Survival and Prognostic Predictors of Primary Arteriovenous Fistula for Hemodialysis

Frequent use of percutaneous transluminal angioplasty is not associated with reduced vascular access recreation in a longitudinal ecology study

The frequency of percutaneous transluminal angioplasty (PTA) procedures has substantially increased, but its effect on vascular access recreation (VAR) remains inconclusive. We conducted a population-based retrospective analysis of Taiwan hemodialysis (HD) centers from 2004 to 2012. Data was accumulated into center-level characteristics, including patients' demographics, baseline characteristics, PTA procedures, and VAR. Center-level characteristics were summarized annually using appropriate measures. A mixed model assessed the association between PTA frequency and VAR rates, considering within-center correlation and adjusting for potential confounders. A total of 82,005 patients (mean age 62.7 ± 13.9 years, 50.5% male, 48.5% with diabetes mellitus) from 820 HD centers were analyzed. From 2004 to 2012, PTA frequency significantly increased from 1.24 to 3.23 per 1000 HD sessions, while VAR rates did not decline as expected (0.5-0.8 per 1000 HD sessions). Compared with the HD centers of infrequent use of PTA (annual lowest quartile, range 0.39-1.20 per 1000 HD sessions), the ones of frequent use (annual highest quartile, range 2.52-5.10 per 1000 HD sessions) didn't have lower VAR (range 0.54-0.99 vs. 0.50-0.91 per 1000 HD sessions, respectively). After controlling the potential confounders, the HD centers' PTA rates were not significantly associated with lower VAR rates (- 2.6, 95% confidence interval: - 30.3; 25.0, p = 0.85). Frequent use of PTA does not seem to improve VA patency at the center level, with no significant association identified with lower VAR. The indication of PTA in daily practice should be re-evaluated in terms of its efficiency in lowering VAR.

Factors influencing arteriovenous fistulas: A multicenter study

In this cross-sectional, descriptive study, the arteriovenous fistulas (AVF) of HD patients were evaluated by physical examination and factors associated with AVF function and longevity were investigated. Data were collected using a patient information form and the Arteriovenous Fistula Assessment Scale (AVF-AS). The study population included 279 patients under chronic HD treatment. Their mean age was 61.14 ± 14.00 years and 58.6% were men. Age, AVF location, and number of AVFs created were identified as factors associated with AVF needle entry site and flow problems, stenosis, and risk of developing ischemic complications (p = 0.005, p = 0.000, p = 0.006, respectively). AVF dysfunction adversely affected HD pump speed (p = 0.000) and HD adequacy (p = 0.000). It was determined that gender, AVF location, last AVF duration, and total number of previous AVF were identified as the risk of AVF complications. The results of this study revealed that regular follow-up and evaluation are needed to minimize the risk of dysfunction and failure due to AVF complications.