Pre-existing arterial pathologic changes affecting arteriovenous fistula patency and cardiovascular mortality in hemodialysis patients

Lee, Ja Young; Kim, Young Ok

doi:10.3904/kjim.2017.268

Cited by 19 publications

(19 citation statements)

References 53 publications

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“…Lee et al . 23 reported that pre-existing arterial pathologic changes such as atherosclerosis affect not only the patency of vascular access but also increase the risk of cardiovascular mortality. These poor conditions of the vessel wall have an even greater effect when patients are concomitant with diabetes or coronary artery disease 22,24 .…”

Section: Discussionmentioning

confidence: 99%

The Impact of Comorbidity Burden on The Association between Vascular Access Type and Clinical Outcomes among Elderly Patients Undergoing Hemodialysis

Jhee

Hwang

Song

et al. 2019

Sci Rep

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The optimal vascular access type for elderly hemodialysis patients is controversial. We evaluated the impact of comorbidity burden on the association between vascular access type and mortality risk among 23,100 hemodialysis patients aged ≥65 years from the Korean Society of Nephrology End-Stage Renal Disease registry data. Subjects were stratified into tertiles according to the simplified Charlson comorbidity index (sCCI), and the survival and hospitalization rates were compared with respect to vascular access type: arteriovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter (CVC). Among all tertiles of sCCI, CVC use showed highest risk of mortality than AVF use. In the lowest to middle tertile, no difference was observed in survival rates between the use of AVF and AVG. However, in the highest tertile, AVG use showed higher risk of mortality than AVF use. When subjects were classified according to a combination of sCCI tertile and access type (AVF vs. AVG), patients with the highest CCI with AVG showed 1.75-folded increased risk of mortality than those with the lowest sCCI with AVF. Hospitalization rates due to access malfunction were highest in patients with CVC in all sCCI tertiles. In the highest tertile, patients with AVG showed increased rates of hospitalization compared to those with AVF due to access malfunction. However, hospitalization rates due to access infection were highest in patients with AVG in all tertiles. The use of AVF may be of benefit and switching to AVF should be considered in elderly hemodialysis patients with a high burden of comorbidity.

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Section: Discussionmentioning

confidence: 99%

The Impact of Comorbidity Burden on The Association between Vascular Access Type and Clinical Outcomes among Elderly Patients Undergoing Hemodialysis

Jhee

Hwang

Song

et al. 2019

Sci Rep

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“…Based on previous findings, maturation failure of AVF might be related to combined impacts of neointimal hyperplasia and unfavorable remodeling majorly owing to preexisting calcified vessels. In fact, these vascular pathologic changes increase both AVF failure rate and mortality rate in hemodialysis patients 18 , 19 .…”

Section: Discussionmentioning

confidence: 99%

Association of early failure of arteriovenous fistula with mortality in hemodialysis patients

Yap

Chi

Lin

et al. 2021

Sci Rep

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Arteriovenous fistula (AVF) is prone to early dysfunction and relates to poor outcome. However, little is known about the role of early AVF dysfunction as an independent risk factor for death in hemodialysis patients. A retrospective cohort study was performed using data of patients who underwent initial AVF surgery at a single institution. Demographic, clinical, biochemistry and AVF parameters were extracted from the electronic records, and the association between these variables and mortality was analyzed by Cox proportional hazards model. A total of 501 patients on hemodialysis (63.4 ± 12.7 years, 57.3% male) were included, and the median observation period was 3.66 years. In multivariate analysis, early failure of AVF (hazard ratio (95% confidence interval): 1.54 (1.06–2.24); p = 0.023) was associated with overall mortality but not cardiovascular mortality. Other identified predictors of overall mortality included older age, peripheral artery disease (PAD), cardiomegaly, higher white blood cell (WBC) count and corrected calcium level, and lower total cholesterol level, while predictors of cardiovascular mortality included older age, coronary artery disease (CAD), PAD and lower hemoglobin level. In conclusion, patients with early AVF failure were associated with increased risk of overall mortality.

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“…It is therefore not possible for us to differentiate between the cause and effect of elevated USTIR artery and the corresponding arterial lesions. We know that pre-existing arterial disease results in poorer vascular access outcomes, 13 so the relevance of USTIR artery may warrant further investigation with a cohort of patients stratified according to pre-surgical levels of arterial disease.…”

Section: Discussionmentioning

confidence: 99%

Computer assisted Doppler waveform analysis and ultrasound derived turbulence intensity ratios can predict early hyperplasia development in newly created vascular access fistula: Pilot study, methodology and analysis

Bartlett

Díaz‐Zuccarini

Tsui

2021

JRSM Cardiovascular Disease

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Objectives Following surgical creation of arterio-venous fistulae (AVF), the desired outward remodeling is often accompanied by the development of neointimal hyperplasia (NIH), which can stymie maturation and may lead to thrombosis and access failure. The aim of this study was to investigate the feasibility of using a non-invasive test, to detect and quantify the turbulent flow patterns believed to be associated with NIH development. Design This was a prospective, observational study. Ultrasound derived turbulence intensity ratios (USTIR) were calculated from spectral Doppler waveforms, recorded from newly formed AVF, and were compared with haemodynamic and structural changes observed during the initial maturation period. Setting Measurements were obtained by accredited Clinical Vascular Scientists, at the Royal Free Hospital, London. Participants Patients with newly created AVF were invited to participate in the study. A total of 30 patients were initially recruited with 19 participants completing the 10 week study protocol. Outcome measures The primary outcome measure was the development of NIH resulting in a haemodynamically significant lesion. The secondary outcome was successful maturation of the AVF at 10 weeks. Results Elevated USTIR in the efferent vein 2 weeks post surgery corresponded to the development of NIH formation (P = 0.02). A cut off of 6.39% predicted NIH development with a sensitivity of 87.5% and a specificity of 80%. Conclusion Analysis of Doppler waveforms can successfully identify deleterious flow patterns and predict inward luminal remodelling in maturing AVF. We propose a longitudinal follow up study to assess the viability of this technique as a surveillance tool.

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Pre-existing arterial pathologic changes affecting arteriovenous fistula patency and cardiovascular mortality in hemodialysis patients

Cited by 19 publications

References 53 publications

The Impact of Comorbidity Burden on The Association between Vascular Access Type and Clinical Outcomes among Elderly Patients Undergoing Hemodialysis

The Impact of Comorbidity Burden on The Association between Vascular Access Type and Clinical Outcomes among Elderly Patients Undergoing Hemodialysis

Association of early failure of arteriovenous fistula with mortality in hemodialysis patients

Computer assisted Doppler waveform analysis and ultrasound derived turbulence intensity ratios can predict early hyperplasia development in newly created vascular access fistula: Pilot study, methodology and analysis

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