Associations between Hemodialysis Access Type and Clinical Outcomes: A Systematic Review
Pietro Ravani,Suetonia C. Palmer,Matthew J. Oliver,Robert R. Quinn,Jennifer M. MacRae,Davina J. Tai,Neesh Pannu,Chandra Thomas,Brenda R. Hemmelgarn,Jonathan C. Craig,Jonathan C. Craig,Jonathan C. Craig,Braden J. Manns,Marcello Tonelli,Giovanni F.M. Strippoli,Matthew T. James +15 more
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TLDR
In conclusion, persons using catheters for hemodialysis seem to have the highest risks for death, infections, and cardiovascular events compared with other vascular access types, and patients with usable fistulas have the lowest risk.Abstract:
Clinical practice guidelines recommend an arteriovenous fistula as the preferred vascular access for hemodialysis, but quantitative associations between vascular access type and various clinical outcomes remain controversial. We performed a systematic review of cohort studies to evaluate the associations between type of vascular access (arteriovenous fistula, arteriovenous graft, and central venous catheter) and risk for death, infection, and major cardiovascular events. We searched MEDLINE, EMBASE, and article reference lists and extracted data describing study design, participants, vascular access type, clinical outcomes, and risk for bias. We identified 3965 citations, of which 67 (62 cohort studies comprising 586,337 participants) met our inclusion criteria. In a random effects meta-analysis, compared with persons with fistulas, those individuals using catheters had higher risks for all-cause mortality (risk ratio=1.53, 95% CI=1.41–1.67), fatal infections (2.12, 1.79–2.52), and cardiovascular events (1.38, 1.24–1.54). Similarly, compared with persons with grafts, those individuals using catheters had higher risks for mortality (1.38, 1.25–1.52), fatal infections (1.49, 1.15–1.93), and cardiovascular events (1.26, 1.11–1.43). Compared with persons with fistulas, those individuals with grafts had increased all-cause mortality (1.18, 1.09–1.27) and fatal infection (1.36, 1.17–1.58), but we did not detect a difference in the risk for cardiovascular events (1.07, 0.95–1.21). The risk for bias, especially selection bias, was high. In conclusion, persons using catheters for hemodialysis seem to have the highest risks for death, infections, and cardiovascular events compared with other vascular access types, and patients with usable fistulas have the lowest risk.read more
Citations
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KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update.
Charmaine E. Lok,Thomas S. Huber,Timmy Lee,Surendra Shenoy,Alexander S. Yevzlin,Kenneth Abreo,Michael Allon,Arif Asif,Brad C. Astor,Marc H. Glickman,Janet Graham,Louise Moist,Dheeraj K. Rajan,Cynthia Roberts,Tushar J. Vachharajani,Rudolph P. Valentini +15 more
TL;DR: The 2019 update to the KDOQI Clinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinary practitioners care for chronic kidney disease patients and their vascular access.
Journal ArticleDOI
Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS).
Jürg Schmidli,Matthias Widmer,Carlo Basile,Gianmarco de Donato,Maurizio Gallieni,Christopher P Gibbons,Patrick Haage,George Hamilton,Ulf Hedin,Lars Kamper,Miltos K. Lazarides,Ben Lindsey,Gaspar Mestres,Marisa Pegoraro,Joy Roy,Carlo Setacci,David Shemesh,Jan H.M. Tordoir,Magda M. van Loon,Philippe Kolh,Gert J. de Borst,Nabil Chakfe,Sebastian Debus,Robert J. Hinchliffe,Stavros K. Kakkos,Igor Koncar,Jes S. Lindholt,Ross Naylor,Melina Vega de Ceniga,Frank Vermassen,Fabio Verzini,Esvs Guidelines Reviewers,Markus G. Mohaupt,Jean-Baptiste Ricco,Ramon Roca-Tey +34 more
TL;DR: The goal of these Guidelines is to summarise and evaluate all the currently available evidence to assist physicians in selecting the best management strategies for all patients needing VA or for pathologies derived from a VA.
Journal ArticleDOI
Vascular access for hemodialysis: current perspectives.
Domenico Santoro,Filippo Benedetto,Patrizia Mondello,Narayana Pipitò,David Barillà,Francesco Spinelli,CarloAlberto Ricciardi,Cernaro,Michele Buemi +8 more
TL;DR: A well-functioning vascular access (VA) is a mainstay to perform an efficient hemodialysis (HD) procedure and has the lowest association with morbidity and mortality, and for this reason AVF use is strongly recommended by guidelines from different countries.
Journal ArticleDOI
Trends in Incident Hemodialysis Access and Mortality
Mahmoud B. Malas,Joseph K. Canner,Caitlin W. Hicks,Isibor Arhuidese,Devin S. Zarkowsky,Umair Qazi,Eric B. Schneider,James H. Black,Dorry L. Segev,Julie A. Freischlag,Julie A. Freischlag +10 more
TL;DR: Current incident AVF practice falls exceedingly short years after recommendations were made in 1997, and a change of current policies and structured multidisciplinary efforts are required to establish matured fistulae prior to HD to ameliorate this deficit in delivering care.
Journal ArticleDOI
Clinical Practice Guideline on management of patients with diabetes and chronic kidney disease stage 3b or higher (eGFR <45 mL/min)
Henk J. G. Bilo,Luís Coentrão,Cécile Couchoud,Adrian Covic,Johan De Sutter,Christiane Drechsler,Luigi Gnudi,David Goldsmith,James G. Heaf,Olof Heimbürger,Kitty J. Jager,Hakan Nacak,María José Soler,Liesbeth Van Huffel,Charles R.V. Tomson,Steven Van Laecke,Laurent Weekers,Andrzej Wiecek,Davide Bolignano,Maria Haller,Evi V. Nagler,Ionut Nistor,Sabine N. van der Veer,Wim Van Biesen +23 more
TL;DR: A guideline on the management of patients with diabetes and CKD stage 3b or higher (eGFR <45 mL/min) was needed and timely because of a paucity of well-designed, prospective studies in this population.
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