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Richards J, Summers D, Sidders A, Allen E, Ayaz Hossain M, Paul S, Slater M, Bartlett M, Lagaac R, Laing E, Hopkins V, Fitzpatrick-Creamer C, Hudson C, Parsons J, Turner S, Tambyraja A, Somalanka S, Hunter J, Dutta S, Hoye N, Lawman S, Salter T, Aslam MF, Bagul A, Sivaprakasam R, Smith GE, Thomas HL, Moinuddin Z, Knight SR, Barnett N, Motallebzadeh R, Pettigrew GJ. Doppler ultrasound surveillance of recently formed haemodialysis arteriovenous fistula: the SONAR observational cohort study. Health Technol Assess 2024; 28:1-54. [PMID: 38768043 PMCID: PMC11145465 DOI: 10.3310/ytbt4172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background Arteriovenous fistulas are considered the best option for haemodialysis provision, but as many as 30% fail to mature or suffer early failure. Objective To assess the feasibility of performing a randomised controlled trial that examines whether, by informing early and effective salvage intervention of fistulas that would otherwise fail, Doppler ultrasound surveillance of developing arteriovenous fistulas improves longer-term arteriovenous fistula patency. Design A prospective multicentre observational cohort study (the 'SONAR' study). Setting Seventeen haemodialysis centres in the UK. Participants Consenting adults with end-stage renal disease who were scheduled to have an arteriovenous fistula created. Intervention Participants underwent Doppler ultrasound surveillance of their arteriovenous fistulas at 2, 4, 6 and 10 weeks after creation, with clinical teams blinded to the ultrasound surveillance findings. Main outcome measures Fistula maturation at week 10 defined according to ultrasound surveillance parameters of representative venous diameter and blood flow (wrist arteriovenous fistulas: ≥ 4 mm and > 400 ml/minute; elbow arteriovenous fistulas: ≥ 5 mm and > 500 ml/minute). Mixed multivariable logistic regression modelling of the early ultrasound scan data was used to predict arteriovenous fistula non-maturation by 10 weeks and fistula failure at 6 months. Results A total of 333 arteriovenous fistulas were created during the study window (47.7% wrist, 52.3% elbow). By 2 weeks, 37 (11.1%) arteriovenous fistulas had failed (thrombosed), but by 10 weeks, 219 of 333 (65.8%) of created arteriovenous fistulas had reached maturity (60.4% wrist, 67.2% elbow). Persistently lower flow rates and venous diameters were observed in those fistulas that did not mature. Models for arteriovenous fistulas' non-maturation could be optimally constructed using the week 4 scan data, with fistula venous diameter and flow rate the most significant variables in explaining wrist fistula maturity failure (positive predictive value 60.6%, 95% confidence interval 43.9% to 77.3%), whereas resistance index and flow rate were most significant for elbow arteriovenous fistulas (positive predictive value 66.7%, 95% confidence interval 48.9% to 84.4%). In contrast to non-maturation, both models predicted fistula maturation much more reliably [negative predictive values of 95.4% (95% confidence interval 91.0% to 99.8%) and 95.6% (95% confidence interval 91.8% to 99.4%) for wrist and elbow, respectively]. Additional follow-up and modelling on a subset (n = 192) of the original SONAR cohort (the SONAR-12M study) revealed the rates of primary, assisted primary and secondary patency arteriovenous fistulas at 6 months were 76.5, 80.7 and 83.3, respectively. Fistula vein size, flow rate and resistance index could identify primary patency failure at 6 months, with similar predictive power as for 10-week arteriovenous fistula maturity failure, but with wide confidence intervals for wrist (positive predictive value 72.7%, 95% confidence interval 46.4% to 99.0%) and elbow (positive predictive value 57.1%, 95% confidence interval 20.5% to 93.8%). These models, moreover, performed poorly at identifying assisted primary and secondary patency failure, likely because a subset of those arteriovenous fistulas identified on ultrasound surveillance as at risk underwent subsequent successful salvage intervention without recourse to early ultrasound data. Conclusions Although early ultrasound can predict fistula maturation and longer-term patency very effectively, it was only moderately good at identifying those fistulas likely to remain immature or to fail within 6 months. Allied to the better- than-expected fistula patency rates achieved (that are further improved by successful salvage), we estimate that a randomised controlled trial comparing early ultrasound-guided intervention against standard care would require at least 1300 fistulas and would achieve only minimal patient benefit. Trial Registration This trial is registered as ISRCTN36033877 and ISRCTN17399438. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR135572) and is published in full in Health Technology Assessment; Vol. 28, No. 24. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- James Richards
