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Santral venöz katateri olan hastalarda radyosefalik arteriyovenöz fistül matürasyonunu için prognostik faktörler ve inflamasyonla ilişkisi

Year 2020, Volume: 11 Issue: 3, 124 - 132, 22.06.2020
https://doi.org/10.18663/tjcl.739377

Abstract

Amaç:Matüre ve fonksiyonel bir arteriovenöz fistül (AVF), hemodiyaliz (HD) tedavisi tedavisinde vasküler erişim için en iyi modalite olarak kabul edilir; ancak erken başarısızlık oranı HD tedavisine santral venöz kateter (SVK) ile başlayan hastalarda yüksektir. Bu çalışmanın amacı, HD tedavilerine SVK ile başlayan ve daha sonra ilk kez radiosefalik AVF (RSAVF) oluşturulan hastalarda belirli hasta özelliklerinin ve spesifik inflamatuar belirteçlerin AVF’nin erken başarısızlığı açısından prognostik değeri ve ilişkisini incelemekti.
Gereç ve Yöntemler: Aynı cerrah tarafından, aynı teknik kullanılarak RSAVF oluşturulan ve konsülte edildiği sırada HD tedavisi için damar erişimi SVK ile önceden sağlanmış son-dönem böbrek hastalığı bulunan 168 hasta retrospektif olarak tarandı. Bu çalışmaya alınan hastalar Grup 1: erken başarısızlık olan (n=46) ve Grup 2: erken başarısızlık olmayan (n=122) olarak iki gruba ayrıldı. Bu hastaların, demografik özellikleri, yandaş hastalıkları, preoperatif doppler ultrasomografi haritalama sonuçları, laboratuar parametreleri, postoperatif takip detayları toplandı. Tüm hastaların primer patens oranları, erken başarısızlık oranı, maturasyon başarısızlık oranı ve SVK süreleri hesaplandı.
Bulgular: Kadın cinsiyet RSAVF erken başarısızlığında anlamlı bir risk faktörü olarak bulunmuştur (%69.5 vs %36.1; p=0.001). Sefalik ven çapı< 2 mm olan hastaların sayısı Grup 1’de fazlaydı (%78.3 vs %22.1 ; p=0.028). Grup 1’de SVK erişim süresi Grup 2’den anlamlı olarak daha uzundu (6.8 ± 3.6 ay vs 2.3 ± 1.7 ay; p<0.05). Maturasyon yetersizlik oranı %12.5 ve 1-yıllık primer patensoranı%72.6 idi.Grup 2’de, Grup 1’e oranla 1.yılda C-Reaktif Proteindüzeyleri (7.2 ± 9.6 vs 3.1 ± 3.3 mg/L, respectively; p=0.001) ve nötrofil lenfosit oranı(2.91± 0.30 vs 2.17 ± 0.22, respectively; p<0.05) anlamlı derecede düşüktü.
Sonuç: Önceden HD tedavisi için damar erişimi SVK ile sağlanan hastalarda, küçük sefalik ven çapı, kadın cinsiyet ve sistemik inflamasyon, ilk defa açılan RSAVF’ün erken başarısızlığında rol oynayabilir.

References

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Prognostic factors for radiocephalic arteriovenous fistula maturation in patients with prior placement of a central venous catheter and relationship with inflammation

Year 2020, Volume: 11 Issue: 3, 124 - 132, 22.06.2020
https://doi.org/10.18663/tjcl.739377

Abstract

Aim: A mature and functional arteriovenous fistula (AVF) is considered the best modality for vascular access(VA) for hemodialysis (HD) treatment but the incidence of early failure is high, especially in patients start their HD with a central venous catheter. The aim of this study was to evaluate the prognostic value and association of certain patient characteristics and specific inflammatory markers with early failure of AVF in patients who started their HD therapy with a CVC and a first autogenous radiocephalic AVF (RCAVF) was created after vascular consultation.
Material and Methods: A retrospective review of 168 patients with end-stage renal disease who underwent RCAVF creation by the same surgeon by using the same surgical technique and whose primary vascular access for HD treatment was obtained via CVC at the time of access consultation was performed. The patients enrolled into this study were categorized into two groups as Group 1: patients with early failure (n=46) and Group 2: patients with no failure (n=122).Demographic characteristics, medical comorbidities, preoperative doppler ultrasound mapping results, laboratory parameters, postoperative follow-up details of these patients were collected. Primary patency of all patients, early failure rate, maturation failure rate, duration of CVC was calculated.
Results: Female gender was found to be a significant risk factor in early failure of RCAVF (69.5% vs 36.1%; p=0.001). The number of patients whose diameter of cephalic vein< 2 mm were significantly higher in EF group (78.3% vs 22.1 ; p=0.028). The duration of CVC access of group 1 was significantly longer than group 2 (6.8 ± 3.6 months vs 2.3 ± 1.7 months, respectively; p<0.05). Overall maturation failure rate was 12.5% and primary patency at 1 year was 72.6%. Levels of C-Reactive protein (7.2 ± 9.6 vs 3.1 ± 3.3 mg/L, respectively; p=0.001) and neutrophil lymphocyte ratio (2.91± 0.30 vs 2.17 ± 0.22, respectively; p<0.05) was significantly lower at group 2 at one year.
Conclusion:In patients whose VA for HD treatment was provided by CVC, small cephalic vein diameter, female gender and systemic inflammation may play a role in early failure of RCAVF.

