TY - GEN
T1 - Arteriovenous fistulae failure in haemodialysis patients
T2 - risk factors
AU - Abdulnabi, K
AU - Denham, Nathan
AU - Omer, H
AU - Karpha, I
AU - Howse, M
AU - Anijeet, H
AU - Rylands, I
AU - Pai, P
AU - Ridgway, D
N1 - https://britishrenal.org/ukkw2018-2/2016-abstracts/
PY - 2014
Y1 - 2014
N2 - INTRODUCTION:Arterio-venous fistula (AVF) failure is associated with significant clinical morbidity, economic burden, hospitalisation and inadequate dialysis which may decrease patient’s survival . This study was designed to assess the effect of co-morbidities, pharmacological therapy, arterial characteristics and interventional procedure on AVF/ graft failure.METHODS: Retrospective data analysis on 426 AVF on prevalent haemodialysis patients was undertaken at a tertiary renal centre. Data on 34 different variables was retrieved from computerised systems; clinic letters, dialysis case notes, by trained doctors. Statistical analysis: Univariate analyses of continuous variables by t test and of categorical variables by X2 test. Multivariate analysis: Linear regression was used for continuous variables and logistic regression for binary and categorical variables. Analysis was conducted at 3; 18 month and cumulative survival follow up. RESULTS:The prevalence of AVF/AVG is 91%, 9% AVG. Primary assisted patency was 84% at 3 month, 75% at 1 year and 62% at 18 months’ time. Cumulative median survival of AVF & AVG was 31 (±38) and 22(±28) months respectively. Radial artery calibres on venous mapping shows negative correlation with 3, 18month and cumulative AVF patency (r=0.247, p=0.02, r=0.321, p=0.004, r=217, p=0.04 respectively). Brachial artery size and flow, radial artery flow and age were not significant statistically. With regard of binary variables:a-Cumulative patency: Variables associated with failure were vessels calcification on venous mapping (OR=2.2, p<0.02), thrombosis (OR=2.4, p<0.0001), angiojet-lysis (OR=5.2, p=0.000005) and previous AVF failure (OR=3.6, p<0.00001).b- 3- month patency: Previous AVF failure (OR=6.65, p<0.00001), calcification (OR=2.4, p<0.04) and positive HIT test (OR=6.1, p<0.04)were associated with failure while warfarin (OR=0.10, p<0.04), male gender (OR=0.42, p<0.01) and proximal site (OR=0.39, p<0.006) reduce risk of failure.c-18- month patency: Previous AVF failure (OR=4.13, p<0.0001), type 2 DM (OR=2.05, p<0.015), type 1 DM (OR=4.08, p<0.002), hypercoagulable state (OR=1.99, p<0.016) and Positive HIT test (OR=18.6, p<0.01) were associated with failure while warfarin (OR=0.30, p=0.044) improved patency. Aspirin, Clopidogrel or Dipyridamole had no effect of AVF survival even in those on dual antiplatelet therapy.Other factors like Age, AF, PVD, IHD, CVA, LVD, HTN, and intra-dialytic hypotension, duration on HD, dual anti-platelets therapy, Doppler quantitative wave form and angioplasty show no statistical significance.CONCLUSION: Previous AVF failure, vascular calcification & radial artery calibre on pre-operative venous mapping, hypercoagulable state, diabetes and venous thrombosis are risk factors for AVF failure, while warfarin, proximal site and male gender were associated with improved fistulae patency. Antiplatelet including dual therapy doesn’t improve AVF patency rate.
AB - INTRODUCTION:Arterio-venous fistula (AVF) failure is associated with significant clinical morbidity, economic burden, hospitalisation and inadequate dialysis which may decrease patient’s survival . This study was designed to assess the effect of co-morbidities, pharmacological therapy, arterial characteristics and interventional procedure on AVF/ graft failure.METHODS: Retrospective data analysis on 426 AVF on prevalent haemodialysis patients was undertaken at a tertiary renal centre. Data on 34 different variables was retrieved from computerised systems; clinic letters, dialysis case notes, by trained doctors. Statistical analysis: Univariate analyses of continuous variables by t test and of categorical variables by X2 test. Multivariate analysis: Linear regression was used for continuous variables and logistic regression for binary and categorical variables. Analysis was conducted at 3; 18 month and cumulative survival follow up. RESULTS:The prevalence of AVF/AVG is 91%, 9% AVG. Primary assisted patency was 84% at 3 month, 75% at 1 year and 62% at 18 months’ time. Cumulative median survival of AVF & AVG was 31 (±38) and 22(±28) months respectively. Radial artery calibres on venous mapping shows negative correlation with 3, 18month and cumulative AVF patency (r=0.247, p=0.02, r=0.321, p=0.004, r=217, p=0.04 respectively). Brachial artery size and flow, radial artery flow and age were not significant statistically. With regard of binary variables:a-Cumulative patency: Variables associated with failure were vessels calcification on venous mapping (OR=2.2, p<0.02), thrombosis (OR=2.4, p<0.0001), angiojet-lysis (OR=5.2, p=0.000005) and previous AVF failure (OR=3.6, p<0.00001).b- 3- month patency: Previous AVF failure (OR=6.65, p<0.00001), calcification (OR=2.4, p<0.04) and positive HIT test (OR=6.1, p<0.04)were associated with failure while warfarin (OR=0.10, p<0.04), male gender (OR=0.42, p<0.01) and proximal site (OR=0.39, p<0.006) reduce risk of failure.c-18- month patency: Previous AVF failure (OR=4.13, p<0.0001), type 2 DM (OR=2.05, p<0.015), type 1 DM (OR=4.08, p<0.002), hypercoagulable state (OR=1.99, p<0.016) and Positive HIT test (OR=18.6, p<0.01) were associated with failure while warfarin (OR=0.30, p=0.044) improved patency. Aspirin, Clopidogrel or Dipyridamole had no effect of AVF survival even in those on dual antiplatelet therapy.Other factors like Age, AF, PVD, IHD, CVA, LVD, HTN, and intra-dialytic hypotension, duration on HD, dual anti-platelets therapy, Doppler quantitative wave form and angioplasty show no statistical significance.CONCLUSION: Previous AVF failure, vascular calcification & radial artery calibre on pre-operative venous mapping, hypercoagulable state, diabetes and venous thrombosis are risk factors for AVF failure, while warfarin, proximal site and male gender were associated with improved fistulae patency. Antiplatelet including dual therapy doesn’t improve AVF patency rate.
M3 - Conference contribution
BT - British Renal Society 2014 Conference Abstracts
ER -