Arteriovenous Fistula Patency Rates Research Articles

Influences of renal insufficiency and ischemia on mitochondrial bioenergetics and limb dysfunction in a novel murine iliac arteriovenous fistula model

ObjectiveHand disability after hemodialysis access surgery has been common yet has remained poorly understood. Arteriovenous fistula (AVF) hemodynamic perturbations have not reliably correlated with the observed measures of hand function. Chronic kidney disease (CKD) is known to precipitate myopathy; however, the interactive influences of renal insufficiency and ischemia on limb outcomes have remained unknown. We hypothesized that CKD would contribute to access-related hand dysfunction via altered mitochondrial bioenergetics. Using a novel murine AVF model, we sought to characterize the skeletal muscle outcomes in mice with and without renal insufficiency. MethodsMale, 8-week-old C57BL/6J mice were fed either an adenine-supplemented diet to induce renal insufficiency (CKD) or a casein-based control chow (CON). After 2 weeks of dietary intervention, the mice were randomly assigned to undergo iliac AVF surgery (n = 12/group) or a sham operation (n = 5/group). Measurements of aortoiliac hemodynamics, hindlimb perfusion, and hindlimb motor function were collected for 2 weeks. The mice were sacrificed on postoperative day 14 to assess skeletal muscle histopathologic features and mitochondrial function. To assess the late outcome trends, 20 additional mice had undergone CKD induction and sham (n = 5) or AVF (n = 15) surgery and followed up for 6 weeks postoperatively before sacrifice. ResultsThe adenine-fed mice had had a significantly reduced glomerular filtration rate and elevated blood urea nitrogen, confirming the presence of CKD. The sham mice had a 100% survival rate and AVF cohorts an 82.1% survival rate with an 84.4% AVF patency rate. The aorta and inferior vena cava velocity measurements and the vessel diameter had increased after AVF creation (P < .0001 vs sham). The AVF groups had had a 78.4% deficit in paw perfusion compared with the contralateral limb after surgery (P < .0001 vs sham). Mitochondrial function was influenced by the presence of CKD. The respiratory capacity of the CKD-sham mice (8443 ± 1509 pmol/s/mg at maximal energy demand) was impaired compared with that of the CON-sham mice (12,870 ± 1203 pmol/s/mg; P = .0001). However, this difference was muted after AVF creation (CKD-AVF, 4478 ± 3685 pmol/s/mg; CON-AVF, 5407 ± 3582 pmol/s/mg; P = .198). The AVF cohorts had had impairments in grip strength (vs sham; P < .0001) and gait (vs sham; P = .012). However, the presence of CKD did not significantly alter the measurements of gross muscle function. The paw perfusion deficits had persisted 6 weeks postoperatively for the AVF mice (P < .0001 vs sham); however, the myopathy had resolved (grip strength, P = .092 vs sham; mitochondrial respiration, P = .108 vs sham). ConclusionsCKD and AVF-induced distal limb ischemia both impaired skeletal muscle mitochondrial function. Renal insufficiency was associated with a baseline myopathy that was exacerbated by the acute ischemic injury resulting from AVF creation. However, ischemia was the primary driver of the observed phenotype of gross motor impairment. This model reliably reproduced the local and systemic influences that contribute to access-related hand dysfunction and provides a platform for further mechanistic and therapeutic investigation.

A national cohort study on hemodialysis arteriovenous fistulas after kidney transplantation - long-term patency, use and complications

ObjectiveTo describe the long-term hemodialysis arteriovenous fistula (AVF) patency, incidence of AVF use, incidence and nature of AVF complications and surgery in patients after kidney transplantation.Patients and methodsWe retrospectively analysed the AVF outcome and complications in all adult kidney allograft recipients transplanted between January 1st, 2000 and December 31, 2015 with a functional AVF at the time of transplantation. Follow-up was until December 31, 2019.ResultsWe included 626 patients. Median AVF follow-up was 4.9 years. One month after kidney transplantation estimated AVF patency rate was 90%, at 1 year it was 82%, at 3 years it was 70% and at 5 years it was 61%; median estimated AVF patency was 7.9 years. The main cause of AVF failure was spontaneous thrombosis occurring in 76% of AVF failure cases, whereas 24% of AVFs were ligated or extirpated. In a Cox multivariate model female sex and grafts were independently associated with more frequent AVF thrombosis. AVF was used in about one third of our patients. AVF-related complications occurred in 29% of patients and included: growing aneurysms, complicated thrombosis, high-flow AVF, signs of distal hypoperfusion, venous hypertension, trauma of the AVF arm, or pain in the AVF/arm.ConclusionsAVFs remain functional after kidney transplantation in the majority of patients and are often re-used after graft failure. AVF-related complications are common and require proper care.

