Factors associated with early fistula failure
Introduction: Around the world, risk factors for fistula failure have been considered in vascular access planning in order to improve results. However, primary fistula failure rates seem to be increasing. Considering this, we conducted a study to identify relevant factors for early fistula failure in a Portuguese cohort with end-stage kidney disease. Subjects and Methods: Retrospective case-control study which included patients from a hospital center who underwent fistula construction between 2012 and 2015. Patients with fistula failure at 6 weeks were matched with consecutive controls in a proportion of 1:1. Clinical and laboratory data were retrieved. Multiple regression analysis was performed to identify factors associated with early complications. Results: Total of 100 predialysis patients with fistula failure at 6 weeks. Mean age of 67.7±11.9 years; most were women (n=54). Factors associated with overall risk of complications were distal location of fistula (OR 2.8; p<0.05) and diabetes mellitus (OR 3.8; p<0.05). Congestive heart failure (OR 7.2; p=0.06) was associated with a tendency for greater risk of inflow complications. Conclusions: In this cohort, despite improvements in vascular access planning, traditional risk factors still have a significant impact on fistula outcomes. The role of new factors is still undefined and further studies are needed. An adequate patient education, an organized vascular access program with nurses, nephrologists and surgeons with expertise, with systematic use of Doppler ultrasound, are key factors for better outcomes
| Main Authors: | , , , , , |
|---|---|
| Format: | Digital revista |
| Language: | English |
| Published: |
Sociedade Portuguesa de Nefrologia
2017
|
| Online Access: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000400003 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Introduction: Around the world, risk factors for fistula failure have been considered in vascular access planning in order to improve results. However, primary fistula failure rates seem to be increasing. Considering this, we conducted a study to identify relevant factors for early fistula failure in a Portuguese cohort with end-stage kidney disease. Subjects and Methods: Retrospective case-control study which included patients from a hospital center who underwent fistula construction between 2012 and 2015. Patients with fistula failure at 6 weeks were matched with consecutive controls in a proportion of 1:1. Clinical and laboratory data were retrieved. Multiple regression analysis was performed to identify factors associated with early complications. Results: Total of 100 predialysis patients with fistula failure at 6 weeks. Mean age of 67.7±11.9 years; most were women (n=54). Factors associated with overall risk of complications were distal location of fistula (OR 2.8; p<0.05) and diabetes mellitus (OR 3.8; p<0.05). Congestive heart failure (OR 7.2; p=0.06) was associated with a tendency for greater risk of inflow complications. Conclusions: In this cohort, despite improvements in vascular access planning, traditional risk factors still have a significant impact on fistula outcomes. The role of new factors is still undefined and further studies are needed. An adequate patient education, an organized vascular access program with nurses, nephrologists and surgeons with expertise, with systematic use of Doppler ultrasound, are key factors for better outcomes |
|---|