Evolutive profile of hemodialysis vascular accesses Hemodialysis accesses
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Abstract
Abstract
Introduction
Arterio-venous fistula (AVF) is the first-choice vascular access for hemodialysis (HD). Hemodialysis catheter (KT) may be a temporary or permanent alternative.
Aim: To evaluate indications of KT and AVF and their predictive factors of complications.
Methods
It’s a retrospective multicentric study interesting KT and AVF in patients treated by hemodialysis, in the Kef Governorate in north-western Tunisia, during the period from 01/07/18 to 31/12/18.
Results
We included 288 AVF and 148 KT that were created on 205 patients. The average age was 58.14 years, the sex ratio was 1.5. Hypertensive patients and diabetics represented respectively 83.9% and 27.3% of the population. Diabetic nephropathy was the most common (25.9%). For the KT, the main indication was the wait for AVF creation (68.9%). The overall incidence of immediate complications was 11.5%. Dysfunction was reported in 23.6% of cases with obesity and tunneled type of KT as contributing factors. KT infection was occuring in 39.2% of cases. It was promoted by prolonged duration of use and hemoglobin level < 8g/dl. The use of antiseptic lock reduced infections’ risk (p=0.011). For AVF, the most common complications were thrombosis (36.2%), aneurysm (29.9%) and stenosis (22.6%). Survival rate was 60% at 2000 days. The AVF impairing factors were diabetes (p=0.05), obesity (p=0.05), anterior AVF creation (p=0.011), AVF grafts (p=0.016), and anticoagulant therapy (p=0.0001). Antiplatelet therapy improved AVF patency (p=0.02).
Conclusion
Much remained to be done to reduce KT complications, creation of AVF on time and prevention of their complications.
Keywords:
renal insufficiency, hemodialysis, arteriovenous fistula, central venous catheterization##plugins.themes.academic_pro.article.details##
References
- [1] Banerjee T, Kim SJ, Astor B, Shafi T, Coresh J, Powe NR. Vascular access type, inflammatory markers, and mortality in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study. Am J Kidney Dis 2014; 64:954-61. [2] Do Hyoung K, Ji In P , Jung Pyo L, Yong-Lim K, Shin-Wook K, Chul Woo Y et al.The effects of vascularaccess types on the survival and quality of life and depression in the incident hemodialysis patients. Ren Fail 2020;42:30-9. [3] Firouraghi N, Jahromi SE, Sami A, Sharifian R. Duration of Vascular Access Usage and Patient Survival in the First Year of Hemodialysis. Iran J Kidney 2019;13:398-403. [4] Agarwal AK, Haddad NJ, Vachharajani TJ, Asif A. Innovations in vascular access for hemodialysis. Kidney Int 2019;95:1053-63 [5] Murea M, Geary RL, Davis RP, Moossavi S. Vascular access for hemodialysis: A perpetual challenge. Semin Dial 2019;32:527-34. [6] Raza H, Hashmi MN, Dianne V, Hamza M, Hejaili F, Sayyari AA. Vascular access outcome with a dedicated vascular team based approach. Saudi J Kidney Dis Transpl 2019;30:39-44. [7] Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966;275:1089-92. [8] Böhlke M, Uliano G, Barcellos FC. Hemodialysis catheter-related infection: prophylaxis, diagnosis and treatment. J Vasc Access 2015;16:347-55. [9] Lee T, Mokrzycki M, Moist L, Maya I, Vazquez M, Lok CE. Standardized definitions for hemodialysis vascular access. Semin Dial 2011;24:515-24. [10] Pisoni RL, Zepel L, Port FK, Robinson BM. Trends in us vascular access use, patient preferences, and related practices: an update from the US DOPPS practice monitor with international comparisons. Am J Kidney Dis 2015;65:905-15. [11] KDOQI clinical practice guideline for vascular access. New York: National Kidney Foundation-Dialysis Outcomes Quality Initiative 2018. [12] Glaudet F, Jaïs JP, Moranne O, Lassalle M. Caractéristiques cliniques et indicateurs de prise en charge des patients en dialyse: rapport annuel du registre REIN. Agence of biomedecine 2016:191-235. [13] Ben Hamida F, M'hibik S, Karoui C, Abderrahim E, Kaaroud H, Beji S, et al. Indications, complications and cost of internal jugular catheters in hemodialysed patients: study of 533 cases. Tunis Med 2005;83:519-23. [14] Pisoni RL, Arrington CJ, Albert JM, Ethier J, Kimata N, Krishnan M, et al. Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis 2009;53:475-91. [15] Aran R, Li Y, Robinson B, Abbott KC, Agodoa LYC, Ayanian J, et al. United States renal data system: vascular access. Am J Kidney Dis. 2019;73:369-86. [16] Randriamanantsoa LN, Rajaonera TA, Ramanamidora DA, Ravalisoa ML, Andriamarotia HW, Rabenatoandro R. Les complications des cathéters veineux centraux d'hémodialyse dans les centres d'hémodialyse d'Antananarivo. Rev Anest Rea Med Urg 2011;3:1-5. [17] Lee T. Fistula first initiative: historical impact on vascular access practice patterns and influence on future vascular access care. Cardiovasc Eng Technol 2017;8:244-54. [18] Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg 2007;204:681-96. [19] Leou S, Garnier F, Testevuide P, Lumbroso C, Rigault S, Cordonnier C, et al. Infectious complications rate from hemodialysis catheters: experience from the French Polynesia Nephrol Ther 2013;9:137-42. [20] David N, Ian R, Elias A, Mohamad ALA, Vincent B, Sandra C, et al. DIALIN Network. 2018. [21] Chan MR. Hemodialysis central venous catheter dysfunction. Semin Dial 2008;21:516-21. [22] Bourquelot P. Abords vasculaires pour hémodialyse. Nephrol Ther 2009;5:239-48. [23] Smith GE, Gohil R, Chetter IC. Factors affecting the patency of arteriovenous fistulas for dialysis access. J Vasc Surg 2012;55:849-55. [24] Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DL. A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 2007;45:420-6. [25] Gibson KD, Gillen DL, Caps MT, Kohler TR, Sherrard DJ, Stehman Breen CO. Vascular access survival and incidence of revisions: a comparison of prosthetic grafts, simple autogenous fistulas, and venous transposition fistulas from the United States renal data system dialysis morbidity and mortality study. J Vasc Surg 2001;34:694-700. [26] Gheith OA, Kamal MM. Dialysis risk factors of vascular access failure in patients on hemodialysis. Iran J Kidney Dis 2008;2:201-7. [27] Kats M, Hawxby AM, Barker J, Allon M. Impact of obesity on arteriovenous fistula outcomes in dialysis patients. Kidney Int 2007;7:39-43. [28] Monroy Cuadros M, Yilmaz S, Salazar Bañ A, Doig C. Risk factors associated with patency loss of hemodialysis vascular access within 6 months. Clin J Am Soc Nephrol 2010;5:1787-92. [29] Wayne EJ, Brier ME, Dwyer AC. Association of maturation period blood pressure with dialysis access patency. Semin Dial 2013;26:90-6. [30] Kalantarinia K, Campbell A, Mourad S, Kauffnan J, Deaver K. 141: Timing of hemodialysis vascular access placement determines access outcomes. Am J Kidney Dis 2010;55:67. [31] Zouaghi MK, Lammouchi MA, Hassen M, Rais L, Smaoui W, Jebali H, et al. Determinants of patency of arteriovenous fistula in hemodialysis patients. Saudi J Kidney Dis Transpl 2018;29:615-22. [32] Asano M, Thumma J, Oguchi K, Pisoni RL, Akizawa T, Akiba T, et al. Vascular access care and treatment practices associated with outcomes of arteriovenous fistula: international comparisons from the dialysis outcomes and practice patterns study. Nephron Clin Pract 2013;124:23-30. [33] Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A, et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis. a randomized controlled trial. JAMA 2008;299:2164-71. [34] Saran R, Dykstra DM, Wolfe RA, Gillespie B, Held PJ, Young EW. Association between vascular access failure and the use of specific drugs: the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis 2002;40:1255-63. [35] United States Renal Data System: Annual Data Report 2018. Available at: http://www.usrds.org/adr.aspx.