Utilize este identificador para referenciar este registo: http://hdl.handle.net/10400.16/2246
Título: Are we building too many arteriovenous fistulas? A single-center experience
Autor: Leal-Moreira, C.
Teixeira, V.
Bessa, L.
Queirós, J.
Silva, F.
Cabrita, A.
Palavras-chave: Arteriovenous Fistula
Central Venous Catheter
Morbidity
Survival
Data: 2017
Editora: Sociedade Portuguesa de Nefrologia
Citação: Port J Nephrol Hypert 2017; 31(4): 274-280
Resumo: Introduction: Arteriovenous fistula has been associated with improved morbimortality in hemodialysis patients. This has resulted in the “fistula First, catheter last” initiative. Nonetheless, the survival benefit of arteriovenous fistula has been questioned. Methods: We conducted a retrospective observational study of all patients with non-end stage renal disease referred for first vascular access building between January 2014 and December 2015 in our hospital center. Our main goal was to evaluate the clinical impact and burden of building fistula in predialysis patients. Results: During this period, of 178 first arteriovenous accesses placed, 87 patients remained in predialysis and 91 patients started a chronic hemodialysis program. Median follow-up time by a nephrologist was 3.9 (2.5, 9.7) years. The mean age was 65.8±14.7 years, with 50.6% (n=90) of male patients. A higher rate of thrombosis in the predialysis group (26% vs 13%, p=0.037) was observed, but vascular access survival did not differ significantly (55% vs 67%, p=0.12). Mean vascular access placing was higher in the predialysis group (1.4±0.7 vs 1.2±0.4, p=0.006) and less interventions were requested (0.2±0.5 vs 0.3±0.6, p=0.10). Median time from vascular access placement to hemodialysis start was 22 (13, 41) months. At hemodialysis initiation, 10 (10.9%) patients used a central venous catheter; 80 (87.9%) patients an arteriovenous fistula, and one patient a graft. A total of 227 vascular accesses were built; 121 (53.3%) in predialysis vs 106 (46.7%) in incident hemodialysis patients. In a multivariate model, the presence of a functional arteriovenous fistula at hemodialysis start was only associated with a trend to survival benefit (HR 0.38, 95% CI 0.14-1.00, p=0.05). Conclusions: Our results stress the need for an individual approach and for future tools to assess the risk of death and progression to end-stage renal disease, therefore helping reduce the number of unutilized vascular accesses and rising cost of interventions.
Peer review: yes
URI: http://hdl.handle.net/10400.16/2246
ISSN: 2183-1289
Versão do Editor: http://www.spnefro.pt/rpnh/browse_all_issues/66_volume_31_number_4
Aparece nas colecções:SNEF - Artigos publicados em revistas não indexadas na Medline

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