Vascular Calcification Markers and Hemodialysis Vascular Access Complications

2018 ◽  
Vol 48 (5) ◽  
pp. 330-338 ◽  
Author(s):  
Beini Lyu ◽  
Tanushree Banerjee ◽  
Julia J. Scialla ◽  
Tariq Shafi ◽  
Alexander S. Yevzlin ◽  
...  
Keyword(s):  
Vascular Calcification ◽  
Vascular Access ◽  
Hemodialysis Patients ◽  
Fetuin A ◽  
Av Fistula ◽  
Morphogenetic Protein ◽  
Disease Study ◽  
Stage Renal Disease ◽  
End Stage ◽  
Access Complications

Background: Arteriovenous (AV) access dysfunction is a common complication in hemodialysis patients. Markers of vascular calcification are associated with cardiovascular outcomes and mortality in this population, but their association with vascular access outcomes is unknown. In this study, we aimed to evaluate the association between selected vascular calcification makers and vascular access complications in a cohort of hemodialysis patients. Method: Fetuin-A, osteopontin (OPN), osteoprotegerin (OPG), and bone morphogenetic protein-7 (BMP-7) were measured in blood samples from 219 dialysis patients in the Choice for Healthy Outcomes in Caring for end-stage renal disease study; these patients were using a permanent vascular access. Participants were followed for up to 1 year or until the occurrence of a vascular access intervention or replacement. Associations with AV fistula (AVF) and AV graft (AVG) intervention-free survival were assessed in models adjusted for demographic characteristics, comorbidities, and inflammation. Results: A total of 24 out 103 participants with an AVF and 43 out of 116 participants with an AVG had an intervention during follow-up. Lower fetuin-A, higher OPN, and higher BMP-7 were associated with a higher risk of AVF intervention (adjusted hazard ratios [aHR] for highest versus lowest tertile = 0.30 [95% CI 0.10–0.94]) for fetuin-A, 3.84 (95% CI 1.16–12.74) for OPN, and 3.49 (95% CI 1.16–10.52) for BMP-7. OPG was not significantly associated with the risk of AVF intervention. The associations of OPN and BMP-7 with AVF intervention appeared stronger among participants without diabetes (aHR 8.06; 95% CI 1.11–58.57 for OPN and aHR 2.55; 95% CI 1.08–6.08 for BMP-7, respectively) than among their counterparts with diabetes (p interaction = 0.06). None of the markers studied were significantly associated with AVG interventions. Conclusion: Lower fetuin-A and higher OPN and BMP-7 are associated with complications in AVF but not in AVG, suggesting a role for calcification in the pathogenesis AVF failure.

scholarly journals Provision of Kidney Disease Education Service is Associated with Improved Vascular Access Outcomes among the US Incident Hemodialysis Patients

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0004502021
Author(s):  
Rupam Ruchi ◽  
Shahab Bozorgmehri ◽  
Gajapathiraju Chamarthi ◽  
Tatiana Orozco ◽  
Rajesh Mohandas ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Vascular Access ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
The Us ◽  
Nephrology Care ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Encompassing Model

