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Zhang RH, Xiang Y. Ipsilateral versus contralateral tunneled dialysis catheter and its impact on arteriovenous fistula function. Asian J Surg 2024:S1015-9584(24)01332-0. [PMID: 38972815 DOI: 10.1016/j.asjsur.2024.06.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/10/2024] [Accepted: 06/28/2024] [Indexed: 07/09/2024] Open
Affiliation(s)
- Rong-Hua Zhang
- Department of Nephrology, Yunyang Traditional Chinese Medicine Hospital, Chongqing, China
| | - Yan Xiang
- Department of Nephrology, Yunyang Traditional Chinese Medicine Hospital, Chongqing, China.
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Koudounas G, Giannopoulos S, Volteas P, Aljobeh A, Karkos C, Virvilis D. Arteriovenous Fistula Maturation in Patients with Ipsilateral Versus Contralateral Tunneled Dialysis Catheter: A Systematic Review and Meta-analysis. Ann Vasc Surg 2024; 103:14-21. [PMID: 38307236 DOI: 10.1016/j.avsg.2023.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/10/2023] [Accepted: 11/25/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Although it is evident that a prior history of tunneled dialysis catheter (TDC) affects arteriovenous fistula (AVF) function, it is unclear whether its location (contralateral versus ipsilateral to AVF) has any effect on AVF maturation and failure rates. We aimed to document this possible effect. METHODS This systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing outcomes between patients with contralateral TDC (CONTRA group) and those with ipsilateral one (IPSI group) were examined for inclusion. A random effects model meta-analysis of the odds ratio (OR) was conducted. Primary outcomes were AVF functional maturation, assisted maturation, and failure rates. RESULTS Four eligible studies comprising 763 patients were included in the meta-analysis. There were no significant differences in terms of AVF functional maturation (OR: 1.49; 95% confidence interval [CI]: 0.64-3.47; I2 = 83.4%), assisted maturation (OR: 0.59; 95% CI: 0.29-1.19; I2 = 61.4%), and failure rates (OR: 0.67; 95% CI: 0.29-1.58; I2 = 83.3%) between the 2 study groups. CONCLUSIONS TDC laterality seems not to affect fistula maturation rate in patients requiring TDC placement and concurrent AVF creation, but rather, vein- and patient-related characteristics might play a more important role in choosing TDC access site. Further studies are needed to validate these results.
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Affiliation(s)
- Georgios Koudounas
- Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Stefanos Giannopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Panagiotis Volteas
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Ahmad Aljobeh
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Christos Karkos
- Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Dimitrios Virvilis
- Department of Vascular and Endovascular Surgery, St Francis Hospital & Heart Center, Roslyn, NY.
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Kim MJ, Ko H, Kim SM. Predicting factors for early failure of vascular access in hemodialysis patients. Ann Surg Treat Res 2024; 106:255-262. [PMID: 38725806 PMCID: PMC11076948 DOI: 10.4174/astr.2024.106.5.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/25/2024] [Accepted: 03/04/2024] [Indexed: 05/12/2024] Open
Abstract
Purpose This study aimed to investigate the incidence of early failure of vascular access for hemodialysis, and determine which factors measured in duplex ultrasound study could predict early failure. Methods We performed a retrospective review of patients who underwent arteriovenous fistula (AVF) or arteriovenous graft (AVG) creation for hemodialysis between September 2019 and January 2023. Early failure was defined as any event that required surgical or endovascular intervention within 6 months following AVF or AVG creation. Results A total of 189 patients were included. Early failure occurred in 36 patients (19.0%), which included 22 AVFs and 14 AVGs. In the patients who underwent AVF, the preoperative venous diameter, postoperative venous and arterial diameters, and flow volume of AVF all were significantly smaller in the early failure group compared to the patent group. In AVG, the preoperative venous diameter was the only parameter that differed between the 2 groups. A sonographic score was defined based on these factors. In a multivariable analysis, male sex, a previous history of AVF or AVG creation, and sonographic score were found to be significantly associated with early failure. The postoperative venous diameter in AVF and the preoperative venous diameter in AVG were highly predictive of early failure (areas under the curves 0.92 and 0.82, respectively). Conclusion Venous diameter measured 6 weeks following AVF operation and preoperative venous diameter in AVG were highly predictive of early failure among the duplex ultrasound parameters. Surveillance strategies in the early phase following vascular access creation can be based on these factors.
