Son dönem böbrek yetmezliği olan 735 hastada ilk vasküler erişim yolu olarak santral venöz kateter ile arteriyovenöz fistülün karşılaştırılması

Year 2022, , 124 - 129, 26.03.2022

Emre Karakaya , Aydıncan Akdur , Deniz Sarp Beyazpınar , Lara Kavasoğlu Gökhan Kahraman Tuğçe Şirinoğlu

https://doi.org/10.18663/tjcl.1040213

Abstract

Amaç: Arteriyovenöz fistül (AVF), hemodiyaliz (HD) için ilk seçenek olarak gösterilse de risk faktörleri göz önüne alındığında santral venöz kateter (CVC)’ye üstünlüğü halen tartışma konusudur. Bu çalışmanın amacı ile HD de ilk vasküler erişim yolu olarak kullanılması gereken AVF ile CVC’nin karşılaştırılmasıydı.
Gereç ve Yöntemler: Hastalar AVF ve CVC kullanımına göre iki gruba ayrıldı. Gruplar yaş, cinsiyet, vücut kitle endeksi (BMI), komorbiditeleri, antiplatelet ve antikoagülan ajan kullanımı, haftalık HD seansı, son dönem böbrek yetmezliği (ESRD) süresi, HD tedavi süresi, vasküler erişim yolu patens süresi ve değişim sayıları açısından karşılaştırıldı.
Bulgular: 499 hasta CVC grubunda, 235 hasta AVF grubunda idi. AVF grubunun yaş ortalaması CVC grubundan daha fazla idi (p=0.010). CVC ve AVF grubu arasındaki ESRD süresideki farklılık anlamlı idi (5 ve 6 ay) (p=0.004). AVF grubunun HD tedavi süresi anlamlı olarak daha uzun idi (p=0.031). CVC’lerin median patens süresi 3 ay iken AVF’lerin patens süresi48 ay idi (p<0.001). CVC grubunda ortalama değişim sayısı 1 iken AVF grubunun ortalama değişim süresi 0 idi ve bu fark istatistiksel olarak anlamlı idi (p<0.001).
Sonuçlar: AVF, patens süresi ve değişim sayısın açısından CVC’den daha üstindür ve HD tedavisinde ilk vasküler erişim yolu olarak tercih edilmelidir.

Keywords

böbrek yetmezliği, renal diyaliz, arteriyovenöz fistül, santral venöz kateter, hemodiyaliz

Comparison of use of central venous catheter and arteriovenous fistula as initial vascular access in 735 patıents with end-stage renal disease

Abstract

Aim: Although arteriovenous fistula (AVF) has been shown as the first choice for hemodialysis (HD), its superiority over central venous catheter (CVC) is still controversial considering the risk factors. Aim was to compare AVF and CVC, which should be is used as the first vascular access in HD.
Material and Methods: Patients were divided into two groups according to the use of AVF and CVC. The groups were compared in terms of age, gender, body mass index (BMI), comorbidities, use of antiplatelet and anticoagulant agents, HD sessions per week, end stage renal disease (ESRD) duration, HD treatment duration, patency of vascular acces and number of changes.
Results: When patients were grouped, 499 patients were in the CVC group and 235 patients were in the AVF group. The mean age of patients in the AVF group was higher than that of the CVC group (p=0.010). The difference between the median ESRD duration of the patients in the CVC and AVF groups was statistically significant (5 vs 6 months) (p=0.004). The duration of HD treatment was significantly longer in the AVF group (p=0.031). The median patency of their CVC was 3 months, while the median patency of their AVF was 48 months (p<0.001). The median number of changes was 1in the CVC group and 0 in the AVF group, this difference was statistically significant (p<0.001).
Conclusions: AVF is superior to CVC in terms of patency and number of changes, and it is the vascular access that should be preferred in first HD

Keywords

kidney failure, renal dialysis, arteriovenous fistula, central venous catheters, hemodialysis.

