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Hemodialysis Arteriovenous Vascular Access Creation After Kidney Transplant Failure.
- Source :
-
American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2015 Oct; Vol. 66 (4), pp. 646-54. Date of Electronic Publication: 2015 May 12. - Publication Year :
- 2015
-
Abstract
- Background: Little is known about vascular access in patients starting hemodialysis therapy after kidney transplant failure.<br />Study Design: Retrospective cohort study.<br />Setting & Participants: Adult patients (aged ≥18 years) who started hemodialysis therapy in Ontario, Canada, from January 1, 2001, through December 31, 2010, after kidney transplant failure.<br />Predictor: Patient clinical and demographic characteristics.<br />Outcomes: Proportion and timing of arteriovenous (AV) vascular access creation (fistula or graft) 12 months prior and up to 24 months after starting hemodialysis therapy.<br />Measurements: Event rates and outcome predictors.<br />Results: Our cohort included 683 patients with a mean age of 48 years and >50% with comorbidity index score < 3. In the 12 months predialysis and 24 months postdialysis, 16% and 47% of patients had an AV access created, respectively. In the postdialysis period, 13%, 26%, and 38% of patients had an AV access creation at 3, 6, and 12 months, respectively. History of coronary artery disease, diabetes mellitus, and peritoneal dialysis use prior to transplantation were associated with a lower likelihood of AV access creation.<br />Limitations: Residual selection bias from unmeasured variables beyond the data elements.<br />Conclusions: In Ontario, AV access creation, both before and after starting hemodialysis therapy, is low in patients with kidney transplant failure despite their being younger and healthier compared to the overall hemodialysis population. This highlights the need for a predialysis care pathway in the transplantation clinic and an active strategy to identify this patient cohort receiving hemodialysis to align modality and access choices.<br /> (Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Age Factors
Aged
Arteriovenous Shunt, Surgical adverse effects
Cohort Studies
Female
Follow-Up Studies
Graft Rejection diagnosis
Graft Rejection mortality
Humans
Kidney Failure, Chronic diagnosis
Kidney Transplantation methods
Male
Middle Aged
Multivariate Analysis
Ontario
Proportional Hazards Models
Renal Dialysis adverse effects
Renal Dialysis methods
Retrospective Studies
Risk Assessment
Sex Factors
Survival Analysis
Time Factors
Treatment Outcome
Arteriovenous Shunt, Surgical methods
Graft Rejection therapy
Kidney Failure, Chronic mortality
Kidney Failure, Chronic surgery
Kidney Transplantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6838
- Volume :
- 66
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- American journal of kidney diseases : the official journal of the National Kidney Foundation
- Publication Type :
- Academic Journal
- Accession number :
- 25975965
- Full Text :
- https://doi.org/10.1053/j.ajkd.2015.03.031