Predictive Parameters Functioning Arteriovenous Fistula For Hemodialysis In The Elderly

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Abstract

Elderly patients with end stage kidney disease represent a challenge for surgeons to create a vascular access. Determine predictive parameters functionality of the arteriovenous fi stulas for hemodialysis in the elderly. Th e study was organized as a retrospective study at the Center for Dialysis, Clinic for Urology and Nephrology, Clinical Center Kragujevac. Th e study included patients older than 65 years with arteriovenous fi stula thrombosis, in the period of four years, in which there is information on the length of the functioning fi stula. Th e study included 48 patients, mean age 71.3 ± 5.2 years, 29 (60%) men and 19 (40%) women. Th e data were analyzed according to gender and demographic structure, type of anastomosis, positioning, length of functioning fi stulas, and the lumen diameter of the arteries and veins that are used to create a fi stula. Th e median length of functioning arteriovenous fi stula, based on Kaplan-Meier model, is 16 months (95% CI 6.9- 25.1). Median functioning for proximaly located fi stulas was 24 months (range, 1-259), while median functioning in patient with distally located fi stulas was 8 months (range, 1-96). Th e diff erence in relation to the positioning of the fi stula was statistically signifi cant (p= 0.006). In univariate Cox regression model, a statistically signifi cant predictor of the functioning of arteriovenous fi stulae is fi stula positioning (B = 0.700; p = 0.022). Th e predictive parameter of survival of arteriovenous fi stulas in elderly is proximally located fi stula.

Abstract

Elderly patients with end stage kidney disease represent a challenge for surgeons to create a vascular access. Determine predictive parameters functionality of the arteriovenous fi stulas for hemodialysis in the elderly. Th e study was organized as a retrospective study at the Center for Dialysis, Clinic for Urology and Nephrology, Clinical Center Kragujevac. Th e study included patients older than 65 years with arteriovenous fi stula thrombosis, in the period of four years, in which there is information on the length of the functioning fi stula. Th e study included 48 patients, mean age 71.3 ± 5.2 years, 29 (60%) men and 19 (40%) women. Th e data were analyzed according to gender and demographic structure, type of anastomosis, positioning, length of functioning fi stulas, and the lumen diameter of the arteries and veins that are used to create a fi stula. Th e median length of functioning arteriovenous fi stula, based on Kaplan-Meier model, is 16 months (95% CI 6.9- 25.1). Median functioning for proximaly located fi stulas was 24 months (range, 1-259), while median functioning in patient with distally located fi stulas was 8 months (range, 1-96). Th e diff erence in relation to the positioning of the fi stula was statistically signifi cant (p= 0.006). In univariate Cox regression model, a statistically signifi cant predictor of the functioning of arteriovenous fi stulae is fi stula positioning (B = 0.700; p = 0.022). Th e predictive parameter of survival of arteriovenous fi stulas in elderly is proximally located fi stula.

References

  • 1. Swindlehurst N, Swindlehurst A, Lumgair H et al. Vascular access for hemodialysis in the elderly. J Vasc Surg 2011; 53: 1039-43; DOI: 10.1016/j.jvs.2010.09.068.

  • 2. Moist ML, Lok CE, Vachharajani TJ et al. Optimal Vascular Access in the Elderly Patient. Semin Dial 2012; 25(6): 640-648.

  • 3. O’Hare AM. Vascular Access for Hemodialysis in Older Adults: A “Patient First” Approach. JASN 2013; 24(8): 1187-90.

  • 4. Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN. A meta-analysis of dialysis access outcome in elderly patients. Journal of Vascular Surgery 2007; 45 (2): 420-6.

  • 5. Lameire N, Van Biesen W. A ‘secular’ view on vascular access in haemodialysis. Nephrol Dial Transplant 2012; 0: 1-4.

  • 6. Cui J, Steele D, Wenger J et al. Hemodialysis arteriovenous fistula as first option not necessary in elderly patients. J Vasc Surg 2016; 63(5): 1326-32; doi:

  • 7. Tordoir JH, Bode AS, van Loon MM. Preferred strategy for hemodialysis access creation in elderly patients. Eur J Vasc Endovasc Surg 2015; 49(6): 738-43; doi:

  • 8. Murea M, Satko S. Looking Beyond “Fistula First” in the Elderly on Hemodialysis. Semin Dial 2016; 29(5): 396-02; doi:

  • 9. U.S. Renal Data System 2008: Chapter 6: Morbidity and mortality. In: USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Available at http:// www.usrds.org/2008/pdf/V2_06_2008.pdf, accessed May 16, 2015.

