Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology follow-up matter?
J Vasc Access 2017; 18(1): 22 - 25
Article Type: ORIGINAL RESEARCH ARTICLE
AuthorsNaveed Ul Haq, Mohamed Said Abdelsalam, Mohammed Mahdi Althaf, Abdulrahman Ali Khormi, Hassan Al Harbi, Bader Alshamsan, Mamdouh Nasser Albaqumi, Dieter Clemens Broering, Lutfi Alkorbi, Hassan Ali Aleid
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 <15 mL/min at six months while 21/34 (61%) had eGFR <15 mL/min at last clinic visit before HD initiation. Only 11/34 (32%) had documented RRT discussion, 8/34 (24%) had VA referral, and 7/34 (21%) had vein mapping. A total of 30/34 (88.3%) started HD with CVC while 4/34 (11.3%) started HD with AVF (p<0.0001).
Early referral to nephrologist by itself may not improve VA care amongst patient with end-stage renal disease.
- • Accepted on 08/10/2016
- • Available online on 28/11/2016
- • Published in print on 18/01/2017
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- Haq, Naveed Ul [PubMed] [Google Scholar] 1, * Corresponding Author (firstname.lastname@example.org)
- Abdelsalam, Mohamed Said [PubMed] [Google Scholar] 1, 2
- Althaf, Mohammed Mahdi [PubMed] [Google Scholar] 1
- Khormi, Abdulrahman Ali [PubMed] [Google Scholar] 1
- Al Harbi, Hassan [PubMed] [Google Scholar] 1
- Alshamsan, Bader [PubMed] [Google Scholar] 1
- Albaqumi, Mamdouh Nasser [PubMed] [Google Scholar] 1
- Broering, Dieter Clemens [PubMed] [Google Scholar] 3
- Alkorbi, Lutfi [PubMed] [Google Scholar] 1
- Aleid, Hassan Ali [PubMed] [Google Scholar] 3
Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh - Kingdom of Saudi Arabia
Nephrology Unit, Department of Internal Medicine, Alexandria University, Alexandria - Egypt
Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh - Kingdom of Saudi Arabia