Abstract
End-stage renal disease (ESRD) is one of the most feared consequences of kidney disease. A large number of patients with ESRD require long-term hemodialysis. Vascular access options for hemodialysis include the placement of arteriovenous (AV) fistulas, AV grafts, and tunneled dialysis catheters (TDCs). An alternative to the TDC is the Hemodialysis Reliable Outflow (HeRO; Cryolife Inc., Eden Prairie, MN, USA) Graft. The HeRO Graft has been designed to overcome the development of central venous stenosis or occlusion. The objective is to evaluate the quality of life of patients using the HeRO Graft in end-stage renal disease for hemodialysis. We searched PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINHAL), Directory of Open Access Journals (DOAJ), Pubpsych, and Google Scholar on October 30, 2018. We included published articles in the English language that used the HeRO Graft for ESRD. The adequacy of dialysis and bacteremia rates proved to be equal to those of conventional AV grafts. It turned out that 2.21 interventions per year were needed to maintain the patency of the HeRO Graft while only 1.17 interventions were needed to maintain the patency of the lower extremity graft. Mortality, ischemia, and infection rates were similar for both groups. The tunneled dialysis catheters have a higher incidence of infection as compared to the HeRO Graft. The initial device and placement costs for the HeRO Graft were higher than those for TDCs but savings from the lower incidence of device complications and longer effective device patency make it cost-effective. Based on the limited evidence, it has been discerned that the HeRO Graft is an optimal option for hemodialysis in patients of ESRD who have exhausted all means of upper extremity access. Though almost similar to the AV grafts in terms of complications and less functional than femoral grafts, it still outclasses them in improving the quality of life of such patients.
Highlights
The conditionEnd-stage renal disease (ESRD) is one of the most feared consequences of kidney disease
According to a study included in this review, which involved data collection from 72 subjects (52 Hemodialysis Reliable Outflow (HeRO) Grafts and 20 AV grafts), primary and secondary patency rates were 34.8% and 67.6% for the HeRO Graft and30.6% and 58.4% in the control group, being almost similar
The results have shown that the tunneled dialysis catheters have a higher incidence of infection as compared to the HeRO Graft and fAVG, suggesting that their use is preferable to catheter dependence [15]
Summary
End-stage renal disease (ESRD) is one of the most feared consequences of kidney disease. It affects over 500,000 patients in the United States and is increasing in prevalence, with over 100,000 new cases reported each year [1]. ESRD occurs when kidney function has deteriorated to an extent that it is no longer adequate to sustain life, unless renal replacement therapy, dialysis, or transplantation is done [2]. A large number of patients with ESRD require long-term hemodialysis (HD), which is a life-preserving therapy [3]. More than 1.5-million patients receive regular HD treatment worldwide, with the number growing at an annual rate of around 7% [4]. With the increased life expectancy of dialysis patients, the challenges of maintaining dialysis access increase as well [5]
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