Effect of far infrared therapy on arteriovenous fistula maturation, survival and stenosis in hemodialysis patients, a randomized, controlled clinical trial: the FAITH on fistula trial

BackgroundAn arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis treatment. After creation many of the AVFs will never mature or if functioning will need an intervention within 1 year due to an AVF stenosis. Studies investigating possible therapies that improves the AVF maturation and survival are scarce. Far infrared therapy (FIR) has shown promising results. In minor single centre and industry supported trials FIR has shown improved AVF maturation and survival. There is a need of a randomized multicentre controlled trial to examine the effect of FIR on the AVF maturation and survival and to explore the possible AVF protective mechanism induced by the FIR treatment.MethodsThis investigator initiated, randomized, controlled, open-labeled, multicenter clinical trial will examine the effect of FIR on AVF maturation in patients with a newly created AVF (incident) and AVF patency rate after 1 year of treatment in patients with an existing AVF (prevalent) compared to a control group. The intervention group will receive FIR to the skin above their AVF three times a week for 1 year. The control group will be observed without any treatment. The primary outcome for incident AVFs is the time from surgically creation of the AVF to successful cannulation. The primary outcome for the prevalent AVFs is the difference in number of AVFs without intervention and still functioning in the treatment and control group after 12 months. Furthermore, the acute changes in inflammatory and vasodilating factors during FIR will be explored. Arterial stiffness as a marker of long term AVF patency will also be examined.DiscussionFIR is a promising new treatment modality that may potentially lead to improved AVF maturation and survival. This randomized controlled open-labelled trial will investigate the effect of FIR and its possible mechanisms.Trial registrationClinicaltrialsgov NCT04011072 (7th of July 2019).

Relationship between Monocytes and Stenosis-Related Autologous Arteriovenous Fistula Dysfunction

Background: Arteriovenous fistula (AVF) is considered to be the best choice of vascular access, but the maturation rate and patency rate of AVF are not satisfactory. Many studies have explored the influencing factors of AVF failure but do not involve the direct relationship between monocyte count and AVF failure. This study aims to explore the relationship between monocyte count and AVF dysfunction related to stenosis. Methods: From September 2017 to September 2018, basic clinical data and laboratory parameters of patients were collected. All included patients were followed up to September 2019. The stenosis-related AVF failure events that occurred after the patient included in the study and the time of their occurrence were recorded. All patients were divided into 3 groups based on the tertile of monocyte count. Kaplan-Meier method was used to compare the patency rate of AVF in each group. The effects of variables on AVF failure were analyzed. A multivariate Cox regression model with p < 0.05 was included in the univariate Cox regression analysis. Results: A total of 120 patients were included in this study. According to the recorded baseline monocyte count levels, they were divided into 3 groups according to their tertiles, 34 cases in the T1 group (T1 < 0.32 × 109/L), 44 cases in the T2 group (0.32 ≤ T2 < 0.51 × 109/L), and 42 cases in T3 group (T3 ≥0.51 × 109/L). After a median follow-up of 20 months, a total of 31 AVF failure events occurred. Kaplan-Meier survival curves showed that patients with a baseline monocyte count ≥0.51 × 109/L had the lowest patency rate of AVF (log-rank test χ2 = 7.525, p = 0.023). After adjusting to basic clinical data and biochemical indicators, there were statistically significant differences in patency rates of the 3 groups (hazard ratio = 2.774, 95% CI = 1.092–7.043). Conclusion: Monocyte count ≥0.51 × 109/L is an independent risk factor for AVF failure, and AVF failure caused by monocytes may be driven by inflammation.