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Affiliation(s)
- Min Jun Kim
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyunmin Ko
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Suh Min Kim
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Hu S, Wang R, Ma T, Lei Q, Yuan F, Zhang Y, Wang D, Cheng J. Association between preoperative C-reactive protein to albumin ratio and late arteriovenous fistula dysfunction in hemodialysis patients: a cohort study. Sci Rep 2023; 13:11184. [PMID: 37433824 DOI: 10.1038/s41598-023-38202-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023] Open
Abstract
Arteriovenous fistula (AVF) dysfunction is a critical complication in hemodialysis (HD) patients, with inflammation potentially contributing to its development. This retrospective cohort study aimed to investigate the association between preoperative C-reactive protein to albumin ratio (CAR) and AVF dysfunction in Chinese HD patients. A total of 726 adults with end-stage renal disease who underwent new AVF placement between 2011 and 2019 were included. Multivariable Cox regression and Fine and Gray competing risk models were employed to assess the relationship between CAR and AVF dysfunction, considering death and renal transplantation as competing risks. Among 726 HD patients, 29.2% experienced AVF dysfunction during a median follow-up of 36 months. Adjusted analyses revealed that higher CAR levels were associated with an increased risk of AVF dysfunction, with a 27% higher risk per one-unit increase in CAR. Furthermore, patients with CAR values ≥ 0.153 exhibited a 75% elevated risk compared to those with CAR values < 0.035 (P = 0.004). The relationship between CAR and AVF dysfunction varied by the site of internal jugular vein catheter placement (P for trend = 0.011). Notably, the Fine and Gray analysis confirmed the association between CAR and AVF dysfunction, with a 31% increased risk per one-unit increase in CAR. The highest CAR tertile remained an independent predictor of AVF dysfunction (HR = 1.77, 95% CI 1.21-2.58, P = 0.003). These findings highlight the potential of CAR as a prognostic marker for AVF dysfunction in Chinese HD patients. Clinicians should consider CAR levels and catheter placement site when assessing the risk of AVF dysfunction in this population.
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Affiliation(s)
- Shouliang Hu
- Division of Nephrology, The First Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, Hubei, China
| | - Runjing Wang
- Department of Basic Medicine, Xiamen Medical College, Xiamen, China
| | - Tean Ma
- Division of Nephrology, The First Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, Hubei, China
| | - Qingfeng Lei
- Division of Nephrology, The First Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, Hubei, China
| | - Fanli Yuan
- Division of Nephrology, The First Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, Hubei, China
| | - Yong Zhang
- Division of Nephrology, Jianli County People's Hospital, Jingzhou, Hubei, China
| | - Dan Wang
- Central Laboratory, The First Hospital of Yangtze University, Jingzhou, Hubei, China.
| | - Junzhang Cheng
- Division of Nephrology, The First Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, Hubei, China.
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Diep J, Makris A, De Guzman I, Wong J, Aravindan A, Nandakoban H, Narayanan G. Impact of Previous Tunneled Vascular Catheters and their Location on Upper Limb Arteriovenous Fistula Function. KIDNEY360 2021; 2:1953-1959. [PMID: 35419532 PMCID: PMC8986056 DOI: 10.34067/kid.0003362021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/07/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND Long-term arteriovenous fistula (AVF) survival has been shown to be adversely affected by the presence of previous tunneled vascular catheters (TVC). We analyzed the effect of previous TVCs and their location (ipsilateral versus contralateral) on the successful function of upper-limb AVFs in the first 12 months after creation. METHODS We retrospectively reviewed clinical data on patients' first upper-limb AVFs, created between January 2013 and December 2017. We analyzed the rates of successful AVF function (successful cannulation using two needles for ≥50% sessions over a 2-week period) at 6 and 12 months after creation, time to AVF maturation, and rates of assisted maturation. RESULTS In total, 287 patients with first AVFs were identified, of which 142 patients had a previous TVC (102 contralateral, 40 ipsilateral) and 145 had no previous TVC. The no TVC group had higher rates of AVF function at both 6 months (69% versus 54%, OR, 1.84; 95% CI, 1.00 to 3.39, P=0.05) and 12 months (84% versus 64%, OR, 3.10; 95% CI, 1.53 to 6.26, P=0.002) compared with the TVC group. The contralateral TVC group had higher rates of AVF function at 6 months (60% versus 40%, OR, 2.21; 95% CI, 1.01 to 4.88, P=0.05), but not at 12 months (66% versus 58%, OR, 1.42; 95% CI, 0.62 to 3.25, P=0.40) compared with the ipsilateral TVC group. The median time to AVF maturation in the contralateral and ipsilateral TVC groups were 121.5 and 146 days respectively (P=0.07). Assisted maturation rates were lower in no TVC group compared with the TVC group (12% versus 28%, P=0.007), but similar between the contralateral and ipsilateral TVC groups (29% versus 26%, P=0.74). CONCLUSIONS Previous TVC use was associated with poorer AVF function at 6 and 12 months, with a higher rate of assisted maturation. The presence of an ipsilateral TVC was associated with lower successful AVF use at 6 months, compared with contralateral TVC.
