Patient-related factors influencing patency of autogenous brachiocephalic haemodialysis fistulas

Objective:To clarify the reasons and beneficial effects and duration of arteriovenous fistula patency after radiological interventions in arteriovenous fistula. The patients investigated were referred due to arteriovenous fistula access flow problems.Material and methods:In 174 patients, 522 radiological investigations and endovascular treatments such as percutaneous transluminal angioplasty were analyzed, retrospectively. All investigations were performed due to clinical suspicion of impaired arteriovenous fistula function.Results:Arterial stenosis was significantly more frequent among patients with diabetic nephropathy (p < 0.001) and interstitial nephritis (p < 0.001). According to the venous stenosis, the diagnosis did not affect the frequency (p = 0.22) or the degree (p = 0.39) of stenosis. The degree of stenosis prior to percutaneous transluminal angioplasty correlated significantly with the degree of remaining stenosis after intervention (p < 0.001). Of the 174 patients, 123 (71%) performed a total of 318 investigations including percutaneous transluminal angioplasty. Repeated percutaneous transluminal angioplasty was performed significantly more often in patients with diabetic nephropathy. The median times to the first percutaneous transluminal angioplasty and to the subsequent percutaneous transluminal angioplasties were 9.5 and 5 months, respectively. Arteriovenous fistula in patients with diabetic nephropathy performed similar to most other diagnoses, although performing more percutaneous transluminal angioplasty/patient than most other diagnoses.Conclusion:Many patients could maintain long-term patency of arteriovenous fistula, including those with diabetic nephropathy, with repeated interventions; this motivates a closer follow-up for these patients. Clinically significant stenosis should be dilated as meticulously and as soon as possible. Occlusions of the arteriovenous fistula in most instances can be successfully thrombolyzed or dilated upon early diagnosis.

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“…The latter is in line with other studies. 15,[17][18][19][20] This motivates a closer follow-up, especially for this group of patients.…”

Section: Discussionmentioning

confidence: 99%

Angiography and phlebography in a hemodialysis population: A retrospective analysis of interventional results

et al. 2019

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“…Primary failure was defined and accepted as the development of occlusion in fistula after the creation of first successful fistula. 1,8 Patient data were recorded in terms of age, gender, diabetes, coronary artery disease (diagnosed by coronary angiography), peripheral artery disease (diagnosed by digital subtraction angiography), previous cerebrovascular disease, obesity (body mass index >30 kg/m 2 ), hyperlipidemia (who are using statin), heart failure (ejection fraction <40%), smoking habits, and education level. Educational levels of the patients were determined according to Turkish National Education System (illiterate, primary school graduate, secondary school graduate, high school graduate, and university graduate).…”

Section: Methodsmentioning

confidence: 99%

“…Primary failure was defined and accepted as the development of occlusion in fistula after the creation of first successful fistula. 1,8…”

Section: Methodsmentioning

confidence: 99%

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Relationship between hemodialysis patients’ educational level and arteriovenous fistula patency

Yolgösteren

2020

Vascular

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Objectives Vascular access is a lifeline for the patients who are in need of long-term hemodialysis. Native arteriovenous fistula is the most intensively preferred vascular access method owing to its longevity and convenience of use. Therefore, in this study, we aimed to determine whether there might be a relationship between hemodialysis patients’ educational levels and arteriovenous fistula patency. Methods A total of 349 patients who were attending in a chronic hemodialysis program between June 2018 and September 2018 at Bursa Uludağ University, Faculty of Medicine Dialysis Unit and in a private dialysis center in İstanbul were included in this study. The patients were grouped into two: those who have had arteriovenous fistula primary failure at least once and those who have never had arteriovenous fistula primary failure. Educational levels of the patients were classified according to Turkish National Education system (illiterate, primary school graduate, secondary school graduate, high school graduate, and university graduate). Mann–Whitney U and Chi-square tests were performed for statistical analyses. Risk factors were determined by applying backward binary logistic regression analysis. Results A total of 349 patients, 161 (46.1%) females and 188 (53.9%) males, were examined retrospectively. The median age of the patients was 64 years (range: 18–90 years). Educational level comparison revealed statistically significant difference in terms of fistula patency ( p = 0.016). In particular, fistula patency was significantly lower in illiterate, primary, secondary, and high school graduates in comparison with university graduates ( p = 0.001, p = 0.015, p = 0.003, and p = 0.018, respectively). When each group of educational level was analyzed separately in terms of fistula patency, it was observed that the higher the educational level was, the lower arteriovenous fistula primary failure rates were. Conclusions In this study, we observed a lower rate of fistula patency in patients with a low level of education. Hence, we are of the opinion that the trainings delivered on arteriovenous fistula care in dialysis centers are required to be shaped in accordance with educational levels of patients.

