The importance of starting regular haemodialysis through a native arterio-venous fistula
Importancia de iniciar hemodiálisis periódica a través de una fístula arterio-venosa interna.
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array:4 [ "nombre" => "Carmen" "apellidos" => "Díaz Corte" "email" => array:1 [ 0 => "carmen@hca.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Emilio" "apellidos" => "Gago González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "María José" "apellidos" => "Ourens" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Teresa" "apellidos" => "Ortega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Central de Asturias Asturias Asturias España, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Importancia de iniciar hemodiálisis periódica a través de una fístula arterio-venosa interna." ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "21418078_t1_p177.jpg" "Alto" => 236 "Ancho" => 543 "Tamanyo" => 27237 ] ] "descripcion" => array:1 [ "en" => "Patient characteristics according to their first vascular access at the start of haemodialysis" ] ] ] "textoCompleto" => "<p class="elsevierStylePara">Dear Editor,</p><p class="elsevierStylePara">Vascular access is very important in the management of patients beginning Long Term Haemodialysis (LTH) nonetheless, in spite of the advances achieved in many fields, there is a very large number of patients that reach dialysis without proper vascular access.</p><p class="elsevierStylePara">Recent data demonstrates that, irrespective of the recommendations of guidelines, the use of Arteriovenous Fistulae (AVF) is even decreasing.<span class="elsevierStyleSup">1,2</span> Therefore, this is a field where much work needs to be done.</p><p class="elsevierStylePara">In our hospital, we have carried out a retrospective study of all patients that began their LTH program between 1 January 2002, and 31 December 2003. Among other data we recorded the type of vascular access used at the beginning of their dialysis and at the end of the study, the dose of erythropoietin given during the entire period of the study to each patient (the annual dose was calculated for each one), the number of hospital admissions, in absolute numbers and calculated by total days, and the comorbidity score using the Charlson Co-Morbidity Index,<span class="elsevierStyleSup">3</span> calculated for the beginning and the end of the study.</p><p class="elsevierStylePara">63 patients began LTH during the period of the study. 41 of them (65%) were men. The average age was 60 ± 16 years for men and women. Fifty one percent of the patients were 65 years old or older. The average amount of time in the study was 9.3 ± 6.3 months. Of the 63 patients, 40 completed the study, The reasons for early termination of the study were <span class="elsevierStyleItalic">exitus</span> (four patients), transfer to another centre (four patients) and transplant (15 patients). The diabetic patients (19%) were older (66 ± 10 vs. 59 ± 17 years old), more obese (BMI 28 ± 7 vs. 25 ± 3) and they had a higher co-morbidity index than the rest of the patients.</p><p class="elsevierStylePara">39 patients began dialysis with AVF (62%) and 24 patients with catheters (38%). At the end of the study, 6 patients were using catheters for dialysis. There were no differences in type of vascular access according to age, in diabetics or non-diabetics or to co-morbidity index. Statistically significant differences were found in the level of albumin, dose of erythropoietin received and in the number of hospital admissions (table 1). The average annual dose of erythropoietin was practically double in those patients that started dialysis with a catheter compared to those that began with an AVF.</p><p class="elsevierStylePara">There were no differences if the vascular access in the results at the end of the study was considered. Kt/V at the end of the study was similar in the group of patients using catheters or an AVF for dialysis. Seventeen patients (27%) were never hospitalized, 22 (35%) were hospitalized once, and the rest, 24 patients (38%), more than once. Only 8% of those that began with a catheter were never hospitalized.