Vascular access in patients on chronic hemodialysis in the Moscow Region: current state and outlook

Cover Page


Cite item

Abstract

Background: The prevalence of chronic kidney disease (CKD) is annually growing worldwide. Stable functioning arteriovenous fistula (AVF) is one of the main prerequisites of survival for patients on chronic hemodialysis (HD). As a rule, available clinical guidelines for creation and maintenance of HD vascular access do not give a clear answer to some important questions. We have summarized and analyzed our experience of the creation and maintenance of the vascular access. Aim: To analyze the results of the creation and maintenance of vascular access in a large population of patients on chronic HD (in the Moscow Region). Materials and methods: We analyzed the results of 3837 surgeries for creation and reconstruction of the vascular access in 1862  patients, performed from 2012 to 2016. Results: The CKD stage 5D incidence has increased from 239 to 391 over the last three years. Currently, 2204  patients are followed up and receiving treatment in 38 outpatient centers. Almost one half of all interventions, 43.5% (1668/3837), has been performed to create AVF. Only one third, i.e. 33% (1266/3837) of them was de novo operations, whereas 10.5% (403/3837) were done to create a new AVF in HD patients after thrombosis of the existing AVF. 15.4%  (590/3837) of the interventions were performed for AVF reconstruction, 4% (154/3837) for AVF closure after successful kidney transplantation, 3.2%  (121/3837) for creation of AVF with vascular graft, 3%  (115/3837) for thrombectomy from the graft, 14.6%  (559/3837) to implant a  permanent central venous catheter (CVC), and 13.6%  (520/3837) for placement of a  temporary CVC. 54.4%  (1012/1862) of the patients had their functional AVF, 2.2% (41/1862) had a vascular graft at the beginning of HD, and one year later, there were 73.8% (1152/1561) and 5.3% (83/1561) of such patients, respectively. The type of vascular access at the start of HD strongly depended on the cause of CKD. 60.4% (192/318) of patients with polycystic kidney disease and 65.1% (181/278) with systemic disease or cancer started HD with the CVC. Oneyear survival of patients who started HD with AVF, who started HD with CVC and switched to AVF, and those who initiated and continued HD with CVC only, was 87.5% (95% confidence interval [CI] 83.5– 90.6), 79.6% [95% CI 72.3–82.5], and 66.4% (95% CI 57–74.2), respectively. The 5-year survival in these groups was 61% (95% CI 51.8–71.9), 53.9% (95% CI 42.5–67), and 31.6%  (95%  CI 21.4–41.4), respectively. At one year, primary and secondary AVF patency amounted to 77.2%  (95%  CI 71.7–81.8) and 87% (95% CI 83.7–89.7), respectively, at 5 years 34.1% (95% CI 27.8–40.5) and 60.9% (95% CI 56.4– 65.1), respectively. Conclusion: A more detailed analysis is necessary to identify risk factors for complications of the vascular access and to optimize approaches to its creation and reconstruction. An effective way to achieve this goal is to establish a local registry of CKD patients. 

About the authors

A. V. Vatazin

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, PhD, Professor, Head of Department of Transplantology, Nephrology and Surgical Hemocorrection

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

A. B. Zulkarnaev

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: 7059899@gmail.com

MD, PhD, Chief Research Fellow, Surgical Department of Transplantology and Dialysis

61/2 Shchepkina ul., Moscow, 129110

Tel.: +7 (916) 705 98 99

Russian Federation

N. M. Fominykh

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, Surgeon, Surgical Department of Transplantology and Dialysis

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

Z. B. Kardanakhishvili

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, Postgraduate Student, Chair of Transplantology, Nephrology and Artificial Organs, Postgraduate Training Faculty

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

E. V. Strugaylo

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, Postgraduate Student, Chair of Transplantology, Nephrology and Artificial Organs, Postgraduate Training Faculty

