Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology follow-up matter?

Native arteriovenous fistulae (AVFs) are preferred while central venous catheters (CVCs) are least suitable vascular access (VA) in patients requiring hemodialysis (HD). Unfortunately, around 80% of patients start HD with CVCs. Late referral to nephrologist is thought to be a factor responsible for...

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Published in:The journal of vascular access 2017-01, Vol.18 (1), p.22-25
Main Authors: Haq, Naveed Ul, Abdelsalam, Mohamed Said, Althaf, Mohammed Mahdi, Khormi, Abdulrahman Ali, Al Harbi, Hassan, Alshamsan, Bader, Albaqumi, Mamdouh Nasser, Broering, Dieter Clemens, Alkorbi, Lutfi, Aleid, Hassan Ali
Format: Article
Language:English
Subjects:
Adult
Arteriovenous Shunt, Surgical - adverse effects
Catheterization, Central Venous - adverse effects
Female
Humans
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - therapy
Kidney Transplantation - adverse effects
Male
Middle Aged
Nephrologists
Nephrology - methods
Practice Patterns, Physicians
Quality Improvement
Quality Indicators, Health Care
Referral and Consultation
Renal Dialysis
Retrospective Studies
Risk Factors
Time Factors
Treatment Failure
Young Adult
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Summary:Native arteriovenous fistulae (AVFs) are preferred while central venous catheters (CVCs) are least suitable vascular access (VA) in patients requiring hemodialysis (HD). Unfortunately, around 80% of patients start HD with CVCs. Late referral to nephrologist is thought to be a factor responsible for this. We retrospectively analyzed the types of VA at HD initiation in renal transplant recipients followed by nephrologists with failed transplant. If early referral to nephrologist improves AVF use, these patients should have higher prevalence of AVF at HD initiation. All patients who failed their kidney transplants from January 2002 to April 2013 were included in the study. Data regarding planning of VA by nephrologist, documented discussion about renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) at 6 months and last clinic visit before HD initiation, time of VA referral, and subsequent VA at dialysis initiation were gathered and analyzed. Eighty-three patients failed their transplants during study period. Data were inaccessible in six patients. Eleven patients started peritoneal dialysis (PD) while 66 started HD. Thirty-two had previous functioning VA while 34 needed VA. There were 11/34 patients (32%) with eGFR
ISSN:1129-7298
1724-6032
DOI:10.5301/jva.5000631