Arterio Venous Access Placement and renal function decline

Ulrika Hahn Lundström, Ulf Hedin, Alessandro Gasparini, Fergus J Caskey, Juan-Jesus Carrero, Marie Evans

Research output: Contribution to journalArticle (Academic Journal)

Abstract

Background:
There is controversial evidence on whether arteriovenous access (AVA) placement may protect renal function and hence should be considered in the timing of access placement. This study aimed to investigate the association between AVA placement and eGFR decline as compared to placement of a peritoneal dialysis catheter (PDC) at a similar time point.

Method:
We studied a cohort of 744 predialysis patients in Stockholm, Sweden, who underwent surgery for AVA or PDC between 2006 and 2012. Data on comorbidity, medication and laboratory measures was collected 100 days before and after surgery. Patients were followed until dialysis start, death or 100 days, whichever came first. The primary outcome was difference in eGFR decline after AVA surgery compared to PDC. Decline in eGFR was estimated through linear mixed models with random intercept and slope, before and after surgery.

Results:
There were 435 AVA and 309 PDC patients. The AVA patients had higher eGFR (8.1 vs 7.0 ml/min/1.73m2) and less rapid eGFR decline before surgery (-5.6 compared to -6.7 ml/min/1.73m2/year for PDC). We found no difference in eGFR decline after surgery in AVA patients compared with PDC patients (AVA progressed -1.14 (-2.38; 0.10) ml/min/1.73m2/year faster after surgery compared to PDC).

Conclusion:
There was no significant difference in eGFR decline after placement of an AVA compared to a PDC. Both forms of access were associated to reduced eGFR decline in our population. The need for dialysis remains the main determinant for timing of access surgery.
Original languageEnglish
Article numbergfz221
Number of pages6
JournalNephrology Dialysis Transplantation
Issue number1-6
Early online date30 Oct 2019
DOIs
Publication statusE-pub ahead of print - 30 Oct 2019

Keywords

  • arteriovenous access
  • chronic kidney disease progression
  • eGFR decline
  • haemodialysis
  • peritoneal dialysis

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  • Cite this

    Lundström, U. H., Hedin, U., Gasparini, A., Caskey, F. J., Carrero, J-J., & Evans, M. (2019). Arterio Venous Access Placement and renal function decline. Nephrology Dialysis Transplantation, (1-6), [gfz221]. https://doi.org/10.1093/ndt/gfz221