Vascular access for hemodialysis

Hayashi, Rick; Huang, Edmund; Nissenson, Allen R.

doi:10.1038/ncpneph0239

Cited by 43 publications

(32 citation statements)

References 69 publications

(50 reference statements)

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“…A major factor that facilitates AV fistula failure in HD patients is thrombosis, which is due to intimal hyperplasia developing in the venous segment of AV fistula [2]. Good vascular access is vital to attain effective dialysis treatment, keep patients' quality of life at a maximum level and prevent unnecessary loss of time and cost increases.…”

Section: Discussionmentioning

confidence: 99%

“…Permanent vascular access in HD patients is provided through a central venous catheter, arteriovenous (AV) graft or native AV fistula [3]. Arteriovenous thrombosis accounts for 80-85% of vascular access loss, and vascular stenosis developing in venous segment of native AV fistula or AV graft is the major predisposing factor for thrombosis, being responsible for 80% of the cases [2]; therefore, it is extremely important to identify the predictors of native AV fistula thrombosis in HD patients.…”

mentioning

confidence: 99%

“…Loss of vascular access is known to be an important cause of morbidity and mortality in hemodialysis (HD) patients [1,2]. Permanent vascular access in HD patients is provided through a central venous catheter, arteriovenous (AV) graft or native AV fistula [3].…”

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confidence: 99%

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Circulating Fibroblast Growth Factor-23 Level and Paraoxonase-1 Lactonase Activity in Chronic Hemodialysis Patients: Their Impact on the Incidence of Native AV Fistula Thrombosis

Zohny¹,

El-Fattah²,

Khan³

2016

CIM

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Purpose: Thrombosis of native arteriovenous (AV) fistula is an important cause of complications in hemodialysis (HD) patients. The purpose of this study was to investigate the usefulness of measuring circulating fibroblast growth factor-23 (FGF-23) level and paraoxonase-1 (PON1) lactonase activity as potential predictors of native AV fistula thrombosis in chronic HD patients.Methods: This study included 83 HD patients (48 with thrombosed and 35 with non-thrombosed native AV fistulas) and 38 healthy volunteers. Serum FGF-23 level was measured using the ELISA technique, while serum PON1 lactonase activity was measured spectrophotometrically using gamma-thiobutyrolactone as a substrate.Results: FGF-23 was significantly increased while PON1 lactonase was markedly decreased in both thrombosed and non-thrombosed HD patients compared with controls (P < 0.001). FGF-23 was elevated whereas PON1 lactonase was decreased in HD patients with thrombosed native AV fistulas compared with HD patients with non-thrombosed native AV fistulas (P = 0.001 and 0.002, respectively). A significant negative correlation was found between FGF-23 and PON1 lactonase in HD patients with thrombosed native AV fistulas (r = −0.342, P = 0.017).Conclusions: This study shows a potential value of FGF-23 and PON1 lactonase as predictors of native AV fistula thrombosis in HD patients.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Circulating Fibroblast Growth Factor-23 Level and Paraoxonase-1 Lactonase Activity in Chronic Hemodialysis Patients: Their Impact on the Incidence of Native AV Fistula Thrombosis

Zohny¹,

El-Fattah²,

Khan³

2016

CIM

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“…Até então, esse método de substituição renal era utilizado para casos agudos e limitados a poucas sessões, dada a dificuldade imposta pelas repetidas punções e o rápido esgotamento dos acessos. O uso de cateteres, utilizados anteriormente nos shunts e atualmente como método de urgência ou mesmo definitivos (cateteres de longa permanên-cia) para o acesso vascular, está relacionado com aumento da mortalidade em até 50%, quando comparado ao uso das FAV em pacientes renais crônicos 4 . Além disso, esses dispositivos acabam por deteriorar o sistema venoso dos pacientes (estenoses centrais, tromboses), impedindo a confecção das FAV em alguns casos.…”

