Abstract
Background and objectives: An arteriovenous fistula is considered to be an ideal vascular access for patients receiving hemodialysis, its main limitation is its high failure rate to achieve maturation and long-term functionality loss. Multiple strategies have attempted to identify patients at risk. Bioelectrical impedance has shown to be a valuable resource in the determination of the hydration status, and the measurement of the phase angle through this method has demonstrated to be a good indicator of the nutritional state and it’s related as a general marker of survival. The objective of this study is to analyze the role of plasma albumin and phase angle measured through bioelectrical impedance as tools useful for predicting failure of arteriovenous fistulas.
Highlights
IntroductionNative arteriovenous fistulas are considered to this date to be the vascular access of choice widely recommended to patients undergoing chronic hemodialysis, due to its advantages, such as its cost-benefit relation, longer duration, lower rate of infection, hospital admission and mortality [1,2].its main inconvenience, is the failure or loss of the vascular access, depending on the series this can be around 60% in the first and includes primary failure presenting within the first 72 hours after its constructions as well as loss of functionality which is described as an impossibility of achieving an adequate dialytic treatment after 6 or 8 weeks with maturation two needle techniques, representing an important cause of morbidity, hospital admission and an increase in healthcare costs [3,4,5].Various factors have been identified to this date related with the failure of establishing a vascular access, some in a clearer manner than other; none of these factors has shown a relevant role in an isolated manner [6,7,8].International Journal of Nephrology and Kidney Failure Open Access JournalWithin the multiples factors identified and those which possible adverse association with an arteriovenous fistula is still unknown among these is the nutritional status [9,10], currently known as protein-energy wasting syndrome, its association with cardiovascular risk and mortality in patients undergoing hemodialysis [9,11,12]
The objective of this study is to evaluate the performance of plasma albumin, phase angle through multi-frequency bioimpedance and its value as a potential predictor of failure in arteriovenous fistulas for hemodialysis and establish if malnutrition determined through this behaves as a new risk factor for adverse results related to vascular access
Of 104 individuals followed during the development of this study a 32.2% achieved a successful maturation of the fistula which allowed for optimal dialytic treatment; in the remaining 67.8% of individual an adequate vascular access was not achieved, which is similar to data described in current literature
Summary
Native arteriovenous fistulas are considered to this date to be the vascular access of choice widely recommended to patients undergoing chronic hemodialysis, due to its advantages, such as its cost-benefit relation, longer duration, lower rate of infection, hospital admission and mortality [1,2].its main inconvenience, is the failure or loss of the vascular access, depending on the series this can be around 60% in the first and includes primary failure presenting within the first 72 hours after its constructions as well as loss of functionality which is described as an impossibility of achieving an adequate dialytic treatment after 6 or 8 weeks with maturation two needle techniques, representing an important cause of morbidity, hospital admission and an increase in healthcare costs [3,4,5].Various factors have been identified to this date related with the failure of establishing a vascular access, some in a clearer manner than other; none of these factors has shown a relevant role in an isolated manner [6,7,8].International Journal of Nephrology and Kidney Failure Open Access JournalWithin the multiples factors identified and those which possible adverse association with an arteriovenous fistula is still unknown among these is the nutritional status [9,10], currently known as protein-energy wasting syndrome, its association with cardiovascular risk and mortality in patients undergoing hemodialysis [9,11,12]. Native arteriovenous fistulas are considered to this date to be the vascular access of choice widely recommended to patients undergoing chronic hemodialysis, due to its advantages, such as its cost-benefit relation, longer duration, lower rate of infection, hospital admission and mortality [1,2]. The relation between malnutriton and adverse surgery results in terms of complications, days of hospital stay, infection and mortality; [13] its association with adverse results in arteriovenous fistulas has not been demonstrated, partially due to difficulties in defining its criteria, among the tools used for its quantification and the use of biological and biochemical markers such as albumin which presents important limitations in patients undergoing hemodialysis. The objective of this study is to analyze the role of plasma albumin and phase angle measured through bioelectrical impedance as tools useful for predicting failure of arteriovenous fistulas
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