Document Detail

Factors associated with unsuccessful utilization and early failure of the arterio-venous fistula for hemodialysis.
MedLine Citation:
PMID:  15931647     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Arteriovenous fistulae survive longer than grafts and catheters. However, their short term outcomes may not be as good. We sought to determine whether fistulae created in patients referred to a nephrologist less than 3 months before dialysis start show higher risk of unsuccessful use and early failure. METHODS: All patients receiving a new vascular access over a six-year period at three centres were enrolled. Logistic and Cox's regression techniques were used to model late referral on successful utilization for <6 consecutive HD-sessions and time to failure within the first month from access creation, adjusting for demographics, comorbidities and surgical strategies. RESULTS: Among the 535 subjects enrolled, 513 received a fistula. Without considering revisions, 119 fistulae (23.2%) were not successfully used and 61 (11.9%) failed early. Independent predictors of unsuccessful utilization were late referral (Odds Ratio 2.15 [95% Confidence Interval 1.23, 3.75]), vascular diseases (1.86 [1.16, 2.97]), absence of treated hypertension (2.07 [1.17, 3.68]), and heart failure limited to late referrals (10.74 [4, 28.82]). Late referral (Hazard Ratio 1.72 [1.05, 2.81]), absence of treated hypertension (1.80 [1.02, 3.18]) and heart failure (2.34 [1.34, 4.08]) also predicted primary early failure. CONCLUSIONS: Late patient referral and presence of cardiovascular diseases, particularly heart failure, are potentially modifiable risk factors for short-term outcomes improvement of hemodialysis fistulae.
Pietro Ravani; Brendan Barrett; Salvatore Mandolfo; Giuliano Brunori; Giovanni Cancarini; Enrico Imbasciati; Fabio Malberti
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of nephrology     Volume:  18     ISSN:  1121-8428     ISO Abbreviation:  J. Nephrol.     Publication Date:    2005 Mar-Apr
Date Detail:
Created Date:  2005-06-02     Completed Date:  2005-10-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9012268     Medline TA:  J Nephrol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  188-96     Citation Subset:  IM    
Division of Nephrology and Dialysis, Cremona, Italy.
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MeSH Terms
Arteriovenous Shunt, Surgical*
Brachial Artery / surgery
Brachiocephalic Veins / surgery
Cardiovascular Diseases / complications
Catheters, Indwelling
Cohort Studies
Kidney Failure, Chronic / complications,  therapy*
Middle Aged
Radial Artery / surgery
Referral and Consultation*
Renal Dialysis*
Risk Factors
Time Factors
Treatment Failure
Vascular Patency

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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