Vascular Access in Patients Treated With Chronic Hemodialysis for 30 Years or More

Abstract

The aim of our study was to evaluate vascular access in patients treated with chronic hemodialysis for 30 years or more. Patients who had started dialysis in 1978 or earlier were identified from the Slovenian Renal Replacement Therapy Registry. The data on vascular access on April 2008 are presented. Sixteen patients were still alive, seven men and nine women aged 62 +/- 12 years (46-84), and they had been treated for 32 +/- 1.7 years (30-35), mainly with chronic HD. They had started HD at the age of 30 +/- 12 years (13-50), and none had diabetes. The vascular access in nine was a native arteriovenous (AV) fistula, on the forearm in eight patients, and a brachiobasilic fistula in one patient. Four patients had their primary AV fistulas still in use (maximum 35 years). In the remaining five patients, multiple salvage procedures had been performed or new AV fistulas created. The vascular access in four patients was the polytetrafluoroethylene (PTFE) graft, functioning for 1-8 years. In three patients, a non-cuffed, single-lumen hemodialysis catheter (a precurved jugular in two patients and a subclavian in one) locked with 30% citrate, with mupirocin at the exit site, was used for 5-12 years. The catheters were exchanged approximately once every two years over a guide-wire because of mechanical damage. None of these three patients had had catheter-related sepsis or exit-site infection. Before catheters, these patients had had multiple AV fistulas and PTFE grafts. Although native AV fistula is the predominant type of vascular access, a greater than 30-year survival on hemodialysis is possible with the combined use of AV fistula, PTFE graft, and a non-cuffed hemodialysis catheter locked with citrate.

Reasons for Refusing Kidney Transplantation Among Chronic Dialysis Patients

“…Although kidney transplantation is widely considered as the best method of RRT, which prolongs the life of kidney transplantation recipients, the outcome of the transplantation itself is difficult to predict for individuals. Considering that dialysis patients are able to survive several decades on dialysis , can have an active life and full employment, and that female dialysis patients are able to give birth to healthy children , it may be understandable that some patients who are well adapted to dialysis can find it difficult to accept the possible risk of kidney transplantation. Fear is therefore the most common reason for refusing kidney transplantation among dialysis patients, as has been reported in the study of Vamos et al.…”

Preoperative ultrasound still valuable for radio-cephalic arteriovenous fistula creation?

“…Radio-cephalic arteriovenous fistula (RCAVF) creation proposed first by Brescia et al in 1966 was a ground-breaking technique that revolutionized vascular access creation and use (1). Today, many practicing nephrologists know that a well-matured and functioning RCAVF represents a precious access that may enable successful dialysis for more than 30 years (2). Unfortunately, RCAVFs suffer from high incidence of primary failure (pooled estimate of 15.3%) and a relatively poor long-term patency (i.e., pooled primary and secondary patencies at 1 year of 63% and 66%, respectively) (3).…”

Dialysis Patients Refusing Kidney Transplantation: Data From the Slovenian Renal Replacement Therapy Registry

“…In parallel to transplantation development, long‐term dialysis survivors (>30 or >40 years of dialysis treatment) are accumulating across the world (8,9) and in Slovenia (10) as living evidence of dialysis potential and achievements. The existence of such patients may have an important impact on a subgroup of dialysis patients already reluctant to enroll for kidney transplantation.…”