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Dominic Summers
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Anna Sidders
- NHS Blood and Transplant Clinical Trials Unit, London, UK
| | - Elisa Allen
- NHS Blood and Transplant Clinical Trials Unit, London, UK
| | | | - Subhankar Paul
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Matthew Slater
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Regin Lagaac
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emma Laing
- NHS Blood and Transplant Clinical Trials Unit, London, UK
| | | | | | - Cara Hudson
- NHS Blood and Transplant Clinical Trials Unit, London, UK
| | - Joseph Parsons
- NHS Blood and Transplant Clinical Trials Unit, London, UK
| | | | | | | | - James Hunter
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Sam Dutta
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Neil Hoye
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Sarah Lawman
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Tracey Salter
- Epsom and St Helier University Hospitals NHS Trust, Epsom, UK
- Frimley Health NHS Foundation Trust, Frimley, UK
| | | | - Atul Bagul
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Helen L Thomas
- NHS Blood and Transplant Clinical Trials Unit, London, UK
| | - Zia Moinuddin
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Simon R Knight
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Gavin J Pettigrew
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
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2
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Yan T, Gameiro J, Grilo J, Filipe R, Rocha E. Hemodialysis vascular access in elderly patients: A comprehensive review. J Vasc Access 2024; 25:27-39. [PMID: 35546530 DOI: 10.1177/11297298221097233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The number of elderly patients initiating hemodialysis (HD) increased considerably over the past decade. Arteriovenous fistulas (AVFs) are the preferred vascular access (VA) type in most HD patients. Choice of VA for older hemodialysis patients presents a challenge. The higher incidence of comorbidities, longer AVF maturation times, risk of primary failure, risk of patency loss, and shorter life expectancy are important factors to consider. In this review we provide a comprehensive analysis on maturation rates, primary failure, patency, and mortality regarding vascular access in patients older than 75 years of age.
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Affiliation(s)
- Teófilo Yan
- Division of Nephrology, Department of Medicine, Unidade Local de Saúde de Castelo Branco, EPE, Castelo Branco, Portugal
| | - Joana Gameiro
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - João Grilo
- Division of Nephrology, Department of Medicine, Unidade Local de Saúde de Castelo Branco, EPE, Castelo Branco, Portugal
| | - Rui Filipe
- Division of Nephrology, Department of Medicine, Unidade Local de Saúde de Castelo Branco, EPE, Castelo Branco, Portugal
| | - Ernesto Rocha
- Division of Nephrology, Department of Medicine, Unidade Local de Saúde de Castelo Branco, EPE, Castelo Branco, Portugal
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Rolnick N, de Sousa Neto IV, da Fonseca EF, Neves RVP, Rosa TDS, Nascimento DDC. Potential implications of blood flow restriction exercise on patients with chronic kidney disease: a brief review. J Exerc Rehabil 2022; 18:81-95. [PMID: 35582687 PMCID: PMC9081410 DOI: 10.12965/jer.2244082.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 11/22/2022] Open
Abstract
Combining blood flow restriction (BFR) with exercise is considered a relevant, helpful method in load-compromised individuals and a viable replacement for traditional heavy-load strength training. BFR exercise may be particularly useful for those unable to withstand high mechanical stresses on joints resulting in skeletal muscle dysfunction, such as patients with chronic kidney disease (CKD). Current literature suggests that BFR training displays similar positive health benefits to exercise training alone for CKD patients, including maintenance of muscle strength, glomerular filtration rate maintenance, uremic parameters, inflammatory profile, redox status, glucose homeostasis, blood pressure adjustments, and low adverse reports. In this review of nine studies in CKD patients, we clarify the potential safety and health effects of exercise training with BFR compared to exercise training alone and recommend insights for future research and practical use. Furthermore, we introduce relevant gaps in this emerging field, providing substantial guidance, critical discussion, and valuable preliminary conclusions in this demographic of patients. However, based on the limited studies in this area, more research is necessary to determine the optimal BFR exercise programming.
