Are continued policies of prioritizing native vascular access in patients on hemodialysis programs useful?
Ibáñez Pallarès, Sara (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Esteve Simó, Vicent (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Velescu, Alina (Hospital del Mar (Barcelona, Catalunya))
Tapia González, Irati (Universitat Autònoma de Barcelona. Departament de Medicina)
Collado, S (Hospital del Mar (Barcelona, Catalunya))
Clará Velasco, Alberto (Hospital del Mar (Barcelona, Catalunya))

Data:	2022
Resum:	The guidelines recommend establishing native vascular access as opposed to prosthetic or catheter-based access despite information relating to its effectiveness being scarce from a patient-orientated perspective. We analyzed the effectiveness of a continued policy of native vascular access (CPNVA) in patients undergoing hemodialysis. A retrospective, observational study, including 150 patients undergoing hemodialysis between 2006 and 2012 at our center, and who underwent a CPNVA. Statistical analysis was based on treatment intention. In 138 patients (92%), the first useful access (FUA) was native, and in 12 patients (8%), it was prosthetic. In 50 patients (33. 3%), more than one procedure had to be carried out in to order to achieve FUA. The probability of dialysis occurring via a FUA was 67. 1% and 45. 3% at 1 and 5 years respectively. Over the follow-up period (mean time = 30 months), 84 patients (56%) required repairs or new access, extending the effectiveness of the CPNVA to 88. 3% and 73. 2% at 1 and 5 years respectively. The effectiveness of the CPNVA was reduced if the patient: required a catheter initially (HR: 3. 6, p = 0. 007); in cases of initially elevated glomerular filtration rate (HR: 1. 1, p = 0. 040); in cases of history of previous access failure before FUA (HR: 3. 9, p = 0. 001); and in female patients (HR: 2. 4, p = 0. 031). The long-term effectiveness of a CPNVA is high. However, the percentage of patients requiring diverse procedures in order to achieve FUA and the need for re-interventions yield the necessity to optimize preoperative evaluation and postoperative follow-up.
Nota:	Altres ajuts: acords transformatius de la UAB
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	AV access ; Dialysis ; Follow-up ; Native vascular access ; Patient-orientated ; Survival
Publicat a:	Therapeutic Apheresis and Dialysis, Vol 26 (2022) , p. 434-440, ISSN 1744-9987

DOI: 10.1111/1744-9987.13711
PMID: 34296527

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