BACKGROUND AND OBJECTIVES: Clinical guidelines support vascular access surveillance to detect access dysfunction and alter the clinical course by radiologic or surgical intervention. The objective of this study was to explore the association between loss of primary functional patency within 6 months of first use and demographic and clinical characteristics of patients receiving chronic renal replacement therapy with arteriovenous fistulas. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a retrospective study of all chronic hemodialysis patients followed by the Southern Alberta Renal Program from January 1, 2005 to June 30, 2008. Demographic and clinical variables and initial intra-access blood flow (IABF) were compared between those with and without loss of primary functional patency. To determine the contribution of independent variables to the dependant variable of loss of primary functional patency, a multivariable analysis using logistic regression was performed. RESULTS: The incidence of primary failure was 10% (81 of 831). Multivariable analysis found that older age (>65 years, odds ratio [OR] 3.6, P < 0.001), history of diabetes (OR 2.3, P = 0.007), history of smoking (OR 4.3, P < 0.001), presence of forearm fistulas (OR 4.0, P < 0.001), and low initial IABF (<500 ml/min, OR 29, P < 0.001) were independently associated with loss of primary patency. CONCLUSIONS: The set of patient risk factors identified in this study, particularly initial IABF, can be used to identify patients who are most at risk for developing vascular access failure and to guide a more directed approach for a vascular access screening protocol.
BACKGROUND AND OBJECTIVES: Clinical guidelines support vascular access surveillance to detect access dysfunction and alter the clinical course by radiologic or surgical intervention. The objective of this study was to explore the association between loss of primary functional patency within 6 months of first use and demographic and clinical characteristics of patients receiving chronic renal replacement therapy with arteriovenous fistulas. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a retrospective study of all chronic hemodialysis patients followed by the Southern Alberta Renal Program from January 1, 2005 to June 30, 2008. Demographic and clinical variables and initial intra-access blood flow (IABF) were compared between those with and without loss of primary functional patency. To determine the contribution of independent variables to the dependant variable of loss of primary functional patency, a multivariable analysis using logistic regression was performed. RESULTS: The incidence of primary failure was 10% (81 of 831). Multivariable analysis found that older age (>65 years, odds ratio [OR] 3.6, P < 0.001), history of diabetes (OR 2.3, P = 0.007), history of smoking (OR 4.3, P < 0.001), presence of forearm fistulas (OR 4.0, P < 0.001), and low initial IABF (<500 ml/min, OR 29, P < 0.001) were independently associated with loss of primary patency. CONCLUSIONS: The set of patient risk factors identified in this study, particularly initial IABF, can be used to identify patients who are most at risk for developing vascular access failure and to guide a more directed approach for a vascular access screening protocol.
Authors: D N Churchill; D W Taylor; R J Cook; P LaPlante; P Barre; P Cartier; W P Fay; M B Goldstein; K Jindal; H Mandin Journal: Am J Kidney Dis Date: 1992-03 Impact factor: 8.860
Authors: Anton N Sidawy; Richard Gray; Anatole Besarab; Mitchell Henry; Enrico Ascher; Michael Silva; Arnold Miller; Larry Scher; Scott Trerotola; Roger T Gregory; Robert B Rutherford; K Craig Kent Journal: J Vasc Surg Date: 2002-03 Impact factor: 4.268
Authors: David A Drew; Charmaine E Lok; Joshua T Cohen; Martin Wagner; Navdeep Tangri; Daniel E Weiner Journal: J Am Soc Nephrol Date: 2014-07-25 Impact factor: 10.121
Authors: Ali Mirza Onder; Joseph T Flynn; Anthony A Billings; Fang Deng; Marissa DeFreitas; Chryso Katsoufis; Matthew M Grinsell; Larry T Patterson; Jennifer Jetton; Sahar Fathallah-Shaykh; Daniel Ranch; Diego Aviles; Lawrence Copelovitch; Eileen Ellis; Vimal Chanda; Ayah Elmaghrabi; Jen-Jar Lin; Lavjay Butani; Maha Haddad; Olivera Marsenic Couloures; Paul Brakeman; Raymond Quigley; H Stella Shin; Rouba Garro; Hui Liu; Javad Rahimikollu; Rupesh Raina; Craig B Langman; Ellen G Wood Journal: Pediatr Nephrol Date: 2018-09-27 Impact factor: 3.714
Authors: Alik Farber; Peter B Imrey; Thomas S Huber; James M Kaufman; Larry W Kraiss; Brett Larive; Liang Li; Harold I Feldman Journal: J Vasc Surg Date: 2016-01 Impact factor: 4.268
Authors: Radojica V Stolić; Zoran Bukumiric; Vekoslav Mitrovic; Maja Sipic; Biljana Krdzic; Goran Relic; Gordana Nikolic; Sasa Sovtic; Naja E Suljkovic Journal: Med Princ Pract Date: 2020-10-29 Impact factor: 1.927
Authors: Gürbey Ocak; Joris I Rotmans; Carla Y Vossen; Frits R Rosendaal; Raymond T Krediet; Elisabeth W Boeschoten; Friedo W Dekker; Marion Verduijn Journal: BMC Nephrol Date: 2013-04-04 Impact factor: 2.388