Systematic Surveillance of Arteriovenous Fistula Patency in Renal Failure Patients – Our Early Experience

Objective: Does systematic surveillance help improve arteriovenous fistula (AVF) patency and health economics in renal failure patients? Materials and Methods: As part of a quality initiative project, prospective data were maintained in the electronic medical records at the Sultan Qaboos University Hospital by our clinical nurse specialist, of AVFs created for patients requiring renal replacement therapy from December 2015. Beginning in January 2018, a surveillance program of patients undergoing intervention to improve patency of AVF was started. The records of these patients up to December 31, 2019, were accessed to see if the program helped improve patency, thereby reducing the number of emergency admissions and improving health economics. The minimum follow-up period was 8 weeks. Results: A total of 143 patients had AVFs created during the study period. Fifty-one patients required fistulogram with or without fistuloplasty. Thirty-six out of 51 (70%) fistulas remain patent, whereas 9 (18%) thrombosed and 6 (12%) were either lost to follow-up or deceased. The number presenting to the emergency department reduced by 50%. In addition, we observed a noticeable reduction in the number of emergency procedures required to sustain the fistula. Both duration of in-hospital stay and repetitive investigations were reduced. Conclusion: A surveillance program requires liaising with the patient, their relatives, local health center, regional dialysis unit, interventional radiology, nephrology, and vascular surgery team. We have seen a significant reduction in emergency interventions, increase in overall patency rate of AVFs, shorter in-patient hospital stays, and a decrease in number of laboratory investigations repeated.

Predictive Value of 1-Week Postoperative Ultrasonography Findings for the Patency Rate of Arteriovenous Fistula

IntroductionMost guidelines in different countries recommend waiting more than 2 weeks for the initial cannulation of an arteriovenous fistula (AVF) after its creation. Although an experienced examiner can subjectively determine if an AVF is ready for early cannulation, there is a lack of objective information to guide whether early cannulation is appropriate or how early cannulation may affect an AVF’s primary patency. The current study examined the relationship between the initial cannulation and the prognosis of AVF, considering ultrasonography (US) findings.MethodsThis retrospective observational study enrolled 103 patients with end-stage renal disease who had started hemodialysis therapy from 2013 to 2015 at the Juntendo University Hospital. All patients had been given a primary AVF before or after the initiation of dialysis, had undergone US examinations both before and 7 days after surgery, had initially cannulated the AVF at ≥7 days after surgery, and were observed for over 1 year.ResultsThe factor associated with the loss of primary patency was a resistance index of brachial artery ≥0.65 on US examination at 7 days after surgery. There was no significant difference in patency rate between the early (within 14 days after surgery) and late initial cannulation groups (≥15 days after surgery).ConclusionBecause a resistance index <0.65 on US findings at 7 days after surgery was a good indicator for predicting an excellent patency rate when we performed first cannulation of AVF located in the forearm within 2 weeks after its creation, 1-week postoperative US evaluation may provide crucial information.

The efficacy of percutaneous transluminal angioplasty for the endovascular management of arteriovenous fistula dysfunction: a retrospective analysis in patients with end-stage renal disease.

To evaluate efficacy of percutaneous transluminal angioplasty (PTA) for the endovascular management of arteriovenous fistula (AVF) dysfunction in patients with end-stage renal disease (ESRD). A total of 135 consecutive patients with ESRD (mean±SD age: 58.8±9.4 years, 74.8% were males) who underwent endovascular treatment for a dysfunctional native AVF were included in this retrospective single-center study. Data on patient demographics, etiology of ESRD, characteristics of AVF, stenotic segments, PTA parameters and postoperative recurrence and patency rates within the 12 months were recorded. Technical and clinical success rates of PTA were 100.0% and 97.0%, respectively. Dysfunction recurrence rate was 30.4%. In patients with vs. without presence of recurrent AVF dysfunction, there was higher percentage of males (P=0.030), older age (P=0.018), diabetic or hypertensive rather than polycystic etiology (P<0.001), younger AVF (P<0.001), longer-segment stenosis (P=0.019) and lower median number (P=0.038) of stenotic segments. Presence of hypertension (OR 12.23, 95% CI: 4.29 to 34.85, P<0.001) and age of the AVF (OR 1.04, 95% CI: 1.00 to 1.08, P=0.029) were significant determinants of increased risk of recurrent AVF dysfunction. Our findings emphasize favorable safety and efficacy of PTA in the management of dysfunctional hemodialysis AVFs in terms of high technical and clinical success and low rates of residual stenosis, complications and post-PTA recurrence of AVF dysfunction. Male gender, older patient age, younger AVF and longer-segment stenosis were associated with higher likelihood of AVF failure, whereas hypertension and age of AVF were the two significant determinants of increased risk of post-PTA recurrence of AVF dysfunction.

