Type of arteriovenous vascular access and association with patency and mortality

BMC Nephrology

Marion Verduijn³  Friedo W Dekker³  Elisabeth W Boeschoten¹  Raymond T Krediet⁴  Frits R Rosendaal⁵  Carla Y Vossen²  Joris I Rotmans⁶  Gürbey Ocak³ 

[1]Hans Mak Institute, Naarden, The Netherlands

[2]Division of Biomedical Genetics, Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands

[3]Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

[4]Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands

[5]Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands

[6]Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands

关键词: Epidemiology;    Mortality;    Patency;    Graft;    Fistula;    Hemodialysis;   

Others  :  1082959
DOI  :  10.1186/1471-2369-14-79

 received in 2012-10-13, accepted in 2013-03-21,  发布年份 2013

【 摘 要 】

Background

There are only a few risk factors known for primary patency loss in patients with an arteriovenous graft or fistula. Furthermore, a limited number of studies have investigated the association between arteriovenous access modality and primary patency loss and mortality. The aim of this study was to investigate risk factors for patency loss and to investigate the association between graft versus fistula use and outcomes (patency loss and mortality).

Methods

We prospectively followed 919 incident hemodialysis patients and calculated hazard ratios (HRs) for putative risk factors of primary patency loss using Cox regression. Furthermore, HRs were calculated to study the association between graft versus fistula use and two-year primary patency loss and two-year mortality.

Results

Cardiovascular disease, prior catheter use, lowest tertile of albumin, highest tertile of hsCRP, and lowest tertile of fetuin-A were associated with primary patency loss in both patients with grafts and fistulas. Increased age, female sex, and diabetes mellitus were only associated with primary patency loss in patients with a fistula. We did not observe an association between primary patency loss and BMI, residual GFR, levels of calcium, phosphorus, and total cholesterol. Furthermore, graft use as compared with fistula use was associated with an 1.4-fold (95% CI 1.0-1.9) increased risk of primary patency loss and with an 1.5-fold(95% CI 1.0-2.2) increased mortality risk.

Conclusion

Cardiovascular disease, prior catheter use, albumin, hsCRP, and fetuin-A are risk factors for patency loss. Graft use as compared with fistula use was associated with an increased risk of patency loss and mortality.