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

References

  1. Бикбов БТ, Томилина НА. Заместительная терапия терминальной хронической почечной недостаточности в Российской Федерации в 1998–2013 гг. Отчет по данным российского регистра заместительной почечной терапии. Часть первая. Нефрология и диализ. 2015;17(3; Прилож.):5–111.
  2. European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2015. 2017. Доступно на: https://www.era-edta-reg.org/files/annualreports/pdf/AnnRep2015.pdf.
  3. United States Renal Data System. 2016 USRDS annual data report. Vol. 2 – Endstage Renal Disease (ESRD) in the United States: 1. Incidence, Prevalence, Patient Characteristics, and Treatment Modalities 2016. Доступно на: https://www.usrds. org/2016/view/Default.aspx.
  4. Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Annual Data Report 2016. 2016. Доступно на: http://www.anzdata.org.au/v1/report_2016.html.
  5. Masakane I, Nakai S, Ogata S, Kimata N, Hanafusa N, Hamano T, Wakai K, Wada A, Nitta K. Annual Dialysis Data Report 2014, JSDT Renal Data Registry (JRDR). Renal Replacement Therapy. 2017;3:18–61. doi: 10.1186/s41100-017- 0097-8.
  6. van Walraven C, Manuel DG, Knoll G. Survival trends in ESRD patients compared with the general population in the United States. Am J Kidney Dis. 2014;63(3):491–9. doi: 10.1053/j. ajkd.2013.09.011.
  7. Vigneau C, Kolko A, Stengel B, Jacquelinet C, Landais P, Rieu P, Bayat S, Couchoud C; REIN registry. Ten-years trends in renal replacement therapy for end-stage renal disease in mainland France: Lessons from the French Renal Epidemiology and Information Network (REIN) registry. Nephrol Ther. 2017;13(4):228–35. doi: 10.1016/j.nephro.2016.07.453.
  8. Neild GH. Life expectancy with chronic kidney disease: an educational review. Pediatr Nephrol. 2017;32(2):243–8. doi: 10.1007/ s00467-016-3383-8.
  9. Arhuidese IJ, Obeid T, Hicks C, Qazi U, Botchey I, Zarkowsky DS, Reifsnyder T, Malas MB. Vascular access modifies the protective effect of obesity on survival in hemodialysis patients. Surgery. 2015;158(6):1628–34. doi: 10.1016/j. surg.2015.04.036.
  10. Malas MB, Canner JK, Hicks CW, Arhuidese IJ, Zarkowsky DS, Qazi U, Schneider EB, Black JH 3rd, Segev DL, Freischlag JA. Trends in incident hemodialysis access and mortality. JAMA Surg. 2015;150(5):441–8. doi: 10.1001/ jamasurg.2014.3484.
  11. Zhang JC, Al-Jaishi AA, Na Y, de Sa E, Moist LM. Association between vascular access type and patient mortality among elderly patients on hemodialysis in Canada. Hemodial Int. 2014;18(3):616–24. doi: 10.1111/hdi.12151.
  12. Xue H, Ix JH, Wang W, Brunelli SM, Lazarus M, Hakim R, Lacson E Jr. Hemodialysis access usage patterns in the incident dialysis year and associated catheter-related complications. Am J Kidney Dis. 2013;61(1):123–30. doi: 10.1053/j. ajkd.2012.09.006.
  13. Woo K, Lok CE. New insights into dialysis vascular access: what is the optimal vascular access type and timing of access creation in CKD and dialysis patients? Clin J Am Soc Nephrol. 2016;11(8):1487–94. doi: 10.2215/ CJN.02190216.
  14. Шилов ЕМ, Смирнов АВ, Козловская НЛ, ред. Нефрология. Клинические рекомендации. М.: ГЭОТАР-Медиа; 2016. 816 с.
  15. Mendelssohn DC, Ethier J, Elder SJ, Saran R, Port FK, Pisoni RL. Haemodialysis vascular access problems in Canada: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS II). Nephrol Dial Transplant. 2006;21(3): 721–8. doi: 10.1093/ndt/gfi281.
  16. Ravani P, Quinn RR, Oliver MJ, Karsanji DJ, James MT, MacRae JM, Palmer SC, Strippoli GF. Preemptive correction of arteriovenous access stenosis: a systematic review and meta-analysis of randomized controlled trials. Am J Kidney Dis. 2016;67(3):446–60. doi: 10.1053/j. ajkd.2015.11.013.
  17. Zulkarnaev A, Vatazin A, Yankovoy A, Fominikh N, Kardanahishvili Z. Preventive surgery for hemodialysis vascular access saving. J Vasc Access. 2017;18(Suppl 2):S21. doi: 10.5301/jva.5000726.
  18. Бикбов БТ, Томилина НА. Состав больных и показатели качества лечения на заместительной терапии терминальной хронической почечной недостаточности в Российской Федерации в 1998–2013 гг. Отчет по данным российского регистра заместитель- ной почечной терапии. Часть вторая. Нефрология и диализ. 2016;18(2):98–164.
