Survival in haemodialysis: is there a role for vascular access?

Almeida, Edgar; Dias, Leone Mendes; Sousa, F T de; Mil-Homens, M C; Pataca, Isabel; Prata, Mateus Martins

doi:10.1093/ndt/12.4.852a

Cited by 9 publications

(4 citation statements)

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“…Starting HD via a catheter is associated with a high burden of infection, hospitalization, and mortality in our study as well as in others. [19][20][21][22][23] Alternate measures help explain why, despite early start of CKD care, very few HD patients have predialysis creation of an access. 15,24 Indeed, of the incident HD population, only 28.7% of the early care group had predialysis access creation, but when we examine the 29.1% of the total population with all three measures of adequate CKD care (early, high cumulative, and consistent critical period care), the proportion of the incident HD population with predialysis access creation increases to 41.7%.…”

Section: Discussionmentioning

confidence: 99%

Inadequate predialysis care and mortality after initiation of renal replacement therapy

Singhal

Hux

Alibhai

et al. 2014

Kidney International

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Adequacy of chronic kidney disease (CKD) care is traditionally measured as early or late, but this does not reflect the effect of cumulative or consistent care. Here we relate alternate measures of CKD care to mortality and other outcomes in patients with end-stage renal disease (ESRD) who started renal replacement therapy (RRT) between 1998 and 2008. CKD care was defined traditionally as early or late, and alternatively as cumulative care (total visits) and consistency of care in the critical period immediately prior to start of RRT (consistent critical period care required visits in 3 or more of the 6 months prior to RRT start). The primary outcome was 1-year mortality, with secondary outcomes of inpatient start and access creation. Of 12,143 patients aged 18-97 years at the start of RRT, 75.9% had early CKD care. Only 38.3% of the early group had high cumulative (over 10 visits) and consistent critical period care. The 1-year mortality of 15.8% was more likely with late care, lower cumulative care, and inconsistent critical period care. Both cumulative care and consistent critical period care independently predicted mortality, as well as secondary outcomes. Alternate measures of CKD care are important predictors of outcomes in ESRD and should be considered when reporting adequacy of care. Thus, patients traditionally classified as receiving early CKD care often do not receive adequate care immediately prior to initiating RRT.

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Section: Discussionmentioning

confidence: 99%

Inadequate predialysis care and mortality after initiation of renal replacement therapy

Singhal

Hux

Alibhai

et al. 2014

Kidney International

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show abstract

“…Risk factors such as female gender, age, diabetic nephropathy, dialysis initiation via CVC and inability of VA maturation before HD initiation are responsible for the majority of VA failure. Repetitive VA failures are risk factor for mortality [56]. It seems that early referral to nephrologist and patient's education leads to initiation of dialysis with permanent VA, better metabolic and clinical situation, lower long-term morbidity and higher 2-year survival [57][58][59][60][61].…”

Section: Permanent Vascular Accessmentioning

confidence: 99%

Vascular Access and New Trends

Grapsa¹,

Pantelias²

2015

Updates in Hemodialysis

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“…Age, female gender, presence of diabetic nephropathy, start of dialysis with a catheter and failure to wait for initial maturation of the VA are risk factors and account for the majority of VA failures during RRT. Repeated VA failure has been identified as a risk factor for mortality [145]. The brachiocephalic AV fistula is the preferred type of VA, if the radiocephalic approach fails.…”

Section: Final Remarks and Conclusionmentioning

confidence: 99%