High low-density lipoprotein cholesterol level is the independent risk factor of primary patency rate of arteriovenous fistula.

An arteriovenous fistula is the first choice of vascular access in dialysis patients. However, the correlations between patient factors and the arteriovenous fistula patency rate remain unclear. Therefore, we examined the effect of dialysis patient factors on arteriovenous fistula patency rate. This study included 101 patients who received maintenance dialysis and used arteriovenous fistula for vascular access at Atami Hospital, International University of Health and Welfare in July 2018. A retrospective review was performed from the time of arteriovenous fistula creation to July 2018, and the primary and secondary arteriovenous fistula patency rates were investigated. The patency rate was calculated using the Kaplan-Meier method, and risk factor analysis was performed using Cox proportional hazards regression analysis. The primary patency rate of arteriovenous fistula was 71.2% at one year and 43.0% at five years, and the secondary patency rate was 92.7% at one year and 79.8% at five years. In the multivariate analysis, high low-density lipoprotein cholesterol (LDL-C) level and a history of diabetes were considered significant risk factors (HR 1.023, p value <0.01 and HR 2.550, p value <0.01, respectively). A log rank test was conducted on the groups of patients with LDL <90 mg/dl and LDL ≥90 mg/dl, and the <90 mg/dl group resulted in a good primary patency rate (p value 0.0327). High LDL-C level was considered the independent risk factors of arteriovenous fistula primary patency rate.

Comparison of outcomes between type 2 diabetic and non-diabetic incident hemodialysis patients with functioning arteriovenous fistulas

This study compared clinical outcomes of patient survival and arteriovenous fistula (AVF) patency between incident hemodialysis patients with and without type 2 diabetes mellitus (T2DM).Between January 2011 and December 2013, 384 consecutive incident hemodialysis patients with confirmed first upper-extremity AVF placement were divided into a T2DM group (n = 180, 46.9%) and a non-DM group (n = 204, 53.1%) and analyzed retrospectively. The primary outcome was all-cause mortality, and secondary outcome was AVF patency.Patients in the T2DM group had a higher prevalence of hypertension (P = .02), smoking (P < .01), cardiovascular disease (P < .01), history of cerebrovascular accident (CVA) (P < .01), and peripheral arterial occlusive disease (P < .01) than those in the non-DM group. On Kaplan-Meier survival analysis, the overall survival and AVF patency rates were significantly higher in the non-DM group relative to the T2DM group (both P < .01). In the adjusted model, older age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.02-1.06; P < .01), T2DM (HR, 1.76; 95% CI, 1.12-2.77; P = .014), and history of CVA (HR, 1.76; 95% CI, 1.04-2.98; P = .04) were significantly associated with an increased risk of mortality. Older age and T2DM were independently associated with decreased primary (HR, 1.03; 95% CI, 1.02-1.04; P < .01, HR, 1.69; 95% CI, 1.22-2.33; P < .01, respectively) and secondary (HR, 1.03; 95% CI, 1.01-1.04; P < .01, HR, 2.07; 95% CI, 1.42-3.00; P < .01, respectively) AVF patency during follow-up.Compared with patients in the non-DM group, patients in the T2DM group had a higher mortality rate and worse AVF patency rates.

Effect of General Anesthesia Versus Regional Brachial Plexus Block on Patency of Vascular Access for Hemodialysis

Primary arteriovenous fistula (AVF) remains the best vascular access for hemodialysis since it has the best long-term primary patency rate, requires less interventions/maintenance, and has the lowest incidence of morbidity and mortality. For this reason, the National Kidney Foundation began the “Fistula First Breakthrough Initiative”, which seeks to increase the amount of successful AVFs placed. Multiple factors play a role in primary AVFs creation; Vein diameter/quality, artery diameter/quality, central venous disease, hypercoagulable states and fistula location. Multiple studies have demonstrated the benefits of creating AVFs under regional anesthesia; Avoiding hemodynamic instability and stress response of general anesthesia and vasodilatation cause and effects. Due to the fact that vein diameter is the major limiting factor for primary AVFs creation and maturation, our aim is to investigate if the vasodilation that accompanies regional anesthesia leads to improved patency and maturation rate of autologous AVF and graft.