  • 10. Lee T, Thamer M, Zhang Y, Zhang Q, Allon M. Outcomes of Elderly Patients after Predialysis Vascular Access Creation. J Am Soc Nephrol 2015; 26(12): 3133-40; doi:

  • 11. Franco MR, Fernandes NM. Dialysis in the elderly patient: a challenge of the XXI century--narrative review. J Bras Nefrol 2013; 35(2): 132-41; doi:

  • 12. Lameire N, Van Biesen W. Moderator’s view: a ‘secular’ view on vascular access in haemodialysis. Nephrol Dial Transplant 2012; 27(10): 3758-61; doi:

  • 13. Fila B, Magaš S, Pavić P, Ivanac R, Ajduk M, Malovrh M. The importance of success prediction in angioaccess surgery. Int Urol Nephrol 2016; 48(9): 1469-75; doi:

  • 14. Lok CE, Allon M, Moist L, Oliver MJ, Shah H, Zimmerman D. Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J Am Soc Nephrol 2006; 17: 3204-12.

  • 15. Basile C, Lomonte C. Pro: the arteriovenous fistula is a blessing of God. Nephrol Dial Transplant 2012; 27(10): 3752-6; doi:

  • 16. Bashar K, Zafar A, Elsheikh S et al. Predictive parameters of arteriovenous fistula functional maturation in a population of patients with end-stage renal disease. PLoS One. 2015 Mar 13;10(3):e0119958. doi:

  • 17. Smith GE, Gohil R, Chetter IC. Factors affecting the patency of arteriovenous fistulas for dialysis access. J Vasc Surg 2012; 55(3): 849-55; doi:

  • 18. Stolic R. Most important chronic complications of arteriovenous fistulas for hemodialysis. Med Princ Pract 2013; 22(3): 220-8; doi:

1. Swindlehurst N, Swindlehurst A, Lumgair H et al. Vascular access for hemodialysis in the elderly. J Vasc Surg 2011; 53: 1039-43; DOI: 10.1016/j.jvs.2010.09.068.

2. Moist ML, Lok CE, Vachharajani TJ et al. Optimal Vascular Access in the Elderly Patient. Semin Dial 2012; 25(6): 640-648.

3. O’Hare AM. Vascular Access for Hemodialysis in Older Adults: A “Patient First” Approach. JASN 2013; 24(8): 1187-90.

4. Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN. A meta-analysis of dialysis access outcome in elderly patients. Journal of Vascular Surgery 2007; 45 (2): 420-6.

5. Lameire N, Van Biesen W. A ‘secular’ view on vascular access in haemodialysis. Nephrol Dial Transplant 2012; 0: 1-4.

6. Cui J, Steele D, Wenger J et al. Hemodialysis arteriovenous fistula as first option not necessary in elderly patients. J Vasc Surg 2016; 63(5): 1326-32; doi:

7. Tordoir JH, Bode AS, van Loon MM. Preferred strategy for hemodialysis access creation in elderly patients. Eur J Vasc Endovasc Surg 2015; 49(6): 738-43; doi:

8. Murea M, Satko S. Looking Beyond “Fistula First” in the Elderly on Hemodialysis. Semin Dial 2016; 29(5): 396-02; doi:

9. U.S. Renal Data System 2008: Chapter 6: Morbidity and mortality. In: USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Available at http:// www.usrds.org/2008/pdf/V2_06_2008.pdf, accessed May 16, 2015.

10. Lee T, Thamer M, Zhang Y, Zhang Q, Allon M. Outcomes of Elderly Patients after Predialysis Vascular Access Creation. J Am Soc Nephrol 2015; 26(12): 3133-40; doi:

11. Franco MR, Fernandes NM. Dialysis in the elderly patient: a challenge of the XXI century--narrative review. J Bras Nefrol 2013; 35(2): 132-41; doi:

12. Lameire N, Van Biesen W. Moderator’s view: a ‘secular’ view on vascular access in haemodialysis. Nephrol Dial Transplant 2012; 27(10): 3758-61; doi:

13. Fila B, Magaš S, Pavić P, Ivanac R, Ajduk M, Malovrh M. The importance of success prediction in angioaccess surgery. Int Urol Nephrol 2016; 48(9): 1469-75; doi:

14. Lok CE, Allon M, Moist L, Oliver MJ, Shah H, Zimmerman D. Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J Am Soc Nephrol 2006; 17: 3204-12.

15. Basile C, Lomonte C. Pro: the arteriovenous fistula is a blessing of God. Nephrol Dial Transplant 2012; 27(10): 3752-6; doi:

16. Bashar K, Zafar A, Elsheikh S et al. Predictive parameters of arteriovenous fistula functional maturation in a population of patients with end-stage renal disease. PLoS One. 2015 Mar 13;10(3):e0119958. doi:

17. Smith GE, Gohil R, Chetter IC. Factors affecting the patency of arteriovenous fistulas for dialysis access. J Vasc Surg 2012; 55(3): 849-55; doi:

18. Stolic R. Most important chronic complications of arteriovenous fistulas for hemodialysis. Med Princ Pract 2013; 22(3): 220-8; doi:

Serbian Journal of Experimental and Clinical Research

The Journal of Faculty of Medical Sciences, University of Kragujevac

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CiteScore 2017: 0.21

SCImago Journal Rank (SJR) 2017: 0.126
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