Background: Pre-end stage renal disease (ESRD) Kidney Disease Education (KDE) has been shown to improve multiple chronic kidney disease (CKD) outcomes but, its impact on vascular access outcomes is not well-studied. In 2010, Medicare launched KDE reimbursements policy for patients with advanced CKD. Methods: In this retrospective USRDS analysis, we identified all adult incident hemodialysis patients with a minimum of 6-months of pre-ESRD Medicare coverage during the first five-years of CMS-KDE policy and divided them into CMS-KDE services recipients (KDE-cohort) and non-recipients (non-KDE cohort). The primary outcome was incident arteriovenous fistula (AVF) and the composite of incident AVF or arteriovenous graft (AVG) utilization. Secondary outcomes were central venous catheter (CVC) with maturing AVF/AVG and pure CVC utilizations. Step-wise multivariate analyses were performed in four progressive models (model 1: KDE alone, model 2: multivariate model encompassing model 1 with socio-demographics, model 3: model 2 with comorbidity and functional status, and model 4: model 3 with pre-ESRD nephrology care). Results: Of the 211,990 qualifying incident hemodialysis patients during the study period, 2,887(1.4%) received KDE services before dialysis initiation. The rates of incident AVF and composite AVF/AVG were more than double (29.7% and 34.9% respectively, compared to 14.2% and 17.2%) and pure catheter use about a third lower (40.4% compared to 64.5%) in the KDE cohort compared to the non-KDE cohort. Maximally adjusted odds ratio(99% confidence interval) in model 4 for study outcomes were: incident AVF use: 1.78 (1.55-2.05), incident AVF/AVG use: 1.78 (1.56-2.03), incident CVC with maturing AVF/AVG: 1.69 (1.44-1.97)and pure CVC without any AVF/AVG: 0.51 (0.45-0.58). The benefits of KDE service were maintained even after accounting for the presence, duration and facility of ESRD care. Conclusion: Occurrence of pre-ESRD KDE service is associated with significantly improved incident vascular access outcomes. Targeted studies are needed to examine the impact of KDE on patient engagement and self-efficacy as a cause for improvement in vascular access outcomes.

scholarly journals Arteriovenous fistula as the vascular access contributes to better survival of hemodialysis patients with COVID-19 infection

2021 ◽  
pp. 112972982110212
Author(s):  
Ahmet Murt ◽  
Serap Yadigar ◽  
Serkan Feyyaz Yalin ◽  
Mevlut Tamer Dincer ◽  
Ergun Parmaksiz ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
High Mortality ◽  
End Stage Renal Disease ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Near Future

Background: While COVID-19 in chronic hemodialysis patients has high mortality and the pandemic will not end in the near future, effective follow up strategies should be implemented for these patients. Surgeries have been triaged according to their level of urgencies and arteriovenous fistula (AVF) operations were among elective surgeries. This study aimed to analyze the effect of vascular access on the outcomes of hemodialysis patients who had COVID-19. Methods: One hundred four hemodialysis patients who had COVID-19 were retrospectively analyzed. Seventy-two of them had AVF as the vascular access while 32 of them had tunneled catheters. Inflammatory markers and outcomes of patients with AVFs and catheters were compared. A logistic regression analysis was performed in order to define factors that contribute to better outcomes in hemodialysis patients. Results: COVID-19 had high mortality rate in hemodialysis patients (36.5%). Patients with catheters have higher peak ferritin levels ( p = 0.02) and longer hospital stay ( p = 0.00). Having AVF as the vascular access (OR = 3.36; 95% CI: 1.05–10.72; p = 0.041) and using medium cut-off dialyzers (OR = 7.99; 95% CI: 1.53–41.65; p = 0.014) were related to higher survival of the patients. COVID severity was inversely proportional to the survival ( p = 0.000) Conclusions: AVFs contribute to higher survival of hemodialysis patients with COVID-19. Even in the pandemic era, end stage renal disease patients should be given the opportunity to have their vascular access properly created.

scholarly journals Comparative Study of Autologous Radiocephalic and Brachiocephalic Arteriovenous Fistula in Patients with End Stage Renal Disease

2020 ◽  
Vol 18 (1) ◽  
pp. 78-81
Author(s):  
Deepak Thapa Magar ◽  
Kiran Shrestha ◽  
Dinesh Chapagain ◽  
Kumar Shrestha ◽  
Sara Thapa
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Failure Rate ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Patency Rate ◽  
Av Fistula ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

Introduction: End-stage renal disease requires treatment with dialysis or renal transplantation. For the dialysis, autologous radiocephalic (RC) or brachiocephalic (BC) arteriovenous fistula (AVF) is the better option for vascular access for hemodialysis. Aims: The aim of this study is to find out the outcome between RC AVF and BC AVF. Methods: This is the retrospective study, conducted for the period of 24 months from September 2017 to September 2019 in the department of Cardiothoracic and Vascular Surgery of Bir Hospital, Nepal. RC and BC AVF were created for the assess of hemodialysis. Outcome and different complications were taken into consideration.  Results: The total number of patients included in this study was 400. The overall failure rate of autologous AV fistula was 12.75%. Out of these, the failure rate was more in RC AV fistula group, 34 (17%) than in BC AV fistula group, 17 (8.5%). The most common complication was bleeding in both groups having an overall rate of 39 (9.75%). The limb edema was more common in BC AV fistula group 16 (8.0%) then in RC AV fistula group 7(3.5%). The overall infection rate was 4.5%. Overall patency rate was 87.25%. Conclusion: Autologous RC AVF and BC AVF are the choices for vascular access for hemodialysis in patients with end-stage renal disease. BC AVF has a better patency rate than RC AVF but with the slight higher risk of complications.