Current state of vascular access in Singapore.

This article described the current state of vascular access management for patients with end-stage renal disease in Singapore. Over the past 10 years, there has been a change in the demographics of end-stage renal disease patients. Aging population and the increase in prevalence of diabetes mellitus has led to the acceleration of chronic kidney disease and increase in incidence and prevalence of end-stage renal disease. Vascular access care has, therefore, been more complicated, with the physical, psychological, and social challenges that occur with increased frequency in elderly patients and patients with multiple co-morbidities. Arteriovenous fistula and arteriovenous graft are created by vascular surgeons, while maintenance of patency of vascular access through endovascular intervention has been a shared responsibility between surgeons, interventional radiologists, and interventional nephrologists. Pre-emptive access creation among end-stage renal disease patients has been low, with up to 80% of new end-stage renal disease patients being commenced on hemodialysis via a dialysis catheter. Access creation is exclusively performed by a dedicated vascular surgeon with arteriovenous fistula success rate up to 78%. The primary and cumulative patency rates of arteriovenous fistula and arteriovenous graft were consistent with the results from many international centers. Vascular access surveillance is not universally practiced in all dialysis centers due to its controversies, in addition to the cost and the limited availability of equipment for surveillance. Timely permanent access placement, with reduced dependence on dialysis catheters, and improved vascular access surveillance are the main areas for potential intervention to improve vascular access management.

The Role of Regional versus General Anesthesia on Arteriovenous Fistula and Graft Outcomes: A Single-Institution Experience and Literature Review

Multiple studies have demonstrated the benefits of creating arteriovenous fistulas (AVFs) under regional anesthesia. This is most likely because of the avoidance of hemodynamic instability and stress response of general anesthesia, as well as the sympathectomy associated with brachial plexus blockade. As vein diameter is the major limiting factor for primary AVF creation and maturation, our aim is to investigate if the vasodilation that accompanies regional anesthesia leads to improved patency and maturation rate of autologous AVF and improved patency of arteriovenous graft (AVG) compared with those placed under general anesthesia. This retrospective study was approved by the institutional review board. A total of 238 patients who had either an AVF or an AVG placed at the Mayo Clinic, Florida, between 2012 and 2017 were analyzed. Demographics, access type, preoperative vein diameter, anesthesia type, change of plan after regional versus general anesthesia, and outcomes were assessed. All statistical tests were 2 sided, with the alpha level set at 0.05 for statistical significance. Among 238 patients, 120 (50.4%) had regional anesthesia. Differences between the 2 groups in risk factors and 30-day or long-term outcomes (failure, abandonment, or reoperation) were not statistically significant. Of the accesses placed under general anesthesia, 58.5% were abandoned compared with 45.2% of those placed under regional anesthesia. Owing to loss of patency, 25.8% of accesses placed under general anesthesia were abandoned compared with 19.2% of those placed under regional anesthesia. Two-month failure was higher in the general anesthesia group than that in the regional anesthesia group (P=0.076). After preoperative vein mapping, 22 patients were originally intended to have an AVG placed under regional anesthesia. After brachial plexus blockade, 9 of these patients (41%) were successfully switched to AVF, while the other 13 followed the original surgical plan and received an AVG. Of these, 0 failed and 0 were abandoned because of loss of patency. This study showed possible improvements in failure rates for vascular accesses placed under regional anesthesia compared with those placed under general anesthesia. In addition, we showed an impact of regional anesthesia on the surgical plan by transitioning from a planned AVG to an AVF, intraoperatively. Giving patients with originally inadequate vein diameter the chance to have the preferred hemodialysis access method by simply switching anesthesia type could reduce the number of grafts placed in favor of fistulas.