References

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  • 14. Dageforde LA, Harms KA, Feurer ID, et al. Increased mini- mum vein diameter on preoperative mapping with duplex ultrasound is associated with arteriovenous fistula maturation and secondary patency. J Vasc Surg 2015;61:170-6.
  • 15. Robbin ML, Chamberlain NE, Lockhart ME, et al. Hemodial- ysis arteriovenous fistula maturity: US evaluation. Radiology 2002; 225: 59-64.
  • 16. National Kidney Foundation’s KDOQI 2006 Vascular Access Guidelines. Am J Kidney Dis 2006;48: S177-322.
  • 17. Sidawy AN, Spergel LM, Besarab A, Allon M, Jennings WC, Padberg Jr FT, et al. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg 2008; 48:2Se 25S.
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  • 20. H. Hu, S. Patel, J.J. Hanisch, et al., Future research directions to improve fistula maturation and reduce access failure, Semin. Vasc. Surg. 29 (4) (2016) 153–171.
  • 21. M.A. Kaygin, U. Halici, A. Aydin, et al., The relationship between arteriovenous fistula success and inflammation, Ren, Fail 35 (8) (2013) 1085–1088.
  • 22. Chou CY, Kuo HL, Yung YF, Liu YL, Huang CC. C-reactive Protein Predicts Vascular Access Thrombosis in Hemodialysis Patients. Blood Purif 2006;24(4):342-6.
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There are 85 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Ali Baran Budak This is me

Tonguc Saba This is me

Nalan Akalın This is me

Gultekin Genctoy This is me

Cevahir Haberal This is me

Publication Date June 22, 2020
Published in Issue Year 2020 Volume: 11 Issue: 3

Cite

APA Budak, A. B., Saba, T., Akalın, N., Genctoy, G., et al. (2020). Prognostic factors for radiocephalic arteriovenous fistula maturation in patients with prior placement of a central venous catheter and relationship with inflammation. Turkish Journal of Clinics and Laboratory, 11(3), 124-132. https://doi.org/10.18663/tjcl.739377
AMA Budak AB, Saba T, Akalın N, Genctoy G, Haberal C. Prognostic factors for radiocephalic arteriovenous fistula maturation in patients with prior placement of a central venous catheter and relationship with inflammation. TJCL. June 2020;11(3):124-132. doi:10.18663/tjcl.739377
Chicago Budak, Ali Baran, Tonguc Saba, Nalan Akalın, Gultekin Genctoy, and Cevahir Haberal. “Prognostic Factors for Radiocephalic Arteriovenous Fistula Maturation in Patients With Prior Placement of a Central Venous Catheter and Relationship With Inflammation”. Turkish Journal of Clinics and Laboratory 11, no. 3 (June 2020): 124-32. https://doi.org/10.18663/tjcl.739377.
EndNote Budak AB, Saba T, Akalın N, Genctoy G, Haberal C (June 1, 2020) Prognostic factors for radiocephalic arteriovenous fistula maturation in patients with prior placement of a central venous catheter and relationship with inflammation. Turkish Journal of Clinics and Laboratory 11 3 124–132.
IEEE A. B. Budak, T. Saba, N. Akalın, G. Genctoy, and C. Haberal, “Prognostic factors for radiocephalic arteriovenous fistula maturation in patients with prior placement of a central venous catheter and relationship with inflammation”, TJCL, vol. 11, no. 3, pp. 124–132, 2020, doi: 10.18663/tjcl.739377.
ISNAD Budak, Ali Baran et al. “Prognostic Factors for Radiocephalic Arteriovenous Fistula Maturation in Patients With Prior Placement of a Central Venous Catheter and Relationship With Inflammation”. Turkish Journal of Clinics and Laboratory 11/3 (June 2020), 124-132. https://doi.org/10.18663/tjcl.739377.
JAMA Budak AB, Saba T, Akalın N, Genctoy G, Haberal C. Prognostic factors for radiocephalic arteriovenous fistula maturation in patients with prior placement of a central venous catheter and relationship with inflammation. TJCL. 2020;11:124–132.
MLA Budak, Ali Baran et al. “Prognostic Factors for Radiocephalic Arteriovenous Fistula Maturation in Patients With Prior Placement of a Central Venous Catheter and Relationship With Inflammation”. Turkish Journal of Clinics and Laboratory, vol. 11, no. 3, 2020, pp. 124-32, doi:10.18663/tjcl.739377.
Vancouver Budak AB, Saba T, Akalın N, Genctoy G, Haberal C. Prognostic factors for radiocephalic arteriovenous fistula maturation in patients with prior placement of a central venous catheter and relationship with inflammation. TJCL. 2020;11(3):124-32.


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