Avoiding hemodialysis access–induced distal ischemia

2020 ◽  
pp. 112972982094346
Author(s):  
Vernon D Horst ◽  
Peter R Nelson ◽  
Alexandros Mallios ◽  
Kelly Kempe ◽  
Viraj Pandit ◽  
...  
Keyword(s):  
Vascular Access ◽  
Hemodialysis Patients ◽  
Hemodialysis Access ◽  
Arteriovenous Fistulas ◽  
Increased Risk ◽  
Surgical History ◽  
Operative Evaluation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Operative Assessment

Timely creation and maintenance of a safe and reliable vascular access is essential for hemodialysis patients with end-stage renal disease. Hemodialysis access–induced distal ischemia (HAIDI) is a recognized complication of arteriovenous fistulas and grafts that may result in serious or even devastating consequences. Avoiding such complications is clearly preferred over treatment of HAIDI once established. Proper recognition of patients at increased risk of HAIDI includes careful pre-operative evaluation of the patient’s medical and surgical history along with physical examination and imaging to determine a plan for creating a functional permanent access while minimizing the risk of distal ischemia. Our aim is to review identifying characteristics of individuals at risk of HAIDI and provide recommendations regarding pre-operative assessment. Vascular access options and techniques are suggested for establishing a functional vascular access without distal ischemia for such patients.

scholarly journals Clinical and paraclinical characteristics of patients undergoing hemodialysis

2021 ◽  
Vol 6 (1) ◽  
pp. e12-e12
Author(s):  
Sanaz Jamshidi ◽  
Sepideh Hajian ◽  
Nafiseh Rastgoo
Keyword(s):  
Vascular Access ◽  
Binding Capacity ◽  
Hemodialysis Patients ◽  
Total Iron ◽  
Dialysis Solution ◽  
Catheter Site ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Iron Binding Capacity

Introduction: End-stage renal disease (ESRD) is an irreversible decrease in kidney function with severe consequences. Objectives: The aim of this study was to investigate clinical and paraclinical characteristics of hemodialysis patients. Patients and Methods: This study was a descriptive-analytical performed on 105 patients undergoing hemodialysis referred to Bou Ali and Velayat hospitals in Qazvin. The data were included age, gender, duration of dialysis, kind of vascular access, kind of catheter, site of catheters, weight, height, systolic and diastolic blood pressure, kind of flux, use of midodrine, kind of dialysis solution, number of dialysis per week, calcium (Ca), iron, total iron binding capacity (TIBC), ferritin, parathyroid hormone (PTH), Kt/V, blood urea nitrogen (BUN) and creatinine (Cr). The data were analyzed using SPSS version 21. Results: The mean age of the patients was 60.97±15.13 years and 44.8% of the patients were females. The mean number of dialysis per week was 2.84 times with a mean duration of 3.90 years. The mean Cr level was 8.89±3.14 mg/dL. Males had higher level of BUN (55.91±16.06 mg/dL versus 65.24±17.53 mg/ dL, P=0.006) and Cr (8.09±2.43 mg/dL versus 9.59±3.47 mg/dL, P=0.010). Arteriovenous fistula/AVF was the most common vascular access (76.2% of cases). With increasing BUN, number of dialysis per week and weight, the level of Cr increases significantly (P<0.05). In the younger patients, Cr showed low level compared to the older patients. Conclusion: The number of dialysis per week, weight and BUN level is factors to predict the level of Cr and with increasing these factors, the level of Cr increases. The mean Cr level was high which showed inadequacy of hemodialysis in these patients. The level of Cr and BUN is higher in men.

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