SAT-048 IMPACT OF ANAESTHESIA ON PROSPECTIVE OUTCOMES AFTER THE CREATION OF ARTERIOVENOUS FISTULA

The burden of patients requiring venous access to facilitate haemodialysis is well known. The preferred surgical access is the creation of a native arteriovenous fistula (AVF). However, these fistulae are known to have high early failure rates. The type of anaesthesia provided during this surgery may influence outcomes. No definitive studies have examined the difference that general anaesthesia (GA) compared to regional anaesthesia in the form of a brachial plexus block (BPB) may have on AVF patency rates. Ethical approval was obtained for this multicentre prospective observational study comparing 6 week radiocephalic (RC) AVF primary patency amongst patients receiving GA vs. BPB. Patients were excluded if they received local anaesthetic infiltration or surgery to concurrent parts of the body or any other vascular access procedure. 8 centres participated. 168 patients were identified. 6 week RC AVF primary patency rate was 89% (95% confidence interval 83-95%) in the BPB group (n=99) compared to 75% (95% confidence interval 65-85%) in the GA group (n=69). There were more obese patients in the BPB group (43%+/-10% vs. 22%+/-10%, p<0.01) and more females in the BPB group (38%+/-10% vs. 22%+/-10%, p=0.03). Operative time was longer in the BPB group than the GA group (median values in minutes: 120 (IQR 35) vs. 105 (IQR 33), p<0.01, respectively). There is a signal that administering a brachial plexus block for the creation of a AVF confers a higher radiocephalic AVF patency rate compared to general anaesthesia. This is apparent even though more patients in the BPB had risk factors that are associated with lower patency rates (obesity and female sex). This needs to be examined further. A multicentre randomised clinical trial comparing BPB to GA is being planned to assess the impact of anaesthesia technique on AVF patency.

Effect of Hydraulic Expansion on Arteriovenous Fistula of Hemodialysis Patients.

Chronic kidney disease has become a serious public health problem in China. Our study is to explore effect of hydraulic expansion on arteriovenous fistula (AVF) of hemodialysis patients. A total of 190 patients with end-stage renal disease (ESRD) were randomly divided into hydraulic expansion group (n = 117) and conventional surgery group (n = 73). Age, sex, the cause of ESRD, height, weight, body mass index (BMI), blood pressure, and diameter of artery and vein from ultrasonography before surgery from patients were recorded. Doppler ultrasonography of vessel was performed with a 12-MHz scanning probe for vascular measurements. The time of first cannulation was recorded. Primary and secondary patency rates were compared between the two groups. The mean arterial pressure for this cohort of patients was around 98.12 mm Hg. The mean diameters of artery and vein ready for anastomoses measured by ultrasonography before surgery were 1.96 and 2.04 mm, respectively. Age, weight, BMI, sex ratio, the cause of renal failure, history of catheter insertion, mean arterial pressure, frequency of hemodialysis, blood flow of hemodialysis, and the mode of anastomoses of AVF in conventional surgery group were similar to hydraulic expansion group. There were no differences in stroke volume of radius arterial and venous pressure before dilation between the two groups. The stroke volume of radius artery increased significantly after hydraulic expansion than before dilation and control group. The primary patency rates of AVF in patients with hydraulic expansion were higher significantly than conventional surgery group. The secondary patency rates in conventional surgery group were not different from hydraulic expansion group. Hydraulic expansion showed no difference from conventional surgery in complication after operation, and could decrease the time reliance on catheters and the risk of catheter-related infection, thrombosis, and decrease the related medical care costs.

Patency rates of arteriovenous fistulas created before versus after hemodialysis initiation.

In an incident hemodialysis (HD) population, we aimed to investigate whether arteriovenous fistula (AVF) creation before HD initiation was associated with improved AVF patency compared with AVF creation from a central venous catheter (CVC), and also to compare patient survival between these patients. Between January 2011 and December 2013, 524 incident HD patients with identified first predialysis vascular access with an AVF (pre-HD group, n = 191) or an AVF from a CVC (on-HD group, n = 333) were included and analyzed retrospectively. The study outcome was defined as AVF patency and all-cause mortality (time to death). On Kaplan–Meier survival analysis, primary and secondary AVF patency rates did not differ significantly between the two groups (P = 0.812 and P = 0.586, respectively), although the overall survival rate was significantly higher in the pre-HD group compared with the on-HD group (P = 0.013). On multivariate analysis, well-known patient factors were associated with decreased primary (older age and diabetes mellitus [DM]) and secondary (DM and peripheral arterial occlusive disease) AVF patency, whereas use of a CVC as the initial predialysis access (hazard ratios, 1.84; 95% confidence intervals, 1.20–2.75; P = 0.005) was significantly associated with worse survival in addition to well-known patient factors (older age, diabetes mellitus, and peripheral arterial occlusive disease). Worse survival in the on-HD group was likely confounded by selection bias because of the retrospective nature of our study. Therefore, the observed lower mortality associated with AVF creation before HD initiation is not fully attributable to CVC use, but rather, affected by other patient-level prognostic factors. There were no CVC-related complications in the pre-HD group, whereas 10.2% of CVC-related complications were noted in the on-HD group. In conclusion, among incident HD patients, compared with patients who underwent creation of an AVF from a CVC, initial AVF creation showed similar primary and secondary AVF patency rates, but lower mortality risk. We also observed that an initial CVC use was an independent risk factor associated with worse survival. A fistula-first strategy might be the best option for incident HD patients who are good candidates for AVF creation.

