The influence of a doppler ultrasound in arteriovenous fistula for dialysis failure related to some risk factors

Lopes, Jocefábia Reika Alves; Marques, Ana Lígia de Barros; Corrêa, João Antônio

doi:10.1590/2175-8239-jbn-2019-0080

Cited by 6 publications

(7 citation statements)

References 35 publications

(52 reference statements)

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“…The increase in the creation of AVFs has shown a rate of primary of maturation failures from 23% to 46%, with a great need for interventions to reach maturity. [1][2][3][4][5] The use of catheters as a bridge for a new AVF has become frequent, and AVGs were reserved for patients without the possibility of having an AVF. Knowledge in vascular access has advanced, and the evidence challenges the dogma that an AVF is always the best access for all patients.…”

Section: Introductionmentioning

confidence: 99%

Is the Fistula First Approach still valid?

Franco¹

2021

Braz. J. Nephrol.

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The Fistula First Breakthrough Initiative, founded in 2003, was responsible for changing the access profile in the United States, increasing the prevalence of arteriovenous fistulas (AVFs) by 50% and reducing that of arteriovenous grafts (AVGs). However, the concept that AVFs are always the best access for all patients has been challenged. Discussion points are: (1) the questionable survival benefit of AVFs over AVGs, if one takes into account the high rates of primary AVF failure; (2) the potential benefits of using AVGs for greater primary success; and (3) the questionable benefit of AVFs over AVGs in patients with shorter survival, such as the elderly. The high rate of primary failure and maturation procedures leads to prolonged use of catheters, and it is one of the weaknesses of the fistula first strategy. AVGs proved to be better than AVFs as a second access after the failure of a first AVF, and in patients with non-ideal vessels, with greater primary success and reduced catheter times. AVGs appear to have a similar survival to AVFs in patients older than 80 years, with less primary failures and interventions to promote maturation. The most recent KDOQUI guidelines suggest an individualized approach in access planning, taking into account life expectancy, comorbidities and individual vascular characteristics, with the aim of chosing adequate access for the right patient, at the right time, for the right reasons.

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Section: Introductionmentioning

confidence: 99%

Is the Fistula First Approach still valid?

Franco¹

2021

Braz. J. Nephrol.

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“…The authors commented on the lack of infrastructure for HD vascular access, especially surgical and endovascular suites, and how the lack of endovascular treatments undermines the creation of vascular accesses, as up to 46% would need an intervention to mature. The impossibility of treating primary failures may lead to the creation of a new AV access, reducing the available creation sites and leading to longer catheter exposure and potential complications (24)(25)(26)(27)(28). Brazil has no regulations for outpatient endovascular procedures; therefore, patients with dysfunctional access need to be hospitalized for treatment.…”

Section: Discussionmentioning

confidence: 99%

Health insurance provider and endovascular treatment availability are associated with different hemodialysis vascular access profiles: A Brazilian national survey

Franco¹,

Chula²,

Campos

2022

Front. Nephrol.

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In Brazil, most hemodialysis (HD) patients are treated by the country’s public health system. However, accessibility to healthcare is different for public and private patients. This study aimed to identify the profile of vascular access in a Brazilian HD sample. Additionally, it aimed to examine the influence of public and private health insurance, accessibility to endovascular treatments, and timely arteriovenous access creation on the prevalence of tunneled catheters (TCs), non-tunneled catheters (NTCs), and arteriovenous (AV) access. We conducted a cross-sectional electronic survey across 834 centers. Centers were inquired about the number of patients with public and private health insurance, the profiles of vascular access, time for AV access creation, accessibility to TC insertion and endovascular treatments, and the availability of peritoneal dialysis and kidney transplantation. Logistic regression and multilevel logistic regression were performed to evaluate possible interactions between the independent variables. A total of 7,973 patients across 47 HD centers were included in the survey. Public health patients accounted for 77% of the study sample. The overall vascular access profiles of the public and private insurance groups were significantly different (p < 0.001). For patients with public health insurance, the prevalence of any catheter was 25%, while that for private patients was 31.8% (p < 0.001). The prevalence of TCs was more common in private patients (15.3% vs. 23.1%, p < 0.001). AV accesses were more common in public health patients (75% vs. 68.2%, p < 0.001), as were fistulas (72.4% vs. 63.1%, p < 0.001). AV grafts were more prevalent among patients with private insurance (2.6 vs. 5.1%, p < 0.001). The availability of endovascular treatments increased the chance of having a TC by 2.3-fold (OR = 2.33, 95% CI = 1.30–4.18); however, it did not reduce the chance of having any catheter. A high chance of having a catheter was found when the time to AV access creation exceeded 60 days. The differences between public and private patients may be explained by underpayments and the decreased accessibility to care infrastructure in the public system, especially for endovascular treatments. In this sample, public health patients had a decreased risk of having a TC over an NTC. Differences in care accessibility and insurance type might influence the type of vascular access.

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“…Several factors such as vessel diameter and quality, surgeon experience, and hemodynamic conditions have been associated with successful AVF maturation 9 . Doppler ultrasound to map and decide which vessels to use in creating an AVF [10][11][12] has been suggested in patients at higher risk of maturation failure 4 . However, besides vascular parameters 4,12 , other clinical characteristics have not been consistently associated with successful AVF maturation in predictive models 8,13 .…”

Section: Introductionmentioning

confidence: 99%

Predictors of arteriovenous fistula maturation in hemodialysis patients: a prospective cohort from an ambulatory surgical center in Joinville, Brazil

et al. 2023

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Introduction: The high rate of arteriovenous fistula maturation failure is a concern in a scenario of growing numbers of patients on hemodialysis. Non-vascular factors tied to maturation success have not been fully discussed. Methods: This prospective observational cohort study included patients with CKD on dialysis or pre-dialysis prescribed arteriovenous fistula creation for the first time in an ambulatory surgical center in Joinville, Brazil, from January 2021 to July 2021. Anthropometric aspects, sociodemographic characteristics, comorbidities, and vascular parameters observed in Doppler ultrasound were analyzed. Variables associated with maturation were analyzed in multivariate models by logistic regression. Results: Eighty-eight of 145 participants (60.1%) were males. Included patients had a median age of 59 years. Successful arteriovenous fistula maturation occurred in 113 (77.9%) patients. Factors such as increased BMI, hematocrit, arm circumference, and skinfold thickness were associated with lower chances of arteriovenous fistula maturation in univariate analysis. On the other hand, larger vein and artery diameter and fistulas in the more proximal portion of the arm were associated with higher maturation success. In multivariate analysis, smoking and larger skinfold and arm circumference were associated with lower chances of successful maturation. Increased systolic blood pressure and vein diameter were associated with greater chance of success. Conclusion: In addition to the vascular parameters assessed in Doppler ultrasonography, factors related to obesity and/or nutritional aspects may influence arteriovenous fistula maturation.

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The influence of a doppler ultrasound in arteriovenous fistula for dialysis failure related to some risk factors

Cited by 6 publications

References 35 publications

Is the Fistula First Approach still valid?

Is the Fistula First Approach still valid?

Health insurance provider and endovascular treatment availability are associated with different hemodialysis vascular access profiles: A Brazilian national survey

Predictors of arteriovenous fistula maturation in hemodialysis patients: a prospective cohort from an ambulatory surgical center in Joinville, Brazil

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