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Predictors of Sustained Arteriovenous Access Use for Haemodialysis
- Source :
- American Journal of Nephrology. 39:491-498
- Publication Year :
- 2014
- Publisher :
- S. Karger AG, 2014.
-
Abstract
- Background: Guidelines encourage early arteriovenous (AV) fistula (AVF) planning for haemodialysis (HD). The aim of this study was to estimate the likelihood of sustained AV access use taking into account age, sex, comorbidity, anatomical site of first AVF and, for pre-dialysis patients, eGFR and proteinuria. Methods: 1,092 patients attending our centre who had AVF as their first AV access procedure between January 1, 2000 and August 23, 2012 were identified from the electronic patient record. The primary end-point was time to first sustained AV access use, defined as use of any AV access for a minimum of 30 consecutive HD sessions. Results: 52.9% (n = 578) of the patients ultimately achieved sustained AV access use. The main reasons for AV access non-use were AVF failure to mature and death. The 3-year Kaplan-Meier probability of sustained AV access use was 68.8% for those not on renal replacement therapy (RRT) (n = 688) and 74.2% for those already on RRT (n = 404) at the time of first AVF. By multivariate analysis in patients not on RRT, male sex (HR 2.22; p < 0.001), uPCR (HR 1.03; p = 0.03) and eGFR (hazard ratio, HR 0.85; p < 0.001) were independent predictors of AV access use. In patients already on RRT, age (HR 0.98; p < 0.001) and peripheral vascular disease (HR 0.48; p = 0.02) were independent predictors of AV access use. Conclusion: Our data suggest that refinement of the current guideline for timing of AV access creation in planning RRT is justified to take into account individual factors that contribute to the likelihood of technical success and clinical need.
- Subjects :
- Adult
Male
Catheterization, Central Venous
congenital, hereditary, and neonatal diseases and abnormalities
medicine.medical_specialty
Time Factors
Adolescent
Fistula
Myocardial Ischemia
Arteriovenous fistula
Comorbidity
Severity of Illness Index
Young Adult
Arteriovenous Shunt, Surgical
Sex Factors
Renal Dialysis
Diabetes Mellitus
medicine
Humans
cardiovascular diseases
Renal Insufficiency, Chronic
Aged
Retrospective Studies
Peripheral Vascular Diseases
business.industry
Age Factors
Middle Aged
medicine.disease
Kidney Transplantation
Surgery
Proteinuria
Nephrology
Practice Guidelines as Topic
Disease Progression
Kidney Failure, Chronic
Female
business
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 14219670 and 02508095
- Volume :
- 39
- Database :
- OpenAIRE
- Journal :
- American Journal of Nephrology
- Accession number :
- edsair.doi.dedup.....956ca563b7b4fe1b570da4c9095ddc8c