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Affiliation(s)
- Jason Diep
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
| | - Angela Makris
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
| | - Imelda De Guzman
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
| | - Jeffery Wong
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
| | | | - Hareeshan Nandakoban
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Govind Narayanan
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
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Bartolomeo K, Vachharajani TJ, Shingarev R. The Sisyphean Task of Getting the Arteriovenous Fistula to Mature. KIDNEY360 2021; 2:1873-1875. [PMID: 35419541 PMCID: PMC8986049 DOI: 10.34067/kid.0007452021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 02/04/2023]
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See YP, Cho Y, Pascoe EM, Cass A, Irish A, Voss D, Polkinghorne KR, Hooi LS, Ong LM, Paul-Brent PA, Kerr PG, Mori TA, Hawley CM, Johnson DW, Viecelli AK. Predictors of Arteriovenous Fistula Failure: A Post Hoc Analysis of the FAVOURED Study. ACTA ACUST UNITED AC 2020; 1:1259-1269. [DOI: 10.34067/kid.0002732020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/27/2020] [Indexed: 11/27/2022]
Abstract
BackgroundAn autologous arteriovenous fistula (AVF) is the preferred hemodialysis vascular access, but successful creation is hampered by high rates of AVF failure. This study aimed to evaluate patient and surgical factors associated with AVF failure to improve vascular access selection and outcomes.MethodsThis is a post hoc analysis of all participants of FAVOURED, a multicenter, double-blind, multinational, randomized, placebo-controlled trial evaluating the effect of fish oil and/or aspirin in preventing AVF failure in patients receiving hemodialysis. The primary outcome of AVF failure was a composite of fistula thrombosis and/or abandonment and/or cannulation failure at 12 months post-AVF creation, and secondary outcomes included individual outcome components. Patient data (demographics, comorbidities, medications, and laboratory data) and surgical factors (surgical expertise, anesthetic, intraoperative heparin use) were examined using multivariable logistic regression analyses to evaluate associations with AVF failure.ResultsOf 536 participants, 253 patients (47%) experienced AVF failure during the study period. The mean age was 55±14.4 years, 64% were male, 45% were diabetic, and 4% had peripheral vascular disease. Factors associated with AVF failure included female sex (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.20 to 2.68), lower diastolic BP (OR for higher DBP, 0.85; 95% CI, 0.74 to 0.99), presence of central venous catheter (OR, 1.49; 95% CI, 1.02 to 2.20; P=0.04), and aspirin requirement (OR, 1.60; 95% CI, 1.00 to 2.56).ConclusionsFemale sex, requirement for aspirin therapy, requiring hemodialysis via a central venous catheter, and lower diastolic BP were factors associated with higher odds of AVF failure. These associations have potential implications for vascular access planning and warrant further studies.
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MacRae JM, Clarke A, Ahmed SB, Elliott M, Quinn RR, James M, King-Shier K, Hiremath S, Oliver MJ, Hemmelgarn B, Scott-Douglas N, Ravani P. Sex differences in the vascular access of hemodialysis patients: a cohort study. Clin Kidney J 2020; 14:1412-1418. [PMID: 33959269 PMCID: PMC8087139 DOI: 10.1093/ckj/sfaa132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 05/18/2020] [Indexed: 11/14/2022] Open
Abstract
Background We describe differences for probability of receiving a fistula attempt, achieving fistula use, remaining catheter-free and the rate of access-related procedures as a function of sex. Methods Prospectively collected vascular access data on incident dialysis patients from five Canadian programs using the Dialysis Measurement Analysis and Reporting System to determine differences in fistula-related outcomes between women and men. The probability of receiving a fistula attempt and the probability of fistula use were determined using binary logistic regression. Catheter and fistula procedure rates were described using Poisson regression. We studied time to fistula attempt and time to fistula use, accounting for competing risks. Results We included 1446 (61%) men and 929 (39%) women. Men had a lower body mass index (P < 0.001) and were more likely to have coronary artery disease (P < 0.001) and peripheral vascular disease (p < 0.001). A total of 688 (48%) men and 403 (43%) women received a fistula attempt. Women were less likely to receive a fistula attempt by 6 months {odds ratio [OR] 0.64 [95% confidence interval (CI) 0.52-0.79]} and to achieve catheter-free use of their fistula by 1 year [OR 0.38 (95% CI 0.27-0.53)]. At an average of 2.30 access procedures per person-year, there is no difference between women and men [incidence rate ratio (IRR) 0.97 (95% CI 0.87-1.07)]. Restricting to those with a fistula attempt, women received more procedures [IRR 1.16 (95% CI 1.04-1.30)] attributed to increased catheter procedures [IRR 1.50 (95% CI 1.27-1.78)]. There was no difference in fistula procedures [IRR women versus men 0.96 (95% CI 0.85-1.07)]. Conclusion Compared with men, fewer women undergo a fistula attempt. This disparity increases after adjusting for comorbidities. Women have the same number of fistula procedures as men but are less likely to successfully use their fistula.
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Affiliation(s)
- Jennifer M MacRae
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Alix Clarke
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sofia B Ahmed
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Meghan Elliott
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rob R Quinn
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Matthew James
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn King-Shier
- Faculty of Nursing and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Matthew J Oliver
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brenda Hemmelgarn
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nairne Scott-Douglas
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pietro Ravani
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
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