</p><p class="elsevierStylePara">Having an AVF prior to the commencement of HD is not only associated with better patient-reported quality of life,<span class="elsevierStyleSup">4</span> but is also linked to lower morbidity and mortality and healthcare expenditure.<span class="elsevierStyleSup">5-7</span> Our study confirms the fact that those patients that began LTH with a catheter have a greater number of hospital admissions, longer hospital stay and need higher doses of erythropoietin for similar levels of haemoglobin. Therefore, although the situation in Spain is fortunately better<span class="elsevierStyleSup">5,6,8</span> than in other countries,<span class="elsevierStyleSup">4</span> more work must be done to ensure the timely formation of an AVF as recommended in in the clinical practice guidelines.<span class="elsevierStyleSup">9,10 </span></p><p class="elsevierStylePara"><a href="grande/21418078_t1_p177.jpg" class="elsevierStyleCrossRefs"><img src="21418078_t1_p177.jpg" alt="Patient characteristics according to their first vascular access at the start of haemodialysis"></img></a></p><p class="elsevierStylePara">Table 1. Patient characteristics according to their first vascular access at the start of haemodialysis</p>" "pdfFichero" => "P-E-S-A214-EN.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "21418078_t1_p177.jpg" "Alto" => 236 "Ancho" => 543 "Tamanyo" => 27237 ] ] "descripcion" => array:1 [ "en" => "Patient characteristics according to their first vascular access at the start of haemodialysis" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Moist LM, Chang SH, Polkinghorne KR, McDonald SP; Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). 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The timely construction of arteriovenous fistulae: a key to reducing morbidity and mortality and to improving cost management. Nephrol Dial Transplant 2005, 20: 598-603. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15647308" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "López Pedret J, Rodríguez Hernández JA, Piera L. El acceso vascular en España: análisis de su distribución, morbilidad y sistemas de monitorización. Nefrología 2001, 21: 45-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11344961" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Schon D, Blume SW, Niebauer K, Hollenbeak CS, de Lissovoy G. 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| 2020 March | 20 | 15 | 35 |
| 2020 February | 18 | 9 | 27 |
| 2020 January | 26 | 17 | 43 |
| 2019 December | 26 | 16 | 42 |
| 2019 November | 21 | 16 | 37 |
| 2019 October | 9 | 6 | 15 |
| 2019 September | 23 | 14 | 37 |
| 2019 August | 10 | 14 | 24 |
| 2019 July | 15 | 15 | 30 |
| 2019 June | 28 | 6 | 34 |
| 2019 May | 17 | 4 | 21 |
| 2019 April | 45 | 16 | 61 |
| 2019 March | 14 | 18 | 32 |
| 2019 February | 14 | 12 | 26 |
| 2019 January | 21 | 13 | 34 |
| 2018 December | 44 | 23 | 67 |
| 2018 November | 49 | 10 | 59 |
| 2018 October | 40 | 11 | 51 |
| 2018 September | 45 | 8 | 53 |
| 2018 August | 13 | 11 | 24 |
| 2018 July | 29 | 10 | 39 |
| 2018 June | 22 | 7 | 29 |
| 2018 May | 18 | 11 | 29 |
| 2018 April | 23 | 7 | 30 |
| 2018 March | 26 | 3 | 29 |
| 2018 February | 29 | 6 | 35 |
| 2018 January | 24 | 4 | 28 |
| 2017 December | 27 | 8 | 35 |
| 2017 November | 20 | 9 | 29 |
| 2017 October | 27 | 5 | 32 |
| 2017 September | 30 | 9 | 39 |
| 2017 August | 20 | 9 | 29 |
| 2017 July | 24 | 11 | 35 |
| 2017 June | 20 | 4 | 24 |
| 2017 May | 31 | 7 | 38 |
| 2017 April | 24 | 10 | 34 |
| 2017 March | 13 | 11 | 24 |
| 2017 February | 23 | 10 | 33 |
| 2017 January | 17 | 6 | 23 |
| 2016 December | 38 | 8 | 46 |
| 2016 November | 38 | 4 | 42 |
| 2016 October | 54 | 8 | 62 |
| 2016 September | 67 | 4 | 71 |
| 2016 August | 127 | 7 | 134 |
| 2016 July | 113 | 10 | 123 |
| 2016 June | 105 | 0 | 105 |
| 2016 May | 105 | 0 | 105 |
| 2016 April | 70 | 0 | 70 |
| 2016 March | 56 | 0 | 56 |
| 2016 February | 71 | 0 | 71 |
| 2016 January | 64 | 0 | 64 |
| 2015 December | 91 | 0 | 91 |
| 2015 November | 64 | 0 | 64 |
| 2015 October | 50 | 0 | 50 |
| 2015 September | 56 | 0 | 56 |
| 2015 August | 60 | 0 | 60 |
| 2015 July | 49 | 0 | 49 |
| 2015 June | 33 | 0 | 33 |
| 2015 May | 47 | 0 | 47 |
| 2015 April | 6 | 0 | 6 |
Show all
