PowerPoint Slides for: Fistula and Survival Outcomes after Fistula Creation among Predialysis Chronic Kidney Disease Stage 5 Patients
Miyamoto M.
Kurita N.
Suemitsu K.
Murakami M.
10.6084/m9.figshare.4769848.v1
https://karger.figshare.com/articles/presentation/PowerPoint_Slides_for_Fistula_and_Survival_Outcomes_after_Fistula_Creation_among_Predialysis_Chronic_Kidney_Disease_Stage_5_Patients/4769848
<p><b><i>Background:</i></b> Most guidelines recommend the creation of
arteriovenous fistula (AVF) in patients with chronic kidney disease
(CKD) stage 4. However, an increasing number of studies suggest that
early AVF creation leads to high rates of AVF failure and death before
dialysis commencement. Only the Japanese guideline recommends AVF
creation at CKD stage 5; however, no data are available regarding
access-related outcomes at this stage. <b><i>Method:</i></b> This was a
multicenter cohort study involving Japanese CKD stage 5 patients who
underwent preemptive AVF creation from 2009 to 2013. The primary outcome
was unnecessary AVF creation, defined as death before requiring
dialysis or AVF failure before dialysis commencement. The secondary
outcome was dialysis commencement. The associations with candidate
predictors and the outcomes were examined. <b><i>Results:</i></b> A
total of 303 patients were registered. Four cases of death before
dialysis and 13 cases of AVF failure before dialysis commencement were
observed. A total of 283 patients who advanced to dialysis were found to
have functional AVFs. The cumulative incidences of unnecessary AVF
creation and dialysis commencement at 1 year were 4.8 and 89.3%,
respectively. Competing risk regression analyses showed that age ≥75
years (subhazard ratio [SHR] 3.12, 95% CI 1.20-8.09) and female gender
(SHR 3.31, 95% CI 1.20-9.09) were associated with unnecessary AVF
creation. <b><i>Conclusions:</i></b> A low incidence of unnecessary AVF
creation was revealed among Japanese patients who received AVF at CKD
stage 5. These results may help clarify the natural history of
unnecessary AVF creation for other countries reformatting their
guidelines regarding late vascular access creation.</p>
2017-03-21 13:02:10
Vascular access
Hemodialysis
Arteriovenous fistula
Unnecessary arteriovenous fistula
Dialysis commencement