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Affiliation(s)
- Nicholas Rolnick
- The Human Performance Mechanic, Lehman College, New York, NY,
USA
| | - Ivo Vieira de Sousa Neto
- Laboratory of Molecular Analysis, Faculty of Ceilândia, Universidade de Brasília, Distrito Federal, Brasilia,
Brazil
- Graduate Program of Sciences and Technology of Health, Faculty of Ceilândia, Universidade de Brasília, Distrito Federal, Brasilia,
Brazil
| | - Eduardo Fernandes da Fonseca
- Post-Graduate Program of Physical Education, Catholic University of Brasilia, Distrito Federal, Brasilia,
Brazil
| | | | - Thiago dos Santos Rosa
- Post-Graduate Program of Physical Education, Catholic University of Brasilia, Distrito Federal, Brasilia,
Brazil
| | - Dahan da Cunha Nascimento
- Post-Graduate Program of Physical Education, Catholic University of Brasilia, Distrito Federal, Brasilia,
Brazil
- Corresponding author: Dahan da Cunha Nascimento, Post-Graduate Program of Physical Education, Catholic University of Brasilia, Distrito Federal, Brasilia 71966-700, Brazil,
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Liu P, Pang SC, Li H, Tan RY, Tng RKA, Gan SWS, Choong HLL, Chong TT, Tan CS. Outcomes of arteriovenous fistula in elderly patients on maintenance haemodialysis. Int Urol Nephrol 2021; 53:1923-1931. [PMID: 33675478 DOI: 10.1007/s11255-021-02822-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The optimal vascular access strategy in elderly patients receiving haemodialysis (HD) remains controversial. We aim to report the outcomes of arteriovenous fistula (AVF) in elderly patients initiated on maintenance HD in our centre. METHODS Medical records of 688 incident patients initiated on HD from 2010 to 2012 in a tertiary centre were retrospectively reviewed. Patients' characteristics and AVF outcomes were compared among those < 65 years (non-elderly), ≥ 65-75 years (early elderly) and ≥ 75 years (late elderly). RESULTS There were 418 non-elderly, 184 early elderly and 86 late elderly patients. There is a higher proportion of brachiocephalic and brachiobasilic fistula created in the late elderly (24.9% vs. 37.0% vs. 41.8%, p = 0.001). The outcomes of accesses created were comparable in the 3 age groups with similar proportions of functional AVFs (80.4% vs. 79.3% vs. 75.6%, p = 0.832) and comparable 1-, 3- and 5-year primary and secondary patency rates (p = 0.351 and 0.282, respectively). However, a longer maturation time (2.78 vs. 2.86 vs. 3.72 months, p = 0.010) and a higher mean number of interventions to assist maturation of the first AVF were required in late elderly patients (0.19 vs. 0.22 vs. 0.35, p = 0.014). Following AVF creation, median patient survival in the non-elderly, early and late elderly was 65.2 vs. 55.1 vs. 49.8 months respectively. CONCLUSION AVFs created in elderly patients have comparable outcomes compared to non-elderly patients although more interventions are required to assist maturation with a longer maturation time necessitating early access creation to allow for time needed due to maturation delay.
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Affiliation(s)
- Peiyun Liu
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
| | - Suh Chien Pang
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Huihua Li
- Division of Research, Singapore General Hospital, Singapore, Singapore
| | - Ru Yu Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Ren Kwang Alvin Tng
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Hui Lin Lina Choong
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
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5
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Xiong Y, Yu Y, Zhang C, Morris E, Wang L, Deng Y, Li Y, Fu P. The role of echocardiography in prognosis for dysfunction and abandonment of radiocephalic arteriovenous fistula in elderly Chinese patients on hemodialysis. Semin Dial 2020; 33:309-315. [PMID: 32201991 DOI: 10.1111/sdi.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/29/2020] [Accepted: 03/06/2020] [Indexed: 02/05/2023]
Abstract
The objective of this study was to examine the impact of cardiac structure and function at baseline on the outcomes associated with arteriovenous fistula (AVF) in patients on hemodialysis (HD). Patients who initiated HD aged ≥70 years and received a mature AVF creation were included retrospectively. Echocardiographic parameters measured within 1 week before AVF creation were acquired. The observational period for each patient was from the point of AVF creation to the last time of follow-up unless AVF abandonment or death occurred. Kaplan-Meier and Cox proportional hazard regression analyses were conducted. A total of 82 elderly Chinese HD patients with mature radiocephalic AVF (RCAVF) and EF ≥50% were analyzed. During the median study period of 26.8 (12-40) months, 42 (51.2%) experienced RCAVF dysfunction and 34 (41.5%) progressed to abandonment. Primary and cumulative patencies at 6, 12, 24, and 36 months were 81%, 73%, 48%, 38%, and 84%, 81%, 68%, 55%, respectively. Left ventricle end-diastolic volume (LVEDV) ≤103.5 mL (HR = 2.5, P = .019) and the right side of RCAVF (HR = 3.59, P = .003) significantly predicted RCAVF dysfunction. The main pulmonary artery internal diameter (MPAID) ≤21.5 mm (HR = 4.3, P = .001) as well as the right side (HR = 2.95, P = .047) were the independent predictors for RCAVF abandonment. In conclusion, LVEDV, MPAID assessed by echocardiography and the right side of RCAVF, showed significant predictive implications for the outcomes of RCAVF. Disparities among nationalities in the areas of utilization and patency of AVFs necessitate additional studies.
