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Wei S, Liu N, Fu Y, Sun M. Novel insights into modifiable risk factors for arteriovenous fistula failure and the importance of CKD lipid profile: A meta-analysis. J Vasc Access 2024; 25:1416-1431. [PMID: 36951426 DOI: 10.1177/11297298221115557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Arteriovenous fistula (AVF) failure can occur in patients undergoing hemodialysis (HD). In this study, we explored the correlation between hyperlipidemia and AVF failure in patients undergoing HD. Moreover, we compared the lipid profiles of patients with chronic kidney disease (CKD) with those of healthy people to provide a basis for lipid-lowering in patients undergoing HD. METHOD AND ANALYSIS We searched PubMed, Web of Science, Embase, the Cochrane library, CNKI, CBM, the China Science Periodical Database, and the China Science and Technology Journal Database. The final search was conducted on August 31, 2021, and the search period was restricted between 2000 and August 31, 2021, without publication restrictions. All studies met the inclusion criteria, and the influences of sex, age, geographical location, diagnosis method, and publication year were excluded. The data were analyzed using the random-effects model and the fixed-effects model. RESULTS Twenty-eight studies were included in the meta-analysis with 121,666 patients in the CKD group and 1714 patients in the AVF failure group. Triglyceride concentration in patients with CKD was higher than in healthy subjects (MD: -31.56, 95% CI: -41.23 to -21.90, p < 0.00001). A high total cholesterol (TC) concentration (MD: 6.97, 95% CI: 2.19-11.74, p = 0.004) and a high low-density lipoprotein cholesterol (LDL-C) concentration (MD: 23.83, 95% CI: 18.48-29.18, p < 0.00001) were associated with AVF failure. Furthermore, HDL-C was lower in the AVF failure group than in the AVF patency group (MD: -2.68, 95% CI: -4.60 to -0.76, p = 0.006). CONCLUSION Our analysis indicates that the AVF failure may be related to the increase of TC/LDL-C and the decrease of HDL-C. Although current guidelines do not consider intensive lipid-lowering therapy as necessary in patients undergoing HD, our research indicates that patients with AVF undergoing HD may need regular TC/LDL-C-lowering therapy to prevent AVF failure. However, this issue still needs well designed prospective trials.
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Affiliation(s)
- Shizhuo Wei
- Department of Nephrology, The First Hospital of Jilin University, Changchun, China
| | - Naimeng Liu
- Department of Breast Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yingli Fu
- Division of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China
| | - Mindan Sun
- Department of Nephrology, The First Hospital of Jilin University, Changchun, China
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Khanfar O, Aydi R, Saada S, Shehada M, Hamdan Z, Sawalmeh O, Hassan M, Hammoudi A, Nazzal Z. Mid-term cumulative patency of fistula and PTFE grafts among hemodialysis patients: A retrospective, single-center study from Palestine. J Vasc Access 2023; 24:559-567. [PMID: 34431381 DOI: 10.1177/11297298211040988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Due to the long waiting time for kidney transplantation, most End-Stage renal disease patients are commenced on either hemodialysis or peritoneal dialysis. Reusable fistulas have the lowest risk for death, cardiovascular events, and infections among all vascular accesses. This study aims to report the outcomes of the arteriovenous fistulas and PTFE grafts and the related predictive clinical and demographic variables. METHODS This retrospective study reviewed the charts of all hemodialysis patients between January 2017 and January 2021 at the Dialysis Center of An-Najah National University Hospital, Nablus, Palestine. Our outcomes were a primary failure, primary and secondary patency, and the related factors. Survival analysis using the Kaplan-Meier method was conducted, and the log-rank test was used to compare patency rates. The Cox proportional hazards regression model tested factors relevant to primary and secondary patency rates in univariate and multivariate analyses. RESULTS A total of 312 procedures were performed during the study period. Primary failure was 7.1% for AVF, 13.9% for arterio-venous graft (AVG) procedures. Peripheral arterial disease and left-sided AVF were associated with more primary failure rates. AVF, primary patency rates at 1, 2, and 3 years were 82%, 69%, and 59%, respectively, while secondary patency rates at 1, 2, and 3 years were 85%, 72%, and 63%, respectively. Factors associated with increased AVF patency in a proportional hazard model were younger age and dual antiplatelet administration. CONCLUSION Our study adds further evidence that autogenous AVF has better results than prosthetic AVG in both primary and secondary patency rates as well as less primary failure rates. Therefore, we encourage further longitudinal studies that assess the benefits of using antiplatelet on AVF outcome versus risks of bleeding, especially with dual agents.