【 授权许可】

   
2013 Ocak et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Feldman HI, Kobrin S, Wasserstein A: Hemodialysis vascular access morbidity. J Am Soc Nephrol 1996, 7:523-535.
• [2]U S Renal Data System: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Bethesda, MD: USRDS 2004 Annual Data Report; 2004.
• [3]Allon M, Robbin ML: Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int 2002, 62:1109-1124.
• [4]Paszkowiak JJ, Dardik A: Arterial wall shear stress: observations from the bench to the bedside. Vasc Endovascular Surg 2003, 37:47-57.
• [5]Roy-Chaudhury P, Kelly BS, Miller MA, Reaves A, Armstrong J, Nanayakkara N, Heffelfinger SC: Venous neointimal hyperplasia in polytetrafluoroethylene dialysis grafts. Kidney Int 2001, 59:2325-2334.
• [6]Roy-Chaudhury P, Kelly BS, Zhang J, Narayana A, Desai P, Melham M, Duncan H, Heffelfinger SC: Hemodialysis vascular access dysfunction: from pathophysiology to novel therapies. Blood Purif 2003, 21:99-110.
• [7]Chang CJ, Ko YS, Ko PJ, Hsu LA, Chen CF, Yang CW, Hsu TS, Pang JH: Thrombosed arteriovenous fistula for hemodialysis access is characterized by a marked inflammatory activity. Kidney Int 2005, 68:1312-1319.
• [8]Chang CJ, Ko PJ, Hsu LA, Ko YS, Ko YL, Chen CF, Huang CC, Hsu TS, Lee YS, Pang JH: Highly increased cell proliferation activity in the restenotic hemodialysis vascular access after percutaneous transluminal angioplasty: implication in prevention of restenosis. Am J Kidney Dis 2004, 43:74-84.
• [9]Rotmans JI, Pasterkamp G, Verhagen HJ, Pattynama PM, Blankestijn PJ, Stroes ES: Hemodialysis access graft failure: time to revisit an unmet clinical need? J Nephrol 2005, 18:9-20.
• [10]Astor BC, Eustace JA, Powe NR, Klag MJ, Fink NE, Coresh J: Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J Am Soc Nephrol 2005, 16:1449-1455.
• [11]Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK: Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int 2001, 60:1443-1451.
• [12]Hermans MM, Brandenburg V, Ketteler M, Kooman JP, van der Sande FM, Boeschoten EW, Leunissen KM, Krediet RT, Dekker FW: Association of serum fetuin-A levels with mortality in dialysis patients. Kidney Int 2007, 72:202-207.
• [13]van Stralen KJ, Dekker FW, Zoccali C, Jager KJ: Confounding. Nephron Clin Pract 2010, 116:c143-c147.
• [14]Ocak G, Halbesma N, le CS, Hoogeveen EK, van DS, Kooman J, Dekker FW, Krediet RT, Boeschoten EW, Verduijn M: Haemodialysis catheters increase mortality as compared to arteriovenous accesses especially in elderly patients. Nephrol Dial Transplant 2011.
• [15]Van Dijk PC, Jager KJ, De CF, Collart F, Cornet R, Dekker FW, Gronhagen-Riska C, Kramar R, Leivestad T, Simpson K, Briggs JD: Renal replacement therapy in Europe: the results of a collaborative effort by the ERA-EDTA registry and six national or regional registries. Nephrol Dial Transplant 2001, 16:1120-1129.
• [16]Monroy-Cuadros M, Yilmaz S, Salazar-Banuelos A, Doig C: Risk factors associated with patency loss of hemodialysis vascular access within 6 months. Clin J Am Soc Nephrol 2010, 5:1787-1792.
• [17]Chen HY, Chiu YL, Chuang YF, Hsu SP, Pai MF, Lai CF, Yang JY, Peng YS, Tsai TJ, Wu KD: Association of low serum fetuin A levels with poor arteriovenous access patency in patients undergoing maintenance hemodialysis. Am J Kidney Dis 2010, 56:720-727.
• [18]Miller PE, Carlton D, Deierhoi MH, Redden DT, Allon M: Natural history of arteriovenous grafts in hemodialysis patients. Am J Kidney Dis 2000, 36:68-74.
• [19]Huijbregts HJ, Bots ML, Wittens CH, Schrama YC, Moll FL, Blankestijn PJ: Hemodialysis arteriovenous fistula patency revisited: results of a prospective, multicenter initiative. Clin J Am Soc Nephrol 2008, 3:714-719.
• [20]Prischl FC, Kirchgatterer A, Brandstatter E, Wallner M, Baldinger C, Roithinger FX, Kramar R: Parameters of prognostic relevance to the patency of vascular access in hemodialysis patients. J Am Soc Nephrol 1995, 6:1613-1618.
• [21]Hodges TC, Fillinger MF, Zwolak RM, Walsh DB, Bech F, Cronenwett JL: Longitudinal comparison of dialysis access methods: risk factors for failure. J Vasc Surg 1997, 26:1009-1019.
• [22]Erkut B, Unlu Y, Ceviz M, Becit N, Ates A, Colak A, Kocak H: Primary arteriovenous fistulas in the forearm for hemodialysis: effect of miscellaneous factors in fistula patency. Ren Fail 2006, 28:275-281.
• [23]Ifudu O, Mayers JD, Cohen LS, Paul H, Brezsnyak WF, Avram MM, Herman AI, Friedman EA: Correlates of vascular access and nonvascular access-related hospitalizations in hemodialysis patients. Am J Nephrol 1996, 16:118-123.
• [24]Ketteler M, Bongartz P, Westenfeld R, Wildberger JE, Mahnken AH, Bohm R, Metzger T, Wanner C, Jahnen-Dechent W, Floege J: Association of low fetuin-A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis: a cross-sectional study. Lancet 2003, 361:827-833.
• [25]Stenvinkel P, Wang K, Qureshi AR, Axelsson J, Pecoits-Filho R, Gao P, Barany P, Lindholm B, Jogestrand T, Heimburger O, Holmes C, Schalling M, Nordfors L: Low fetuin-A levels are associated with cardiovascular death: Impact of variations in the gene encoding fetuin. Kidney Int 2005, 67:2383-2392.
• [26]Honda H, Qureshi AR, Heimburger O, Barany P, Wang K, Pecoits-Filho R, Stenvinkel P, Lindholm B: Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD. Am J Kidney Dis 2006, 47:139-148.
• [27]Lee T, Chauhan V, Krishnamoorthy M, Wang Y, Arend L, Mistry MJ, El-Khatib M, Banerjee R, Munda R, Roy-Chaudhury P: Severe venous neointimal hyperplasia prior to dialysis access surgery. Nephrol Dial Transplant 2011, 26:2264-2270.
• [28]Hansson GK: Atherosclerosis–an immune disease: The Anitschkov Lecture 2007. Atherosclerosis 2009, 202:2-10.
• [29]Hansson GK, Jonasson L, Lojsthed B, Stemme S, Kocher O, Gabbiani G: Localization of T lymphocytes and macrophages in fibrous and complicated human atherosclerotic plaques. Atherosclerosis 1988, 72:135-141.
• [30]Allon M, Lok CE: Dialysis fistula or graft: the role for randomized clinical trials. Clin J Am Soc Nephrol 2010, 5:2348-2354.
• [31]NKF-KDOQI clinical practice guidelines for vascular access: National Kidney Foundation-Dialysis Outcomes Quality Initiative. Am J Kidney Dis 1997, 30:S150-S191.