Obesity is not an obstacle for successful autogenous arteriovenous fistula creation in haemodialysis

Weyde, Wacław; Krajewska, Magdalena; Letachowicz, Waldemar; Porażko, Tomasz; Watorek, Ewa; Kusztal, Mariusz; Banasik, Mirosław; Gołębiowski, Tomasz; Bartosik, Hanna; Madziarska, Katarzyna; Janczak, Dariusz; Klinger, Marian

doi:10.1093/ndt/gfm739

Cited by 36 publications

(32 citation statements)

References 14 publications

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“…demonstrated in 71 obese patients with a mean BMI of 34.6, results of acceptable dialysis adequacy based on set parameters, primary patency rates of 65% and 59% at 6 and 12 months, and secondary patency of 83% at both 6 and 12 months, respectively. These patency rates are comparable to those in normal weight individuals with the authors concluding that obesity should not preclude placement of AVF and may even protect venous vessels from iatrogenic insult (36).…”

Section: Discussionmentioning

confidence: 66%

Obesity as a Predictor of Vascular Access Outcomes: Analysis of the USRDS DMMS Wave II Study

Chan

Young

Becker

et al. 2008

Seminars in Dialysis

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Arteriovenous fistulae (AVF) are widely regarded as the preferred vascular access in hemodialysis patients due to their primary patency and patient survival benefits. While the obesity paradox has been associated with improved cardiovascular morbidity and all-cause mortality in dialysis patients, its long-term vascular access outcomes are less clear. Recent literature has suggested that obese patients may have increased early and late fistula failure. The purpose of this study was to explore the relationships between obesity and vascular access outcomes. We performed a retrospective cohort analysis using the USRDS DMMS Wave 2 data set. All incident dialysis patients as of January 1, 1996, over the age of 18, receiving only hemodialysis as mode of renal replacement therapy were eligible for inclusion. Among other variables, data collected for the DMMS Wave 2 included: type and location of vascular access, AVF maturity, vascular access revision, and failure. Logistic regression analyses were used to examine the relationships between obesity and vascular access outcomes, adjusting for important covariates. In all, 1486 hemodialysis patients were included. Using body mass index (BMI) <30 kg/m(2) as reference, obesity did not emerge as a factor in predicting vascular access revisions or failures. An increased risk of AVF failure to mature was found only in the highest BMI quartile (>or=35 kg/m(2)) (aOR 3.66 [95% CI 1.27-10.55], p = 0.017). Peripheral vascular disease was independently associated with an increased risk of AVF failure (aOR 2.78 [95% CI 1.01-7.63], p = 0.047) and arteriovenous graft (AVG) failure (aOR 1.65 [95% CI 1.03-2.64], p = 0.036). Obesity was not associated with increased AVF or AVG revision rates or failure and only associated with poorer AVF maturity at highest BMI quartile. We conclude that obesity should not preclude placement of AVF as vascular access of choice, except in the very obese where assessment should be individually based.

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Section: Discussionmentioning

confidence: 66%

Obesity as a Predictor of Vascular Access Outcomes: Analysis of the USRDS DMMS Wave II Study

Chan

Young

Becker

et al. 2008

Seminars in Dialysis

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“…We were therefore less surprised by their updated results published in 2008 showing evidence of lower primary patency rates of 59% at 1 year. 15 Bronder et al 16 also recently published results after elevation in 46 RCFs. Primary and secondary patency rates were in agreement with the updated results of Weyde et al, with 60% and 71% at 1 year, respectively.…”

Section: Discussionmentioning

confidence: 98%

Lipectomy as a new approach to secondary procedure superficialization of direct autogenous forearm radial-cephalic arteriovenous accesses for hemodialysis

Bourquelot

Tawakol

Gaudric

et al. 2009

Journal of Vascular Surgery

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Lipectomy is a safe, effective, and durable approach to make deep arterialized forearm veins accessible for routine cannulation for hemodialysis in obese patients. It might even be hypothesized that incident obese dialysis patients will eventually have the highest proportion of radial-cephalic fistulas because they often have distal veins that have been preserved by their fat from previous attempts at cannulation for blood sampling or infusion.

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“…The prevalence of fistulae was lower in females, patients with PVD, black patients, obese patients, and older patients [ 6 , 83 ]. In obese patients, low rates of long-term AVF preservation are usually caused by early vessel thrombosis, which is considered to degenerate from advanced myointimal hyperplasia, resulting in earlier vessel stenosis.…”

Section: Factors Associated With Avf Maturationmentioning

confidence: 99%

Maturation of arteriovenous fistula: Analysis of key factors

Siddiqui

Ashraff

Carline

2017

Kidney Res Clin Pract.

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The growing proportion of individuals suffering from chronic kidney disease has considerable repercussions for both kidney specialists and primary care. Progressive and permanent renal failure is most frequently treated with hemodialysis. The efficiency of hemodialysis treatment relies on the functional status of vascular access. Determining the type of vascular access has prime significance for maximizing successful maturation of a fistula and avoiding surgical revision. Despite the frequency of arteriovenous fistula procedures, there are no consistent criteria applied before creation of arteriovenous fistulae. Increased prevalence and use of arteriovenous fistulae would result if there were reliable criteria to assess which arteriovenous fistulae are more likely to reach maturity without additional procedures. Published studies assessing the predictive markers of fistula maturation vary to a great extent with regard to definitions, design, study size, patient sample, and clinical factors. As a result, surgeons and specialists must decide which possible risk factors are most likely to occur, as well as which parameters to employ when evaluating the success rate of fistula development in patients awaiting the creation of permanent access. The purpose of this literature review is to discuss the role of patient factors and blood markers in the development of arteriovenous fistulae.

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Obesity is not an obstacle for successful autogenous arteriovenous fistula creation in haemodialysis

Abstract: Obesity does not prevent successful autogenous arteriovenous fistula formation, and may protect forearm venous vessels from the iatrogenic damage that occurs before the onset of haemodialysis therapy.

Cited by 36 publications

References 14 publications

Obesity as a Predictor of Vascular Access Outcomes: Analysis of the USRDS DMMS Wave II Study

Obesity as a Predictor of Vascular Access Outcomes: Analysis of the USRDS DMMS Wave II Study

Lipectomy as a new approach to secondary procedure superficialization of direct autogenous forearm radial-cephalic arteriovenous accesses for hemodialysis

Maturation of arteriovenous fistula: Analysis of key factors

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