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Affiliation(s)
- Obada Khanfar
- Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Ramadan Aydi
- Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sultan Saada
- Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Vascular Surgery Department, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Mohammad Shehada
- Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Zakaria Hamdan
- Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Nephrology Department, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Osama Sawalmeh
- Internal Medicine Department, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Mohannad Hassan
- Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Nephrology Department, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Ahmad Hammoudi
- Internal Medicine Department, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Zaher Nazzal
- Family and Community Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Alam F, Al Salmi I, Al Zadjali M, Jha DK, Hannawi S. Demography and Outcomes of Arteriovenous Fistula: Challenges and Future Directions. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:627-638. [PMID: 37955455 DOI: 10.4103/1319-2442.389423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
The incidence and prevalence rates of treated end-stage kidney disease (ESKD) patients are on the rise worldwide. Hemodialysis remains the main modality of providing renal replacement therapy for the ESKD patients, and the preferred vascular access is an arteriovenous fistula (AVF). The objective is to assess the patency rates and primary failures of the AVF. All patients who attended the Royal Hospital in Muscat, Oman, from January 2010 to December 2014 for AVF creation were included in this study. Data were extracted from the hospital's electronic medical record system where data are entered prospectively. During the period of study from 2010 to 2014, 465 primary fistulae were created in 427 patients. The mean age of the patient was 58 years. Only 6% needed general anesthesia, while the rest were done under regional or local anesthesia. Fifty-one percent of the patients were diabetic. Preemptive AVF was constructed in only 12% of patients. Most cases (47%) had left brachiocephalic (BC) fistulae. The left radiocephalic (RC) fistulae constituted 25.7% and the left brachiobasilic fistulae 9.9%. The remaining were constructed in the right upper limb. The total patency was achieved in 80% of fistulae and the failure rate was 20% at 6 months. Whereas, at 12 months, the total patency rate was 71% and the failure rate was 29%. Thus, we can conclude that more than 50% of patients, half of them being females, were diabetics. This resulted in more fistulae being constructed in the arm, namely left BC fistulae and left RC fistulae. Furthermore, it is important to note that only a very small percentage of patients had an established preemptive AVF. These factors may be responsible for a failure rate of 20% and 29% of the AVFs at 6 months and 12 months, respectively.
