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Predictive parameters of arteriovenous fistula functional maturation in a population of patients with end-stage renal disease.

Bashar K, Zafar A, Elsheikh S, Healy DA, Clarke-Moloney M, Casserly L, Burke PE, Kavanagh EG, Walsh SR - PLoS ONE (2015)

Bottom Line: Female gender showed significant association with nonmaturation (P = 0.004) and was the only predictor for non-maturation in a logistic regression model (P = 0.011).Female gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation.In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.

ABSTRACT

Introduction: With increasing numbers of patients diagnosed with ESRD, arteriovenous fistula (AVF) maturation has become a major factor in improving both dialysis related outcomes and quality of life of those patients. Compared to other types of access it has been established that a functional AVF access is the least likely to be associated with thrombosis, infection, hospital admissions, secondary interventions to maintain patency and death.

Aim: Study of demographic factors implicated in the functional maturation of arteriovenous fistulas. Also, to explore any possible association between preoperative haematological investigations and functional maturation.

Methods: We performed a retrospective chart review of all patients with ESRD who were referred to the vascular service in the University Hospital of Limerick for creation of vascular access for HD. We included patients with primary AVFs; and excluded those who underwent secondary procedures.

Results: Overall AVF functional maturation rate in our study was 53.7% (52/97). Female gender showed significant association with nonmaturation (P = 0.004) and was the only predictor for non-maturation in a logistic regression model (P = 0.011). Patients who had history of renal transplant (P = 0.036), had relatively lower haemoglobin levels (P = 0.01) and were on calcium channel blockers (P = 0.001) showed better functional maturation rates.

Conclusion: Female gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation. In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.

No MeSH data available.


Related in: MedlinePlus

Variation in age between males and females groups.
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pone.0119958.g003: Variation in age between males and females groups.

Mentions: The study included a total of 86 patients (all diagnosed with ESRD by their attending consultant nephrologists and referred to the vascular department for access creation) with 97 arteriovenous fistulas formed to serve as vascular access for HD sessions. The most common cause leading to ESRD was diabetes (n = 37/97; 38.1%) followed by congenital renal agenesis (8/97; 8.2%), hypertension (7/97; 7.2%) and ischaemic injury (6/97; 6.2%). Other diagnosis included vasculitis, hypercalcaemia and a number of autoimmune diseases. From the 97 AVFs included in the study, 68 (70.1%) were constructed in men while 29 (29.9%) were constructed in female patients. Age did not follow a normal distribution with regards to gender variation in our patients [Figs. 1 and 2]. Age of all included patients was (mean ± SD) 60.9 ± 16.9; men aged 63.7 ± 14.8 with a median of 67 (22–86) while women aged 54.5 ± 19.6 with a median of 55 (21–81); this difference was statistically significant (P = 0.012) [Fig. 3]. Demographic data of included patients along with comorbidities and drug therapy at the time of fistula formation are summarised in [Table 1], and summary of the continuous variables in our study can be found in [Table 2].


Predictive parameters of arteriovenous fistula functional maturation in a population of patients with end-stage renal disease.

Bashar K, Zafar A, Elsheikh S, Healy DA, Clarke-Moloney M, Casserly L, Burke PE, Kavanagh EG, Walsh SR - PLoS ONE (2015)

Variation in age between males and females groups.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4358953&req=5

pone.0119958.g003: Variation in age between males and females groups.
Mentions: The study included a total of 86 patients (all diagnosed with ESRD by their attending consultant nephrologists and referred to the vascular department for access creation) with 97 arteriovenous fistulas formed to serve as vascular access for HD sessions. The most common cause leading to ESRD was diabetes (n = 37/97; 38.1%) followed by congenital renal agenesis (8/97; 8.2%), hypertension (7/97; 7.2%) and ischaemic injury (6/97; 6.2%). Other diagnosis included vasculitis, hypercalcaemia and a number of autoimmune diseases. From the 97 AVFs included in the study, 68 (70.1%) were constructed in men while 29 (29.9%) were constructed in female patients. Age did not follow a normal distribution with regards to gender variation in our patients [Figs. 1 and 2]. Age of all included patients was (mean ± SD) 60.9 ± 16.9; men aged 63.7 ± 14.8 with a median of 67 (22–86) while women aged 54.5 ± 19.6 with a median of 55 (21–81); this difference was statistically significant (P = 0.012) [Fig. 3]. Demographic data of included patients along with comorbidities and drug therapy at the time of fistula formation are summarised in [Table 1], and summary of the continuous variables in our study can be found in [Table 2].

Bottom Line: Female gender showed significant association with nonmaturation (P = 0.004) and was the only predictor for non-maturation in a logistic regression model (P = 0.011).Female gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation.In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.

ABSTRACT

Introduction: With increasing numbers of patients diagnosed with ESRD, arteriovenous fistula (AVF) maturation has become a major factor in improving both dialysis related outcomes and quality of life of those patients. Compared to other types of access it has been established that a functional AVF access is the least likely to be associated with thrombosis, infection, hospital admissions, secondary interventions to maintain patency and death.

Aim: Study of demographic factors implicated in the functional maturation of arteriovenous fistulas. Also, to explore any possible association between preoperative haematological investigations and functional maturation.

Methods: We performed a retrospective chart review of all patients with ESRD who were referred to the vascular service in the University Hospital of Limerick for creation of vascular access for HD. We included patients with primary AVFs; and excluded those who underwent secondary procedures.

Results: Overall AVF functional maturation rate in our study was 53.7% (52/97). Female gender showed significant association with nonmaturation (P = 0.004) and was the only predictor for non-maturation in a logistic regression model (P = 0.011). Patients who had history of renal transplant (P = 0.036), had relatively lower haemoglobin levels (P = 0.01) and were on calcium channel blockers (P = 0.001) showed better functional maturation rates.

Conclusion: Female gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation. In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.

No MeSH data available.


Related in: MedlinePlus