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“…[23][24][25][26][27] If we focus our attention on "recurrent" dysfunction requiring repeated interventions to maintain patency of access, diabetes is identified as a strong predictor of recurrent vascular access dysfunction in several studies. 17,28, 29 As far as we know, diabetes is also a risk factor for cardiovascular disease/dysfunction in hemodialysis patients. 30 Moreover, in the present study, 55.6% of the patients in the group with persistent dysfunction also suffered from diabetes, to a higher extent than the other 2 groups (50.5% and 50.6% in groups 1 and 2; P<0.001) Nonetheless, MACE was still related to vascular access dysfunction with statistical significance after controlling for the traditional cardiovascular risk factors, including diabetes, in our analysis.…”

Section: Comparing Mace In Groups Of Patients With Different Temporal Patterns Of Vascular Access Dysfunctionmentioning

confidence: 99%

Association of Dysfunction of Vascular Access for Hemodialysis With Major Adverse Cardiovascular Events　― A Group-Based Trajectory Model Analysis ―

Kuo

Chang

et al. 2020

Circ J

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Background: An unconventional risk factor, "dysfunction of hemodialysis vascular access", was demonstrated to be associated with subsequent major adverse cardiovascular events (MACE) in our previous study. However, applying this suggestion in a clinical scenario may be not intuitive. A group-based trajectory model was applied to further recognize those patients with the highest risks for MACE. Methods and Results:In a cohort of patients who received hemodialysis from 2001 to 2010, we identified 9,711 cases that developed MACE in the stage of stable maintenance dialysis, and 19,422 randomly selected controls matched to cases on age, gender and duration of dialysis. Events of vascular access dysfunction in the 6-month period before MACE for cases and index dates for controls were evaluated. By group-based trajectory modeling, patients according to their counts of vascular access dysfunction in each month over the 6-month period prior to MACE or index dates were categorized. There were 26,744 patients in group 1 (no dysfunction), 650 in group 2 (escalating dysfunction) and 1,739 in group 3 (persistent dysfunction). Logistic regression analysis indicated that patients in group 3 had the highest chance of subsequent MACE (odds ratio 2.47, in comparison with group 1) after controlling for all the available potential confounders.Conclusions: Uninterrupted clusters of vascular access dysfunction are associated with a higher risk of subsequent MACE.

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Patient-related factors influencing patency of autogenous brachiocephalic haemodialysis fistulas

Cited by 9 publications

References 22 publications

Angiography and phlebography in a hemodialysis population: A retrospective analysis of interventional results

Angiography and phlebography in a hemodialysis population: A retrospective analysis of interventional results

Relationship between hemodialysis patients’ educational level and arteriovenous fistula patency

Association of Dysfunction of Vascular Access for Hemodialysis With Major Adverse Cardiovascular Events　― A Group-Based Trajectory Model Analysis ―

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Patient-related factors influencing patency of autogenous brachiocephalic haemodialysis fistulas

Cited by 9 publications

References 22 publications

Angiography and phlebography in a hemodialysis population: A retrospective analysis of interventional results

Angiography and phlebography in a hemodialysis population: A retrospective analysis of interventional results

Relationship between hemodialysis patients’ educational level and arteriovenous fistula patency

Association of Dysfunction of Vascular Access for Hemodialysis With Major Adverse Cardiovascular Events ― A Group-Based Trajectory Model Analysis ―

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Association of Dysfunction of Vascular Access for Hemodialysis With Major Adverse Cardiovascular Events　― A Group-Based Trajectory Model Analysis ―