  19. Brown RS, Patibandla BK, Goldfarb-Rumyantzev AS. The survival benefit of "Fistula First, Catheter Last" in hemodialysis is primarily due to patient factors. J Am Soc Nephrol. 2017;28(2):645–52. doi: 10.1681/ ASN.2016010019.
  20. Sequeira A, Naljayan M, Vachharajani TJ. Vascular access guidelines: summary, rationale, and controversies. Tech Vasc Interv Radiol. 2017;20(1):2–8. doi: 10.1053/j.tvir.2016.11.001.
  21. Jindal K, Chan CT, Deziel C, Hirsch D, Soroka SD, Tonelli M, Culleton BF; Canadian Society of Nephrology Committee for Clinical Practice Guidelines. Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. J Am Soc Nephrol. 2006;17(3 Suppl 1):S1–27. doi: 10.1681/ASN.2005121372.
  22. Kukita K, Ohira S, Amano I, Naito H, Azuma N, Ikeda K, Kanno Y, Satou T, Sakai S, Sugimoto T, Takemoto Y, Haruguchi H, Minakuchi J, Miyata A, Murotani N, Hirakata H, Tomo T, Akizawa T; Vascular Access Construction and Repair for Chronic Hemodialysis Guideline Working Group, Japanese Society for Dialysis Therapy. 2011 update Japanese Society for Dialysis Therapy Guidelines of Vascular Access Construction and Repair for Chronic Hemodialysis. Ther Apher Dial. 2015;19 Suppl 1:1–39. doi: 10.1111/1744-9987.12296.
  23. Tordoir J, Canaud B, Haage P, Konner K, Basci A, Fouque D, Kooman J, Martin-Malo A, Pedrini L, Pizzarelli F, Tattersall J, Vennegoor M, Wanner C, ter Wee P, Vanholder R. EBPG on Vascular Access. Nephrol Dial Transplant. 2007;22 Suppl 2:ii88–117. doi: 10.1093/ndt/gfm021.
  24. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) Clinical Practice Guidelines and Clinical Practice Recommendations (2006 Update). Clinical Practice Guidelines For Vascular Access. 2006. Доступно на: http://kidneyfoundation. cachefly.net/professionals/KDOQI/guideline_
  25. upHD_PD_VA/index.htm.
  26. Oliver MJ, Quinn RR, Garg AX, Kim SJ, Wald R, Paterson JM. Likelihood of starting dialysis after incident fistula creation. Clin J Am Soc Nephrol. 2012;7(3):466–71. doi: 10.2215/ CJN.08920811.
  27. Hod T, Patibandla BK, Vin Y, Brown RS, Goldfarb-Rumyantzev AS. Arteriovenous fistula placement in the elderly: when is the optimal time? J Am Soc Nephrol. 2015;26(2):448–56. doi: 10.1681/ASN.2013070740.
  28. Martínez-Gallardo R, Ferreira-Morong F, García-Pino G, Cerezo-Arias I, Hernández-Gallego R, Caravaca F. Congestive heart failure in patients with advanced chronic kidney disease: association with pre-emptive vascular access placement. Nefrologia. 2012;32(2): 206–12. doi: 10.3265/Nefrologia.pre2011.
  29. Wilmink T, Hollingworth L, Stevenson T, Powers S. Is early cannulation of an arteriovenous fistula associated with early failure of the fistula? J Vasc Access. 2017;18(Suppl 1):92–7. doi: 10.5301/jva.5000674.
  30. Al Shakarchi J, Inston N. Timing of cannulation of arteriovenous grafts: are we too cautious? Clin Kidney J. 2015;8(3):290–2. doi: 10.1093/ ckj/sfu146.
  31. Alencar de Pinho N, Coscas R, Metzger M, Labeeuw M, Ayav C, Jacquelinet C, Massy ZA, Stengel B; French REIN registry. Vascular access conversion and patient outcome after hemodialysis initiation with a nonfunctional arteriovenous access: a prospective registry-based study. BMC Nephrol. 2017;18(1):74. doi: 10.1186/s12882-017-0492-y.
  32. Allon M, Daugirdas J, Depner TA, Greene T, Ornt D, Schwab SJ. Effect of change in vascular access on patient mortality in hemodialysis patients. Am J Kidney Dis. 2006;47(3):469–77. doi: 10.1053/j.ajkd.2005.11.023.
  33. Bradbury BD, Chen F, Furniss A, Pisoni RL, Keen M, Mapes D, Krishnan M. Conversion of vascular access type among incident hemodialysis patients: description and association with mortality. Am J Kidney Dis. 2009;53(5): 804–14. doi: 10.1053/j.ajkd.2008.11.031.
  34. Lacson E Jr, Wang W, Lazarus JM, Hakim RM. Change in vascular access and mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2009;54(5):912–21. doi: 10.1053/j. ajkd.2009.07.008.
  35. Mehrotra R, Cheung AK, Meyer T, Nath KA. Vascular access for hemodialysis and value-based purchasing for ESRD. J Am Soc Nephrol. 2017;28(2):395–7. doi: 10.1681/ ASN.2016070769.

Supplementary files

There are no supplementary files to display.


Copyright (c) 2017 Vatazin A.V., Zulkarnaev A.B., Fominykh N.M., Kardanakhishvili Z.B., Strugaylo E.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies