus occurred between 1 and 73 days (mean: 28.4±26.1) in 10 patients. It was found that the female gender (p<0.001), presence of thrill (p=0.014), quality of vein (p<0.001), peak systolic velocity and end-diastolic velocity of the radial artery at the snuffbox region on day 1 after the operation (p=0.035 and p=0.049, respectively), and the cephalic vein diameter in the Brescia-Cimino region (p=0.011) were associated with thrombosis formation. No relation was found among blood pressure, fistula region, quality of artery, spasm of artery and vein, hematologic and biochemical parameters, coagulation parameters, active protein C resistance, anti-cardiolipin antibody, D-dimer, C-reactive protein, or erythrocyte sedimentation rate and thrombosis formation (p>0.05).Conclusion: Thrombosis occurs at a relatively early period in approximately a quarter of arteriovenous fistulas. Female gender, quality of vein, and the absence of thrill in the post-operative period are important factors in thrombosis formation.

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Long-Term Survival of Vascular Accesses in a Large Chronic Hemodialysis Population

Cited by 98 publications

References 4 publications

Arteriovenous Fistulas among Incident Hemodialysis Patients in Department of Defense and Veterans Affairs Facilities

Arteriovenous Fistulas among Incident Hemodialysis Patients in Department of Defense and Veterans Affairs Facilities

Low-Intensity Warfarin Is Ineffective for the Prevention of PTFE Graft Failure in Patients on Hemodialysis

Evaluation of Risk Factors for Arteriovenous Fistula Failure in Patients Undergoing Hemodialysis

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