Comparison of the one-year patency rates of radiocephalic arteriovenous fistulas created using no-touch versus conventional technique.

This study aims to compare the patency rates of radiocephalic arteriovenous fistulas prepared preserving the perivenous vascular tissues versus those prepared using the conventional technique. A total of 169 patients (107 males, 62 females; mean age 59.5 years; range, 39 to 87 years) who underwent a radiocephalic arteriovenous fistula construction were included in this study. In 95 patients, the tissues surrounding the cephalic vein were stripped off as per the conventional method, while the no-touch technique preserving the perivenous vascular tissues was utilized for vein harvesting in 74 patients. Patients were followed-up to compare primary and secondary patency rates of the arteriovenous fistulas at one year. Fistula failure developed in 22 patients within the first year resulting in primary patency rates of 90.5% versus 84.2% for the no-touch and the conventional groups, respectively (p=0.225). Likewise, secondary patency rates were 94.6% versus 93.7% for the no-touch and the conventional groups, respectively (p=0.803). The two groups did not differ with regards to primary or secondary patency rates. Findings of this study were not in favor of the no-touch technique compared to the conventional methods in terms of arteriovenous fistula patency at one year.

Primary Patency Rate of Arteriovenous Fistula Created for Hemodialysis Patients: The Indonesian Experience

IntroductionClinical practice guidelines endorse the arteriovenous fistula as the preferred form of vascular access. Concerns have been raised regarding its high risk of primary failure. Its estimated primary patency rate varies in the literature. Since most of the current data are from Western countries and information from the developing countries is scarce, we aim to evaluate the primary patency rate of arteriovenous fistula created for hemodialysis patients in our hospital. MethodologyWe analyzed data from all patients undergoing the creation of arteriovenous fistula for hemodialysis at the PGI Hospital Cikini in Jakarta, Indonesia, from January to December 2015. Information needed was retrieved from the medical records. Actuarial patency rate was created by the Kaplan-Meier product-limit method. Differences between curves were compared by means of a log-rank test. ResultsA total of 253 arteriovenous fistula in the upper arm were created in patients requiring hemodialysis. The overall 6-, 12-, and 18-month primary patency rates of arteriovenous fistula created for hemodialysis patients were 88%, 85%, and 79%, respectively. There was a difference in primary patency rate of arteriovenous fistula by gender. The 6- and 12-month primary patency rates of arteriovenous fistula created for male hemodialysis patients were 92% and 89%; the rates for female patients were 81% and 78%, respectively (P = .027). ConclusionsCareful preoperative patient assessment, optimal surgical techniques, and adequate postoperative care play an important role for the favorable outcome. The primary patency rate in male hemodialysis patients was significantly higher than in female patients.

Effect of hyperphosphatemia on patency rate of arteriovenous fistula of patients with late fistula dysfunction/failure after reoperation

