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Patient characteristics predict patency of early-cannulation arteriovenous grafts

There is a new emphasis on tailoring appropriate vascular access for hemodialysis to patients and their life-plans, but there is little known about the optimal use of newer devices such as early-cannulation arteriovenous grafts (ecAVG), with studies utilising them in a wide variety of situations. Th...

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Autores principales: Kingsmore, David B., Stevenson, Karen S., Richarz, S., Isaak, Andrej, Jackson, Andrew, Kasthuri, Ram, Thomson, Peter C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144603/
https://www.ncbi.nlm.nih.gov/pubmed/34031434
http://dx.doi.org/10.1038/s41598-021-87750-6
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author Kingsmore, David B.
Stevenson, Karen S.
Richarz, S.
Isaak, Andrej
Jackson, Andrew
Kasthuri, Ram
Thomson, Peter C.
author_facet Kingsmore, David B.
Stevenson, Karen S.
Richarz, S.
Isaak, Andrej
Jackson, Andrew
Kasthuri, Ram
Thomson, Peter C.
author_sort Kingsmore, David B.
collection PubMed
description There is a new emphasis on tailoring appropriate vascular access for hemodialysis to patients and their life-plans, but there is little known about the optimal use of newer devices such as early-cannulation arteriovenous grafts (ecAVG), with studies utilising them in a wide variety of situations. The aim of this study was to determine if the outcome of ecAVG can be predicted by patient characteristics known pre-operatively. This retrospective analysis of 278 consecutive ecAVG with minimum one-year follow-up correlated functional patency with demographic data, renal history, renal replacement and vascular access history. On univariate analysis, aetiology of renal disease, indication for an ecAVG, the number of previous tunnelled central venous catheters (TCVC) prior to insertion of an ecAVG, peripheral vascular disease, and BMI were significant associates with functional patency. On multivariate analysis the number of previous TCVC, the presence of peripheral vascular disease and indication were independently associated with outcome after allowing for age, sex and BMI. When selecting for vascular access, understanding the clinical circumstances such as indication and previous vascular access can identify patients with differing outcomes. Importantly, strategies that result in TCVC exposure have an independent and cumulative association with decreasing long-term patency for subsequent ecAVG. As such, TCVC exposure is best avoided or minimised particularly when ecAVG can be considered.
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spelling pubmed-81446032021-05-26 Patient characteristics predict patency of early-cannulation arteriovenous grafts Kingsmore, David B. Stevenson, Karen S. Richarz, S. Isaak, Andrej Jackson, Andrew Kasthuri, Ram Thomson, Peter C. Sci Rep Article There is a new emphasis on tailoring appropriate vascular access for hemodialysis to patients and their life-plans, but there is little known about the optimal use of newer devices such as early-cannulation arteriovenous grafts (ecAVG), with studies utilising them in a wide variety of situations. The aim of this study was to determine if the outcome of ecAVG can be predicted by patient characteristics known pre-operatively. This retrospective analysis of 278 consecutive ecAVG with minimum one-year follow-up correlated functional patency with demographic data, renal history, renal replacement and vascular access history. On univariate analysis, aetiology of renal disease, indication for an ecAVG, the number of previous tunnelled central venous catheters (TCVC) prior to insertion of an ecAVG, peripheral vascular disease, and BMI were significant associates with functional patency. On multivariate analysis the number of previous TCVC, the presence of peripheral vascular disease and indication were independently associated with outcome after allowing for age, sex and BMI. When selecting for vascular access, understanding the clinical circumstances such as indication and previous vascular access can identify patients with differing outcomes. Importantly, strategies that result in TCVC exposure have an independent and cumulative association with decreasing long-term patency for subsequent ecAVG. As such, TCVC exposure is best avoided or minimised particularly when ecAVG can be considered. Nature Publishing Group UK 2021-05-24 /pmc/articles/PMC8144603/ /pubmed/34031434 http://dx.doi.org/10.1038/s41598-021-87750-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Kingsmore, David B.
Stevenson, Karen S.
Richarz, S.
Isaak, Andrej
Jackson, Andrew
Kasthuri, Ram
Thomson, Peter C.
Patient characteristics predict patency of early-cannulation arteriovenous grafts
title Patient characteristics predict patency of early-cannulation arteriovenous grafts
title_full Patient characteristics predict patency of early-cannulation arteriovenous grafts
title_fullStr Patient characteristics predict patency of early-cannulation arteriovenous grafts
title_full_unstemmed Patient characteristics predict patency of early-cannulation arteriovenous grafts
title_short Patient characteristics predict patency of early-cannulation arteriovenous grafts
title_sort patient characteristics predict patency of early-cannulation arteriovenous grafts
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144603/
https://www.ncbi.nlm.nih.gov/pubmed/34031434
http://dx.doi.org/10.1038/s41598-021-87750-6
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