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Are we building too many arteriovenous fistulas? A single-center experience

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dc.contributor.authorLeal-Moreira, C.
dc.contributor.authorTeixeira, V.
dc.contributor.authorBessa, L.
dc.contributor.authorQueirós, J.
dc.contributor.authorSilva, F.
dc.contributor.authorCabrita, A.
dc.date.accessioned2018-10-30T12:38:30Z
dc.date.available2018-10-30T12:38:30Z
dc.date.issued2017
dc.description.abstractIntroduction: 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationPort J Nephrol Hypert 2017; 31(4): 274-280pt_PT
dc.identifier.issn2183-1289
dc.identifier.urihttp://hdl.handle.net/10400.16/2246
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSociedade Portuguesa de Nefrologiapt_PT
dc.relation.publisherversionhttp://www.spnefro.pt/rpnh/browse_all_issues/66_volume_31_number_4pt_PT
dc.subjectArteriovenous Fistulapt_PT
dc.subjectCentral Venous Catheterpt_PT
dc.subjectMorbiditypt_PT
dc.subjectSurvivalpt_PT
dc.titleAre we building too many arteriovenous fistulas? A single-center experiencept_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlacePortugalpt_PT
oaire.citation.endPage280pt_PT
oaire.citation.issue4pt_PT
oaire.citation.startPage274pt_PT
oaire.citation.titlePortuguese Journal of Nephrology and Hypertensionpt_PT
oaire.citation.volume31pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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