Objective: To investigate the effect of hyperphosphatemia on long-term patency of arteriovenous fistula (AVF) of patients with late fistula dysfunction/failure after reoperation. Methods: The study was carried out in the Department of Nephrology of the First Affiliated Hospital of Tsinghua University between March 2012 and March 2013. A total of 136 maintenance hemodialysis patients[73 males, 63 females, with an average age of (57.7±16.1) years]with late AVF dysfunction/faliure who received AVF reoperation were enrolled in the study. After follow-up for 3 years, 118 patients were left and divided into two groups: fistula dysfunction group (n=38), fistula patency group (n=80). Patients were aslo divided into two groups according to the blood phosphorus level: the blood phosphorus >1.78 mmol/L group (n=53) and the blood phosphorus ≤1.78 mmol/L group (n=65). t test was used to compare the serum phosphorus levels of patients with dysfunction group and fistula patency group. Patency rate was calculated by survival analysis method and log-rank test was used to compare secondary patency rate between groups of blood phosphorus >1.78 mmol/L and blood phosphorus ≤1.78 mmol/L. Multivariate Cox regression was used to analyze the influencing factors. Results: The average blood phosphorus level was significantly higher in dysfunction group[(1.87±0.42) mmol/L vs (1.65±0.39) mmol/L, P=0.008], and patency rate was significantly lower in patients of blood phosphorus>1.78 mmol/L group than that in patients of blood phosphorus ≤1.78 mmol/L (42.2% vs 60.4%, P=0.009). Blood phosphorus>1.78 mmol/L (RR=2.527, 95% CI: 1.272-5.023, P=0.008), diabetes (RR=2.667, 95% CI: 1.339-5.313, P=0.005) and C-reactive protein (CRP)>5 mg/L (RR=2.749, 95% CI: 1.324-5.710, P=0.007) were risk factors affecting secondary patency rate of internal fistua. Conclusion: Hyperphosphatemia is an independent risk factors for the patency rate of AVF after reoperation in hemodialysis patients.

The use of doppler ultrasound in evaluation and follow-up of arteriovenous fistula patients

Objectives: The aim of the present study was to search the effect of preoperative Doppler ultrasonography (DUS) of the concerning limb on AVF patency for arteriovenous fistula (AVF) to be performed on the patients with end-stage renal disease. Methods: One hundred and three patients were enrolled into the study. The exclusion criteria were previous central catheter procedure, history of thrombophlebitis on the upper limb and previous surgery on the upper limb. Among the remaining patients, those who fulfilled the physical examination criteria were included. The patients were divided into two groups as the control, DUS (-) group and the study group, DUS (+). The patients in the control group were taken into the procedure after a physical examination only. Brescio-Cimino method was preferred for all patients. Function of the AVF was controlled on the procedure day, at day 10, months 1, 3 and 6 as well as year 1 after the procedure. The results in both groups were statistically evaluated. Results: Twenty patients in the DUS (+) group (50% male, mean age: 57.25 ± 13.34 years) and 20 patients in the DUS (-) group (45% male, mean age: 56.10 ± 12.35) were recorded in the study. Cumulative primary patency rates between DUS (+) group and DUS(-) group for 12 months were 95% and 65%, respectively (log-rank, p = 0.022). Conclusion: We believe that the DUS performed before AVF procedure would increase the primary patency rates of AVF created between the most convenient vessels and reduce the procedure failure.

Optimal Cutoff Values for Radial Artery Diameter in Secondary Patency Rates and Risk Factors Affecting of Arteriovenous Fistulas

Radial artery diameter on preoperative ultrasound has previously been investigated as a risk factor for the primary patency rate of arteriovenous fistulas. However, the cutoff values for long-term secondary patency rates have not been reported in detail. The present study verified the cutoff values that predict long-term secondary patency. This was a single-center retrospective study. Among the arteriovenous fistula operations performed at our hospital from March 2008 to April 2013, 204 patients who underwent ultrasonography prior to the operation and whose secondary patency data were available were enrolled in this study. Secondary patency rates were calculated at 1, 3, and 5years. Risk factors, including radial artery diameters (divided into quartiles), age, sex, diabetes mellitus, calcification, right versus left radial artery, and operative time (divided into quartiles) were examined using the log-rank test. Next, we performed multivariate Cox proportional hazard analysis using risk factors that were significant in the log-rank test. Further studies using time-dependent receiver operating characteristic curves were conducted to examine the cutoff values for radial artery diameters. The 1-, 3-, and 5-year secondary patency rates were 78.9%, 69.8%, and 67.4%, respectively. Significant risk factors included radial artery diameter and age ≥65years. The cutoff value was 2.0mm. A radial artery diameter cutoff value of 2.0mm may increase the secondary patency rate of arteriovenous fistulas. This result agrees with the radial artery diameter reported for primary patency rates and is a clinically significant indicator.