Seeing Eye to Eye: The Key to Reducing Catheter Use

Chaudhry, M. Usman; Bhola, Cynthia; Joarder, Mohammad; Zimmerman, Deborah; Quinan, Patty; Mendelssohn, David C.; Lok, Charmaine E.

doi:10.5301/jva.2011.6390

Cited by 41 publications

(40 citation statements)

References 21 publications

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“…Further, these failures may lead patients to doubt the overall benefit of fistulas. Patient refusal is a significant barrier to fistula creation: Currently, up to 30% of eligible patients decline fistula creation (24,(45)(46)(47). In a novel qualitative study conducted by Xi et al, negative personal or vicarious experience with a fistula emerged as a major reason for patient refusal of a fistula (45).…”

Section: Discussionmentioning

confidence: 99%

Cumulative Patency of Contemporary Fistulas versus Grafts (2000–2010)

Lok

Sontrop

Tomlinson

et al. 2013

Clinical Journal of the American Society of Nephrology

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203

201

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SummaryBackground and objectives Comparisons of fistulas and grafts often overlook the high primary failure rate of fistulas. This study compared cumulative patency (time from access creation to permanent failure) of fistulas and grafts.Design, setting, participants, & measurements Vascular accesses of 1140 hemodialysis patients from two centers (Toronto and London, Ontario, Canada, 200022010) were analyzed. Cumulative patency was compared between groups using Kaplan-Meier survival curves and log-rank tests. Hazard ratios (HRs) for fistula failure relative to grafts and 95% confidence intervals (95% CIs) are reported.Results There were 1012 (88.8%) fistulas and 128 (11.2%) grafts. The primary failure rate was two times greater for fistulas than for grafts: 40% versus 19% (P,0.001). Cumulative patency did not differ between fistulas and grafts for the patients' first access (median, 7.4 versus 15.0 months, respectively [HR, 0.99; 95% CI, 0.7921.23; P=0.85]) or for 600 with a subsequent access (7.0 versus 9.0 months [HR, 0.93; 95% CI, 0.7721.13; P=0.39]). However, when primary failures were excluded, cumulative patency became significantly longer for fistulas than for grafts for both first and subsequent accesses (61.9 versus 23.8 months [HR, 0.56; 95% CI, 0.4320.74; P,0.001] and 42.8 versus 15.9 months [HR, 0.56; 95% CI, 0.4420.72; P,0.001]). Results were similar for forearm and upper-arm accesses. Compared with functioning fistulas, grafts necessitated twice as many angioplasties (1.4 versus 3.2/ 1000 days, respectively; P,0.001) and significantly more thrombolysis interventions (0.06 versus 0.98/1000 days; P,0.001) to maintain patency once matured and successfully used for dialysis.Conclusions Cumulative patency did not differ between fistulas and grafts; however, grafts necessitated more interventions to maintain functional patency.

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Section: Discussionmentioning

confidence: 99%

Cumulative Patency of Contemporary Fistulas versus Grafts (2000–2010)

Lok

Sontrop

Tomlinson

et al. 2013

Clinical Journal of the American Society of Nephrology

Self Cite

203

201

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“…Overall, only 24% of patients had no preference; 12% preferred a CVC (nonblack women had the highest CVC preference at 17%). The most common reasons for preferring a CVC were no puncture and no bleeding, avoidance of disfigurement, and better cosmesis (51,54). The DOPPS survey revealed that up to 20% of patients received little or no vascular accessrelated education, suggesting that they did not fully understand the risks and benefits of various vascular access types.…”

Section: Comorbiditiesmentioning

confidence: 99%

“…Depending on whether the patients are predialysis or on dialysis, they would have had differing exposures and experiences with AV accesseither their own or shared by other patients in waiting rooms or on dialysis. As clinicians, we are concerned about the AV access type and their associated complications; however, patients may have far differing concerns (50,51). Patients are much more worried about daily quality of life issues with their vascular access, such as pain with cannulation, and influenced by their prior experiences with a failed AV access that required painful interventions.…”

Section: Comorbiditiesmentioning

confidence: 99%

“…These data emphasize the need for better education and counseling from clinicians. However, although some patients' vascular access concerns may be associated with deficiencies in patient education (55), others are not easily managed by education alone, especially quality of life and aesthetic concerns (51). Under valid circumstances, strong patient preference for a specific access type should be respected, especially when the competent patient has been properly informed and consented as to their vascular access choice, including dialyzing through a CVC and refusing AVF or AV graft creation.…”

Section: Comorbiditiesmentioning

confidence: 99%

See 1 more Smart Citation

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

Woo

2016

CJASN

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Optimal vascular access planning begins when the patient is in the predialysis stages of CKD. The choice of optimal vascular access for an individual patient and determining timing of access creation are dependent on a multitude of factors that can vary widely with each patient, including demographics, comorbidities, anatomy, and personal preferences. It is important to consider every patient's ESRD life plan (hence, their overall dialysis access life plan for every vascular access creation or placement). Optimal access type and timing of access creation are also influenced by factors external to the patient, such as surgeon experience and processes of care. In this review, we will discuss the key determinants in optimal access type and timing of access creation for upper extremity arteriovenous fistulas and grafts.

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“…The fact that our entire cohort was relatively young and that acute kidney injury in the kidney transplant setting is more frequent in younger individuals [31] could possibly explain these findings. Equally important, esthetic concerns related to permanent dialysis access [32] and an unwillingness to commit to a dialysis modality during the predialysis period may be more frequent in the younger age group.…”

Section: Discussionmentioning

confidence: 99%

Suboptimal Initiation of Home Hemodialysis: Determinants and Clinical Outcomes

et al. 2013

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Background/Aims: Suboptimal initiation of conventional hemodialysis is associated with poor clinical outcomes. In this study, we aimed to ascertain the determinants and adverse events associated with suboptimal starts in home hemodialysis (HHD). Methods: We conducted a retrospective cohort study including consecutive incident HHD patients from January 1996 to December 2011. All patients had HHD as their first renal replacement therapy or returned to HHD after kidney transplantation. A suboptimal start was defined by dialysis initiation as an inpatient or with a central venous catheter. The primary outcome was time to first hospitalization, technique failure or death. Secondary outcomes included hospitalization rate, hospital days and determinants of suboptimal starts. Suboptimal starts were further categorized as unavoidable as adjudicated by two independent observers with prespecified criteria. Results: Among 95 incident HHD patients, 44 (46%) and 51 (54%) had optimal and suboptimal starts, respectively. A suboptimal start was associated with a shorter time to the primary outcome (log-rank p < 0.001). In a multivariable Cox proportional hazards model, the hazard ratio for the composite outcome (comparing suboptimal to optimal starts) was 2.94 (95% confidence interval, CI, 1.49-5.78, p = 0.002). Transplantation clinic follow-up (OR 3.18, 95% CI 1.15-8.79) and the Charlson comorbidity index (OR 1.47, 95% CI 1.09-1.97) were associated with higher odds of suboptimal start. Conclusion: Suboptimal initiation of HHD is associated with adverse clinical events including early hospitalization. Given the high proportion of suboptimal starts in patients returning from transplantation, better incorporation of dialysis planning and renal replacement therapy education is warranted.

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Seeing Eye to Eye: The Key to Reducing Catheter Use

Cited by 41 publications

References 21 publications

Cumulative Patency of Contemporary Fistulas versus Grafts (2000–2010)

Cumulative Patency of Contemporary Fistulas versus Grafts (2000–2010)

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

Suboptimal Initiation of Home Hemodialysis: Determinants and Clinical Outcomes

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