Radiocephalic Arteriovenous Fistula Patency and Use : A Post Hoc Analysis of Multicenter Randomized Clinical Trials
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc..
We sought to confirm and extend the understanding of clinical outcomes following creation of a common distal autogenous access, the radiocephalic arteriovenous fistula (RCAVF).
Background: Interdisciplinary guidelines recommend distal autogenous arteriovenous fistulae as the preferred hemodialysis (HD) access, yet uncertainty about durability and function present barriers to adoption.
Methods: Pooled data from the 2014-2019 multicenter randomized-controlled PATENCY-1 and PATENCY-2 trials were analyzed. New RC-AVFs were created in 914 patients, and outcomes were tracked prospectively for 3-years. Cox proportional hazards and Fine-Gray regression models were constructed to explore patient, anatomic, and procedural associations with access patency and use.
Results: Mean (SD) age was 57 (13) years; 45% were on dialysis at baseline. Kaplan-Meier estimates of 3-year primary, primary-assisted, and secondary patency were 27.6%, 56.4%, and 66.6%, respectively. Cause-specific 1-year cumulative incidence estimates of unassisted and overall RC-AVF use were 46.8% and 66.9%, respectively. Patients with larger baseline cephalic vein diameters had improved primary (per mm, hazard ratio [HR] 0.89, 95% confidence intervals 0.81-0.99), primary-assisted (HR 0.75, 0.64-0.87), and secondary (HR 0.67, 0.57-0.80) patency; and higher rates of unassisted (subdistribution hazard ratio 1.21, 95% confidence intervals 1.02-1.44) and overall RCAVF use (subdistribution hazard ratio 1.26, 1.11-1.45). Similarly, patients not requiring HD at the time of RCAVF creation had better primary, primary-assisted, and secondary patency. Successful RCAVF use occurred at increased rates when accesses were created using regional anesthesia and at higher volume centers.
Conclusions: These insights can inform patient counseling and guide shared decision-making regarding HD access options when developing an individualized end-stage kidney disease life-plan.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:3 |
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| Enthalten in: |
Annals of surgery open : perspectives of surgical history, education, and clinical approaches - 3(2022), 3 vom: 05. Sept., Seite e199 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Heindel, Patrick [VerfasserIn] |
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| Links: |
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| Themen: |
Arteriovenous fistula |
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| Anmerkungen: |
Date Revised 01.11.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1097/AS9.0000000000000199 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM347148808 |
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| 100 | 1 | |a Heindel, Patrick |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Radiocephalic Arteriovenous Fistula Patency and Use |b A Post Hoc Analysis of Multicenter Randomized Clinical Trials |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Revised 01.11.2022 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. | ||
| 520 | |a We sought to confirm and extend the understanding of clinical outcomes following creation of a common distal autogenous access, the radiocephalic arteriovenous fistula (RCAVF) | ||
| 520 | |a Background: Interdisciplinary guidelines recommend distal autogenous arteriovenous fistulae as the preferred hemodialysis (HD) access, yet uncertainty about durability and function present barriers to adoption | ||
| 520 | |a Methods: Pooled data from the 2014-2019 multicenter randomized-controlled PATENCY-1 and PATENCY-2 trials were analyzed. New RC-AVFs were created in 914 patients, and outcomes were tracked prospectively for 3-years. Cox proportional hazards and Fine-Gray regression models were constructed to explore patient, anatomic, and procedural associations with access patency and use | ||
| 520 | |a Results: Mean (SD) age was 57 (13) years; 45% were on dialysis at baseline. Kaplan-Meier estimates of 3-year primary, primary-assisted, and secondary patency were 27.6%, 56.4%, and 66.6%, respectively. Cause-specific 1-year cumulative incidence estimates of unassisted and overall RC-AVF use were 46.8% and 66.9%, respectively. Patients with larger baseline cephalic vein diameters had improved primary (per mm, hazard ratio [HR] 0.89, 95% confidence intervals 0.81-0.99), primary-assisted (HR 0.75, 0.64-0.87), and secondary (HR 0.67, 0.57-0.80) patency; and higher rates of unassisted (subdistribution hazard ratio 1.21, 95% confidence intervals 1.02-1.44) and overall RCAVF use (subdistribution hazard ratio 1.26, 1.11-1.45). Similarly, patients not requiring HD at the time of RCAVF creation had better primary, primary-assisted, and secondary patency. Successful RCAVF use occurred at increased rates when accesses were created using regional anesthesia and at higher volume centers | ||
| 520 | |a Conclusions: These insights can inform patient counseling and guide shared decision-making regarding HD access options when developing an individualized end-stage kidney disease life-plan | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Chronic kidney disease | |
| 650 | 4 | |a arteriovenous fistula | |
| 650 | 4 | |a hemodialysis access | |
| 650 | 4 | |a maturation | |
| 650 | 4 | |a patency | |
| 650 | 4 | |a radiocephalic | |
| 650 | 4 | |a use | |
| 700 | 1 | |a Yu, Peng |e verfasserin |4 aut | |
| 700 | 1 | |a Feliz, Jessica D |e verfasserin |4 aut | |
| 700 | 1 | |a Hentschel, Dirk M |e verfasserin |4 aut | |
| 700 | 1 | |a Burke, Steven K |e verfasserin |4 aut | |
| 700 | 1 | |a Al-Omran, Mohammed |e verfasserin |4 aut | |
| 700 | 1 | |a Bhatt, Deepak L |e verfasserin |4 aut | |
| 700 | 1 | |a Belkin, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Ozaki, C Keith |e verfasserin |4 aut | |
| 700 | 1 | |a Hussain, Mohamad A |e verfasserin |4 aut | |
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