References

• 1. Liyanage T, Ninomiya T, Jha V et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 2015; 385: 1975-82.
• 2. Roberts DJ, Clarke A, Elliott M et al. Association Between Attempted Arteriovenous Fistula Creation and Mortality in People Starting Hemodialysis via a Catheter: A Multicenter, Retrospective Cohort Study. Can J Kidney Health Dis 2021; 8: 20543581211032846.
• 3. Saran R, Robinson B, Abbott KCet al. US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis 2019; 73:7-8.
• 4. Jindal K, Chan CT, Deziel C, et al. Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. J Am Soc Nephrol 2006; 17: 1-27.
• 5. Polkinghorne K and Caring for Australians with Renal I. The CARI guidelines. Vascular access surveillance. Nephrology (Carlton) 2008; 13: 1-11.
• 6. Arhuidese IJ, Orandi BJ, Nejim B et al. Utilization, patency, and complications associated with vascular access for hemodialysis in the United States. J Vasc Surg 2018; 68: 1166-74.
• 7. Lee T, Qian JZ, Zhang Y et al. Long-Term Outcomes of Arteriovenous Fistulas with Unassisted versus Assisted Maturation: A Retrospective National Hemodialysis Cohort Study. J Am Soc Nephrol 2019; 30: 2209-18.
• 8. Lok CE, Oliver MJ, Su J et al. Arteriovenous fistula outcomes in the era of the elderly dialysis population. Kidney Int 2005; 67: 2462-69.
• 9. Lyu B, Chan MR, Yevzlin AS, et al. Catheter Dependence After Arteriovenous Fistula or Graft Placement Among Elderly Patients on Hemodialysis. Am J Kidney Dis 2021; 78: 399-408.
• 10. Alpert MA, Agrawal H, Aggarwal K et al. Heart failure and obesity in adults: pathophysiology, clinical manifestations and management. Curr Heart Fail Rep 2014; 11: 156-65.
• 11. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: 1-253.
• 12. Poirier P, Alpert MA, Fleisher LA et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circulation 2009; 120: 86-95.
• 13. Henning RJ. Obesity and obesity-induced inflammatory disease contribute to atherosclerosis: a review of the pathophysiology and treatment of obesity. Am J Cardiovasc Dis 2021; 11: 504-29.
• 14. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 73: 285-350.
• 15. Oh DJ, Lee JH, Kwon YE, et al. Relationship Between Arteriovenous Fistula Stenosis and Circulating Levels of Neutrophil Granule Proteins in Chronic Hemodialysis Patients. Ann Vasc Surg 2021
• 16. Su J, Zhao Q, Zhao A et al. Serum metabolic signatures of subclinical atherosclerosis in patients with type 2 diabetes mellitus: a preliminary study. Acta Diabetol 2021; 58: 1217-24.
• 17. Basile C, Lomonte C, Vernaglione L et al. The relationship between the flow of arteriovenous fistula and cardiac output in haemodialysis patients. Nephrol Dial Transplant 2008; 23: 282-87.
• 18. Lee T and Roy-Chaudhury P. Advances and new frontiers in the pathophysiology of venous neointimal hyperplasia and dialysis access stenosis. Adv Chronic Kidney Dis 2009; 16: 329-38.
• 19. Dember LM, Beck GJ, Allon M et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA 2008; 299: 2164-71.
• 20. Palmer SC, Di Micco L, Razavian M et al. Antiplatelet therapy to prevent hemodialysis vascular access failure: systematic review and meta-analysis. Am J Kidney Dis 2013; 61: 112-22.
• 21. Chen Z, Zhou Y and Yang T. Histopathological assessment of radial artery calcification in patients with end-stage kidney disease. Ren Fail 2021; 43: 362-70.
• 22. Iglesias R, Lodi M, Rubiella C et al. Ultrasound guided cannulation of dialysis access. J Vasc Access 2021: 11297298211047328.
• 23. van Loon MM, Kessels AG, Van der Sande FM et al. Cannulation and vascular access-related complications in hemodialysis: factors determining successful cannulation. Hemodial Int 2009; 13: 498-504.