Use of Arteriovenous Fistulae for Home Parenteral Nutrition – a Review of the Literature

Al-Amin, Azzam; Wood, Jonathan; Atturu, Gnanesh; Gouda, M.; Donnellan, Clare; Burke, Dermot

doi:10.5301/jva.5000138

Cited by 5 publications

(5 citation statements)

References 14 publications

(17 reference statements)

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“…Second, Q b is critical for sufficient urea removal, and therefore, chronic alloHD therapy may require central-venous or arterio-venous vascular access, such as an arterio-venous fistula (AVF). Notably, the clinical experience with AVF in patients without kidney failure, such as those with sickle-cell disease [3], hemophilia [4], or home parenteral nutrition [5], is mostly favorable.…”

Section: Discussionmentioning

confidence: 99%

Allo-Hemodialysis, a Novel Dialytic Treatment Option for Patients with Kidney Failure: Outcomes of Mathematical Modelling, Prototyping, and Ex Vivo Testing

Maheshwari,

Grobe,

Wang

et al. 2024

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It has been estimated that in 2010, over two million patients with end-stage kidney disease may have faced premature death due to a lack of access to affordable renal replacement therapy, mostly dialysis. To address this shortfall in dialytic kidney replacement therapy, we propose a novel, cost-effective, and low-complexity hemodialysis method called allo-hemodialysis (alloHD). With alloHD, instead of conventional hemodialysis, the blood of a patient with kidney failure flows through the dialyzer’s dialysate compartment counter-currently to the blood of a healthy subject (referred to as a “buddy”) flowing through the blood compartment. Along the concentration and hydrostatic pressure gradients, uremic solutes and excess fluid are transferred from the patient to the buddy and subsequently excreted by the healthy kidneys of the buddy. We developed a mathematical model of alloHD to systematically explore dialysis adequacy in terms of weekly standard urea Kt/V. We showed that in the case of an anuric child (20 kg), four 4 h alloHD sessions are sufficient to attain a weekly standard Kt/V of >2.0. In the case of an anuric adult patient (70 kg), six 4 h alloHD sessions are necessary. As a next step, we designed and built an alloHD machine prototype that comprises off-the-shelf components. We then used this prototype to perform ex vivo experiments to investigate the transport of solutes, including urea, creatinine, and protein-bound uremic retention products, and to quantitate the accuracy and precision of the machine’s ultrafiltration control. These experiments showed that alloHD performed as expected, encouraging future in vivo studies in animals with and without kidney failure.

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Section: Discussionmentioning

confidence: 99%

Allo-Hemodialysis, a Novel Dialytic Treatment Option for Patients with Kidney Failure: Outcomes of Mathematical Modelling, Prototyping, and Ex Vivo Testing

Maheshwari,

Grobe,

Wang

et al. 2024

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“…Reviewing the literature for other reports of arteriovenous access for uses other than hemodialysis, the data are quite sparse but much better than what we present here. One literature review reports patency out as far as 300 months when used for total parenteral nutrition (10). Two additional papers report arteriovenous access use for chemotherapy, one in patients already with ESRD on dialysis (11) and one with access specifically created for chemotherapy administration (12).…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous access does not perform as well for plasmapheresis

et al. 2017

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“…A vascular access is a lifeline for patients with end-stage kidney disease (ESKD) who need haemodialysis (HD) 1 and in rare cases of chronic intestinal failure (CIF) who need parenteral nutrition (PN). 2 For short-term treatment central venous catheters (CVCs) are often used as vascular access, but because of high infection rates of the CVCs in both ESKD patients [3][4][5][6] and CIF patients [7][8][9][10] the arteriovenous fistula (AVF) is usually preferred when treatment is expected to be long-term or life-long. 11 The AVF is a surgical connection between the arterial and venous system.…”

Section: Introductionmentioning

confidence: 99%

Long-term patency rate of the translocated autologous saphenous vein versus prosthetic material in vascular access surgery for haemodialysis and parenteral nutrition

et al. 2021

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Objective: To evaluate the long-term patency rate of the arteriovenous angioaccess (AVA) with interposition of either autologous or prosthetic material as a last option for vascular access in the upper extremity. Methods: This is a retrospective chart review study of all patients who received an AVA with autologous saphenous vein (SV Group, n = 38) or prosthetic material (PTFE Group, n = 25) as a conduit from the year 1996 to 2020 in the Radboud University Medical Center (Radboudumc). Data were retrospectively extracted from two prospectively updated local databases for vascular access, one for haemodialysis (HD) and one for parenteral nutrition (PN). When required, the medical records of each patient were used. Data were eventually collected anonymously and analysed in SPSS 25. Kaplan-Meier life-tables were used for the statistical analysis. Results: Primary patency at 12 and 48 months was 30% and 20% in the SV group and 45% and 14% in the PTFE group. No significant difference was shown in the median primary patency rate ( p = 0.715). Secondary patency at 12 and 48 months was 63% and 39% in the SV group and 55% and 19% in the PTFE group. This was considered a significant difference in median secondary patency in favour of the SV with 41.16 ± 17.67 months against 13.77 ± 10.22 months for PTFE ( p = 0.032). The incidence of infection was significantly lower in the SV group ( p = 0.0002). A Kaplan-Meier curve could not detect a significant difference in secondary patency between the access for haemodialysis and the access for parenteral nutrition. The secondary patency of the SV in parenteral nutrition access, was significantly higher when compared with PTFE ( p = 0.004). Conclusion: The SV can be preferred over PTFE when conduit material is needed for long-term vascular access for HD or PN treatment due to its higher secondary patency and lower infection risk.

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Use of Arteriovenous Fistulae for Home Parenteral Nutrition – a Review of the Literature

Abstract: There is relatively little data regarding this method. AVFs have been used successfully for HPN in patients with poor vasculature, on hemodialysis or recurrent line sepsis. This technique perhaps warrants more thorough exploration. Further research is required.

Cited by 5 publications

References 14 publications

Allo-Hemodialysis, a Novel Dialytic Treatment Option for Patients with Kidney Failure: Outcomes of Mathematical Modelling, Prototyping, and Ex Vivo Testing

Allo-Hemodialysis, a Novel Dialytic Treatment Option for Patients with Kidney Failure: Outcomes of Mathematical Modelling, Prototyping, and Ex Vivo Testing

Arteriovenous access does not perform as well for plasmapheresis

Long-term patency rate of the translocated autologous saphenous vein versus prosthetic material in vascular access surgery for haemodialysis and parenteral nutrition

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