Predictors of Initiation for Predialysis Arteriovenous Fistula

Al-Balas, Alian; Lee, Timmy; Young, Carlton J.; Barker-Finkel, Jill; Allon, Michael

doi:10.2215/cjn.00700116

Cited by 26 publications

(37 citation statements)

References 22 publications

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“…Several factors have been associated with an accelerated eGFR decline including young age, proteinuria, male sex, systolic hypertension and diabetes. In contrast, ACE inhibitor and ARB are known to slow eGFR decline [17, 18]. In the present study, black race was associated with steeper eGFR decline through time while increased age was associated with slower kidney function decline.…”

Section: Discussionmentioning

confidence: 41%

Impact of Arteriovenous fistula creation on estimated glomerular filtration rate decline in Predialysis patients

et al. 2019

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BackgroundArteriovenous fistula (AVF) is the vascular access of choice for patients on hemodialysis. Recent evidence suggests that AVF creation may slow estimated glomerular filtration rate (eGFR) decline. The study objective was to assess the impact of the AVF creation on eGFR decline, after controlling for key confounding factors.MethodsThis retrospective cohort study included adult patients followed in a single-center predialysis clinic between 1999 and 2016. Patients with a patent AVF were followed up to 2 years pre- and post-AVF creation. Estimated GFR trajectory was reported using linear mixed models adjusted for demographic characteristics, comorbidities and use of renin-angiotensin-aldosterone blockade.ResultsA total of 146 patients were studied with a median age 68.7 (60.5–75.4) years and a median eGFR at time of AVF creation of 12.8 (11.3–13.9) mL/min/1.73m2. The crude annual eGFR decline rates were − 3.60 ± 4.00 mL/min/1.73 m2 pre- and − 2.28 ± 3.56 mL/min/1.73 m2 post-AVF, resulting in a mean difference of 1.28 mL/min/1.73 m2 (95% CI 0.49, 2.07). In a mixed effect linear regression model, monthly eGFR decline was − 0.63 (95% CI -0.81, − 0.46; p < 0.001) mL/min/1.73m2/month. The period after AVF creation was associated with a relatively higher eGFR (β 0.94, 95% CI 0.61–1.26, p < 0.001). There was a significant association between follow-up time and the period pre/post AVF (β 0.19, 95% CI 0.16, 0.22; p < 0.001) such that eGFR decline was more attenuated each month after AVF creation.ConclusionsIn this cohort, AVF creation was associated with a significant reduction of eGFR decline. Further prospective studies are needed to confirm this association.

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Section: Discussionmentioning

confidence: 41%

Impact of Arteriovenous fistula creation on estimated glomerular filtration rate decline in Predialysis patients

et al. 2019

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“…The best strategy would be to develop techniques that speed fistula maturation below 2 months' time after surgical creation, what would make planning much easier and accurate [87]. Despite the tremendous heterogeneity in the decline of kidney function in stage 5 CKD patients, factoring in the presence of diabetes, the degree of proteinuria and the eGFR trajectory in the preceding year, significantly improved our prediction capability of dialysis commencement [88].…”

Section: Timing Of Referral For Vascular Access Surgerymentioning

confidence: 99%

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

Canaud¹,

Ponce²,

Parisotto³

et al. 2019

Vascular Access Surgery - Tips and Tricks

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A good functioning vascular access (VA) is a prerequisite to obtain a successful dialysis treatment. This chapter reviews VA management in advanced chronic kidney disease (CKD) patients drawn from the experience of a large network dialysis care provider with the following sections: overview on VA management in advanced CKD that follows patient pathway and patient profile, current practice patterns in line with best clinical practices; VA creation addressing crucial themes: when and what type of VA to construct, how to assess patient pre-emptively, how to proceed for the construction and monitoring to prevent early failures and complications; VA management with particular focus on clinical monitoring, surveillance and interventional procedures required to preserve patency and functionality of VA; the often-forgotten patient perspective is VA usage. What information to share, how to proceed for preventing pain, and fears related with VA needling? What should patients know about their VA and how to manage in daily life? Competences, skills and responsibilities of nursing staff when using and managing VA; and future of VA in terms of innovative concept for creating and maintaining VA conduits in dialysis patients.

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“…FTM has compounded the error. [9][10][11][12][13] Nurses, technicians, and nephrologists work together to decide when the time is right to attempt initial cannulation. The fear of premature cannulation causing hematomas, thrombosis, and irreversible AVF damage can delay use.…”

Section: Introductionmentioning

confidence: 99%

Point-of-care ultrasound for assessing arteriovenous fistula maturity in outpatient hemodialysis

et al. 2020

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Background: Point-of-care ultrasound in end-stage renal disease is on the rise. Presently the decision to cannulate an arteriovenous fistula is based on its duration since surgery and physical exam. This study examines the effects of point-of-care ultrasound on decreasing the time to arteriovenous fistula cannulation, time spent with a central venous catheter, and the complications and infections that arise. Methods: Prospective point-of-care ultrasound patients were recruited between January 2015 and January 2018, while retrospective data (non-point-of-care ultrasound) were collected via chart review from patients who had fistula creation between November 2011 and May 2014. Patients had point-of-care ultrasound within 3 weeks after arteriovenous fistula creation and were followed for 1 year. Arteriovenous fistula cannulation was initiated when the following parameters were met: diameter > 6 mm (with no depreciable narrowing of more than 20% throughout), depth < 6 mm, and length > 6 cm. Demographic data, as well as time to cannulation and central venous catheter removal, number of infections, complications, and interventions were compared between point-of-care ultrasound and non-point-of-care ultrasound groups using unpaired t-test, chi-square, and Fisher exact test statistical analysis. Results: A total of 37 patients with new arteriovenous fistulas were followed by point-of-care ultrasound compared to 29 non-point-of-care ultrasound patients. Point-of-care ultrasound patients had earlier cannulations (35.5 vs 63.3 days, p < 0.05), shorter central venous catheter duration (68.2 vs 98.3 days, p < 0.05), and less infections (12 vs 19) without differences in complication compared to the non-point-of-care ultrasound. Conclusion: Point-of-care ultrasound facilitates early and safe arteriovenous fistula cannulation leading to a reduction in central venous catheter time and risk of infection. Point-of-care ultrasound may also aid in earlier identification of complications and difficult cannulations.

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Predictors of Initiation for Predialysis Arteriovenous Fistula

Cited by 26 publications

References 22 publications

Impact of Arteriovenous fistula creation on estimated glomerular filtration rate decline in Predialysis patients

Impact of Arteriovenous fistula creation on estimated glomerular filtration rate decline in Predialysis patients

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

Point-of-care ultrasound for assessing arteriovenous fistula maturity in outpatient hemodialysis

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