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Affiliation(s)
- Yuqin Xiong
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Yang Yu
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.,National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Chunle Zhang
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Emily Morris
- Department of Biostatistics, University of Michigan, Ann Arbor, USA
| | - Liya Wang
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuchen Deng
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, USA
| | - Ping Fu
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.,National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
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Viecelli AK, Lok CE. Hemodialysis vascular access in the elderly-getting it right. Kidney Int 2019; 95:38-49. [PMID: 30606427 DOI: 10.1016/j.kint.2018.09.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/21/2018] [Accepted: 09/11/2018] [Indexed: 01/01/2023]
Abstract
Choosing the optimal hemodialysis vascular access for the elderly patient is best achieved by a patient-centered coordinated multidisciplinary team approach that aligns the patient's end-stage kidney disease Life-Plan, i.e., the individual treatment approach (supportive care, time-limited or long-term kidney replacement therapy, or combination thereof) and selection of dialysis modality (peritoneal dialysis versus hemodialysis) with the most suitable dialysis access. Finding the right balance between the patient's preferences, the likelihood of access function and survival, and potential complications in the context of available resources and limited patient survival can be extremely challenging. The framework for choosing the most appropriate vascular access for the elderly presented in this review considers the individual end-stage kidney disease Life-Plan, the patient life expectancy, the likelihood of access function and survival, the timing of dialysis relative to access placement, prior access history, and patient preference. This complex decision-making process should be dynamic in order to accommodate patients' changing needs and life and health circumstances. Effective and timely communication between the patient, their caregivers, and treating team is key to delivering truly patient-centered care. Delivering this care also requires overcoming the limitations of the currently available evidence that is predominantly based on observational data with its inherent risks of bias. While challenging, future randomized controlled studies exploring the risks, benefits, costs, and timing of placement of available access types in the elderly are required to help us "get it right" for our patients.
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Affiliation(s)
- Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Charmaine E Lok
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Comparative outcomes of vascular access in patients older than 70 years with end-stage renal disease. J Vasc Surg 2019; 69:1196-1206.e5. [DOI: 10.1016/j.jvs.2018.07.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 07/22/2018] [Indexed: 11/19/2022]
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8
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Bae E, Lee H, Kim DK, Oh KH, Kim YS, Ahn C, Han JS, Min SI, Min SK, Kim HC, Joo KW. Autologous arteriovenous fistula is associated with superior outcomes in elderly hemodialysis patients. BMC Nephrol 2018; 19:306. [PMID: 30400882 PMCID: PMC6218981 DOI: 10.1186/s12882-018-1109-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/19/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The number of elderly patients with end-stage renal disease is increasing rapidly. The higher prevalence of comorbidities and shorter life expectancy in these patients make it difficult to decide on the type of vascular access (VA). We explored the optimal choice for VA in elderly hemodialysis patients. METHODS We included elderly patients (> 65 years) visiting our VA clinic and divided them into three groups as follows: radiocephalic arteriovenous fistula (AVF), brachiocephalic AVF, and prosthetic arteriovenous graft (AVG). The primary outcomes were VA abandonment and all-cause mortality. The secondary outcome was maturation failure (MF). RESULTS Of 529 patients, 61.2% were men. The mean age was 73.6 ± 6.0 years. The VA types were as follows: 49.9% radiocephalic AVF, 31.8% brachiocephalic AVF, and 18.3% AVG. Patients with an AVG tended to be older, female, and have a lower body mass index. More than half of patients (n = 302, 57.1%) started dialysis with central catheters, but the proportion of predialysis central catheter placement was not different among the VA types. Radiocephalic AVF was significantly superior to AVG in terms of VA abandonment (P = 0.005) and all-cause mortality (P < 0.001) in spite of a higher probability of MF. Brachiocephalic AVF was associated with a shorter time to the first needling and fewer interventions before maturation than radiocephalic AVF. CONCLUSIONS Autologous AVF was suggested as the preferred VA choice in terms of long-term outcomes in elderly patients.
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Affiliation(s)
- Eunjin Bae
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Suk Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang-Il Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080 Republic of Korea
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Regional Versus Local Anaesthesia for Haemodialysis Arteriovenous Fistula Formation: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2017; 53:734-742. [DOI: 10.1016/j.ejvs.2017.01.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/31/2017] [Indexed: 01/09/2023]
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