Arteriovenous Fistula Versus Graft Access Strategy in Older Adults Receiving Hemodialysis: A Pilot Randomized Trial.
Arteriovenous graft
arteriovenous fistula
hemodialysis
older adults
randomized trial
Journal
Kidney medicine
ISSN: 2590-0595
Titre abrégé: Kidney Med
Pays: United States
ID NLM: 101756300
Informations de publication
Date de publication:
Historique:
entrez:
14
4
2021
pubmed:
15
4
2021
medline:
15
4
2021
Statut:
epublish
Résumé
It is unclear whether surgical placement of an arteriovenous (AV) fistula (AVF) confers substantial clinical benefits over an AV graft (AVG) in older adults with end-stage kidney disease (ESKD). We report vascular access outcomes of a pilot clinical trial. Pilot randomized parallel-group open-label trial. Patients 65 years and older with ESKD and no prior AV access receiving maintenance hemodialysis through a tunneled central venous catheter referred for AV access placement by their treating nephrologist. Participants were randomly assigned in a 1:1 ratio to surgical placement of an AVG or AVF. Index AV access primary failure, successful cannulation, adjuvant interventions and infections. Of 122 older adults receiving hemodialysis and no prior AV access surgery, 24% died before (n = 18) or were too sick for (n = 11) referral for a permanent AV access. Of 46 eligible patients, 36 (78%) consented and were randomly assigned to AVG (n = 18) and AVF (n = 18) placement, of whom 13 (72%) and 16 (89%) underwent index AV access surgical placement, respectively. At a median follow-up of 321.0 days, primary AV access failure was noted in 31% in each group. The proportion of patients with successful cannulation was 62% (8 of 13) in the AVG and 50% (8 of 16) in the AVF group; median times to successful cannulation were 75.0 and 113.5 days, respectively. Endovascular procedures were recorded in 38% and 44%, and surgical reinterventions, in 23% and 25%, respectively. AV access infection was seen in 3 (23%) and 2 (13%) patients, respectively. Small sample size precludes statistical inference. Almost one-quarter of older adults with incident ESKD and a central venous catheter as primary access were not referred for AV access placement due to medical reasons. Based on these limited results, there is little reason to favor either an AVF or AVG in this population until results from a larger randomized clinical trial become available. Government funding to an author (Dr Murea is supported by National Institutes of Health∖National Institute on Aging grant 1R03 AG060178-01). NCT03545113.
Sections du résumé
BACKGROUND
BACKGROUND
It is unclear whether surgical placement of an arteriovenous (AV) fistula (AVF) confers substantial clinical benefits over an AV graft (AVG) in older adults with end-stage kidney disease (ESKD). We report vascular access outcomes of a pilot clinical trial.
STUDY DESIGN
METHODS
Pilot randomized parallel-group open-label trial.
SETTING & PARTICIPANTS
METHODS
Patients 65 years and older with ESKD and no prior AV access receiving maintenance hemodialysis through a tunneled central venous catheter referred for AV access placement by their treating nephrologist.
INTERVENTION
METHODS
Participants were randomly assigned in a 1:1 ratio to surgical placement of an AVG or AVF.
OUTCOMES
RESULTS
Index AV access primary failure, successful cannulation, adjuvant interventions and infections.
RESULTS
RESULTS
Of 122 older adults receiving hemodialysis and no prior AV access surgery, 24% died before (n = 18) or were too sick for (n = 11) referral for a permanent AV access. Of 46 eligible patients, 36 (78%) consented and were randomly assigned to AVG (n = 18) and AVF (n = 18) placement, of whom 13 (72%) and 16 (89%) underwent index AV access surgical placement, respectively. At a median follow-up of 321.0 days, primary AV access failure was noted in 31% in each group. The proportion of patients with successful cannulation was 62% (8 of 13) in the AVG and 50% (8 of 16) in the AVF group; median times to successful cannulation were 75.0 and 113.5 days, respectively. Endovascular procedures were recorded in 38% and 44%, and surgical reinterventions, in 23% and 25%, respectively. AV access infection was seen in 3 (23%) and 2 (13%) patients, respectively.
LIMITATIONS
CONCLUSIONS
Small sample size precludes statistical inference.
CONCLUSIONS
CONCLUSIONS
Almost one-quarter of older adults with incident ESKD and a central venous catheter as primary access were not referred for AV access placement due to medical reasons. Based on these limited results, there is little reason to favor either an AVF or AVG in this population until results from a larger randomized clinical trial become available.
FUNDING
BACKGROUND
Government funding to an author (Dr Murea is supported by National Institutes of Health∖National Institute on Aging grant 1R03 AG060178-01).
TRIAL REGISTRATION
BACKGROUND
NCT03545113.
Identifiants
pubmed: 33851120
doi: 10.1016/j.xkme.2020.11.016
pii: S2590-0595(21)00018-2
pmc: PMC8039401
doi:
Banques de données
ClinicalTrials.gov
['NCT03545113']
Types de publication
Journal Article
Langues
eng
Pagination
248-256.e1Informations de copyright
© 2021 The Authors.
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