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Affiliation(s)
- Faisal Alam
- Department of Surgery, The Royal Hospital, Muscat, Oman
| | - Issa Al Salmi
- Department of Renal Medicine, The Royal Hospital, Muscat, Oman
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Wärme A, Hadimeri H, Nasic S, Stegmayr B. The association of erythropoietin-stimulating agents and increased risk for AV-fistula dysfunction in hemodialysis patients. A retrospective analysis. BMC Nephrol 2021; 22:30. [PMID: 33461526 PMCID: PMC7814716 DOI: 10.1186/s12882-020-02209-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients in maintenance hemodialysis (HD) need a patent vascular access for optimal treatment. The recommended first choice is a native arteriovenous fistula (AVF). Complications of AVF are frequent and include thrombosis, stenosis and infections leading to worsening of dialysis efficacy. Some known risk factors are age, gender and the presence of diabetes mellitus. The aim was to investigate if further risk variables are associated with dysfunctional AVF. METHODS This retrospective observational study included 153 chronic HD patients (Cases) referred to a total of 473 radiological investigations due to clinically suspected complications of their native AVF. Another group of chronic HD patients (n = 52) who had a native AVF but were without history of previous complications for at least 2 years were controls. Statistical analyses included ANOVA, logistic regression, parametric and non-parametric methods such as Student's T-test and Mann-Whitney test. RESULTS Among Cases, at least one significant stenosis (> 50% of the lumen) was detected in 348 occasions. Subsequent PTA was performed in 248 (71%). Median erythropoiesis-stimulating agent (ESA) weekly doses were higher in Cases than in Controls (8000 vs 5000 IU, p < 0.001). Cases received higher doses of intravenous iron/week than the Controls before the investigation (median 50 mg vs 25 mg, p = 0.004) and low molecular weight heparin (LMWH, p = 0.028). Compared to Controls, Cases had a lower level of parathyroid hormone (median 25 vs 20 ρmol/L, p = 0.009). In patients with diabetes mellitus, HbA1c was higher among Cases than Controls (50 vs 38 mmol/mol, p < 0.001). Multiple regression analysis revealed significant associations between Cases and female gender, prescription of doxazocin, and doses of ESA and LMWH. There was no difference between the groups regarding hemoglobin, CRP or ferritin. CONCLUSION In conclusion, the present study indicated that the factors associated with AVF problems were high doses of ESA, iron administration, and tendency of thromboembolism (indicated by high LMWH doses); the use of doxazocin prescription, however, requires further investigation.
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Affiliation(s)
- Anna Wärme
- Dept of Internal Medicine and Clinical Nutrition, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Nephrology, Skaraborg hospital, 541 85 Skovde, Sweden
| | - Henrik Hadimeri
- Dept of Internal Medicine and Clinical Nutrition, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skovde, Sweden
| | - Bernd Stegmayr
- Dept of Public Health and Clinical Medicine, Umea University, Umea, Sweden
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Obeidat KA, Saadeh RA, Hammouri HM, Obeidat MA, Tawalbeh RA. Outcomes of arteriovenous fistula creation: A Jordanian experience. J Vasc Access 2020; 21:977-982. [DOI: 10.1177/1129729820920140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: The arteriovenous fistula is considered the preferred hemodialysis access due to its lower complication rate and longer patency. The aim of this study is to report the outcomes of arteriovenous fistula creation and to study the predictive factors for these outcomes. Study design and method: This is a retrospective study of all patients who underwent autogenous arteriovenous fistula creation procedure by a single surgeon during the period from October 2011 till December 2017. Material: All the procedures were performed at an academic referral center by a single surgeon. All patients who underwent arteriovenous fistula creation in the upper limb during the study period were included. All patients were diagnosed with end-stage renal disease and referred for arteriovenous fistula creation either before or after initiating hemodialysis. Method: Data were collected from the patients’ charts. The primary outcomes were the primary failure and secondary patency rates. Secondary outcome was to find the factors associated with decreased patency. The Kaplan–Meier curve with the log-rank test was used to describe the patency while univariate and multivariate analyses were done to the factors considered relevant to the patency. Results: The total number of procedures was 291; of which, 18 were lost to follow-up. The primary failure rate was 12%. Secondary patency rate at 1 and 5 years was 79% and 53%, respectively. Diabetes mellitus and fistulae placed on right side were associated with decreased patency. Conclusion: The primary failure rate was relatively low in this study but the long-term functionality of the arteriovenous fistulae needs to be improved.
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Affiliation(s)
- Khaled A Obeidat
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rami A Saadeh
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan M Hammouri
- Department of Mathematics and Statistics, Faculty of Science, Jordan University of Science and Technology, Irbid, Jordan
| | - Motaz A Obeidat
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ra’fat A Tawalbeh
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Tanaka A, Inaguma D, Watanabe Y, Ito E, Kamegai N, Shimogushi H, Shinjo H, Koike K, Otsuka Y, Takeda A. Factors associated with early failure of vascular access in acute-phase patients. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0074-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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