Section: Introductionunclassified

Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise

et al. 2011

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ResumoContexto: A insuficiência renal crônica é uma doença de alta prevalência e morbidade, o que determina queda da qualidade de vida. Pacientes em hemodiálise necessitam de um acesso vascular que permita a conexão da circulação do paciente ao circuito externo de hemodiálise. Dentre os acessos disponíveis, as fístulas arteriovenosas (FAV) são as que mais se aproximam do acesso ideal. Objetivo: Avaliar a perviedade precoce das FAV, identificando os fatores relacionados ao insucesso destas. Métodos: Foram acompanhados todos os pacientes submetidos à confecção das FAV no Hospital do Servidor Público Municipal de São Paulo, no período de agosto de 2008 a janeiro de 2009, avaliando-se a perviedade destas no 1º, 10º e 30º pós-operatório. Foram realizadas 31 FAV no período, apresentando-se média de idade de 63,06 anos, sendo 18 pacientes do sexo masculino e 13 do feminino. Resultados: Vinte e seis FAV foram distais, todas radiocefálicas; quatro foram proximais, das quais duas braquiocefálicas e duas braquiobasílicas superficializadas; uma FAV confeccionada com alça de politetrafluoretileno (PTFE) fêmoro-femoral esquerda. A taxa de perviedade no primeiro mês foi de 71% dos casos. O uso de cateteres venosos centrais apresentou-se como fator de risco para oclusão da FAV (p=0,01). As FAV continuam sendo o acesso vascular para hemodiálise mais aceito e mais seguro. A indicação precoce para confecção das FAV é de fundamental importância, evitando-se, assim, o uso de cateteres e suas complicações. Conclusões: A perviedade precoce encontrada neste estudo é semelhante à da literatura, e o uso prévio de cateteres é o fator de risco mais significativo para oclusão precoce desta. Palavras-chave: Fístula arteriovenosa, diálise renal, desobstrução vascular AbstractBackground: Chronic renal failure is a disease of high prevalence and high morbidity, which impairs the patients' quality of life. Patients on hemodialysis need a vascular access for connection with the hemodialysis equipment. Arteriovenous fistulas (AVF) are the best option for this purpose. Objective: To evaluate the early patency of AVFs and to identify the causes of their failure. Methods: All patients AVF underwent operations for dialysis from August, 2008 to January, 2009. The AVF patency was evaluated on the 1 st , 10 th and 30 th postoperative days. Thirty-one operations for AVF were performed in our hospital in the period; 18 patients were males and the mean age was 63.03 years. Results: Twenty-six AVF were distal, all radial-cephalic; four were proximal, out of which two were brachiocephalic and two were brachiobasilic; one AVF was a femoral-femoral loop PTFE graft. The patency rate in the first month was of 71%. The use of central venous catheters was a risk factor for AVF occlusion (p=0.01). AVF remains the most accepted and safe vascular access. Early performance of the AVF is very important to avoid the complications resulting from long-term use of central venous catheters. Conclusions: Data regarding early patency found in this study were similar to those f...

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“…Such catheters are the preferred method for obtaining temporary vascular access in acute renal failure (ARF) and need of detoxification as well as for patients suffering from end-stage renal disease (ESRD) without permanent vascular access, e.g. arteriovenous fistula (AVF)/graft or permanent catheter [1, 2]. The latter problem occurs in general in late referral patients resulting in delayed permanent vascular access formation.…”

Section: Introductionmentioning

confidence: 99%

Femoral Localization and Higher Ultrafiltration Rate but Not Concentration of Heparin Used for Canal Locking of Hemodialysis Catheter Are Negative Predictors for Its Malfunction

et al. 2007

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Background/Aim: Non-tunneled, temporal hemodialysis (HD) catheters are commonly used as short-term vascular access for the HD procedure. One of their late complications is thrombotic occlusion of the catheter ensuing in their malfunction. A heparin lock is conventionally used for maintaining the patency of the catheter. The aim of the study was to evaluate the influence of heparin concentration used for locking the catheter canals (5,000 vs. 2,500 IU/ml) and some other clinical and laboratory variables at the time of temporal HD catheter functioning. Methods: Catheter malfunction was defined as the inability to attain and maintain a blood flow of at least 150 ml/min. 174 consecutive HD catheters inserted into jugular or femoral veins (114 patients) were followed up and remained in use for a total of 3,284 days. Results: Catheter thrombosis occurred in 53 cases (30.5%) during the study period, giving an overall rate of 16 episodes per 1,000 catheter-days at risk. In univariate Cox proportional hazard analysis, predictors of catheter dysfunction were: femoral localization (HR 4.92, 95% CI 4.30–5.50), acute renal failure (HR 1.75, 95% CI 1.18–2.32), higher mean ultrafiltration (UF) (HR 1.31, 95% CI 0.99–1.63) and higher concentration of hemoglobin (HR 1.15, 95% CI 0.99–1.33). The concentration of heparin used for canal locking did not influence the time of catheter functioning (HR 1.1, p = 0.7). In multivariate Cox proportional hazard analysis (χ² = 38.5, d.f. = 4, p < 0.0001) the remaining statistically independent predictors of catheter malfunction were: femoral localization (HR 5.94, 95% CI 5.27–6.61, p < 0.0001) and higher UF (HR 1.60, 95% CI 1.24–1.94, p < 0.01). Conclusions: A lower concentration of heparin (2,500 IU/ml) prevents catheter thrombosis as effectively as a standard one (5,000 IU/ml). Femoral localization of HD catheters and higher UF during the HD procedure are the factors predisposing for catheter malfunction.

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Vascular access for hemodialysis

Cited by 43 publications

References 69 publications

Circulating Fibroblast Growth Factor-23 Level and Paraoxonase-1 Lactonase Activity in Chronic Hemodialysis Patients: Their Impact on the Incidence of Native AV Fistula Thrombosis

Circulating Fibroblast Growth Factor-23 Level and Paraoxonase-1 Lactonase Activity in Chronic Hemodialysis Patients: Their Impact on the Incidence of Native AV Fistula Thrombosis

Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise

Femoral Localization and Higher Ultrafiltration Rate but Not Concentration of Heparin Used for Canal Locking of Hemodialysis Catheter Are Negative Predictors for Its Malfunction

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